“Well, it’s clear that you’ve never set foot into a nursing home.”
I know you’ve thought that while reading a memo from the Centers for Medicare & Medicaid Services or your state agency, taking in a newspaper or TV report, listening to a politician speak, or even looking through your own policy and procedure manual.
And I know you’ve thought that more than once. I certainly have during my career. Sadly, the person “laying down the truth,” the person who makes your eyes roll or blood boil, is often the one coming from a position of power.
Over the last few decades, I’ve tried to improve the quality of the nursing home industry, but it feels like I’ve spent just as much time giving explanations to external stakeholders who seem to hold dominion over the industry yet know so little about it. How could that be? They are confident, often armed with data. And since their self-determined insights are “data-driven,” doesn’t that mean they are true?
Thanks to The New York Times and many other news outlets, plaintiff attorneys, insurers, government bureaucrats, and external stakeholders, I’ve realized that data without subject matter expertise is more harmful than the absence of data. Why? Because data without subject matter expertise can be weaponized against you.
It is essential, therefore, to not allow your data story to be told absent of you, the subject matter expert. I liken it to an opinion piece written by ChatGPT. (Incidentally, I tried writing this blog using ChatGPT. It was fascinating, frightening and laughable.) Without true subject matter expertise, something written by ChatGPT cannot account for context, delve for insights, or express any actual knowledge.
Instead, all the AI tool can currently produce is a collection of generally accepted concepts that skim the surface of the topic. People who have data but don’t truly understand it can do little better.
To better illustrate my point, I recall the last couple of cases in which I provided expert witness support to the defense team. In each case, the nursing home was being sued and accused of inadequate staffing, among other things. What happened at the bedside could not be determined from PBJ data and cost reports, but regardless, the plaintiff’s attorneys were using this data to present conclusions about care to the jury. Elements of Five-Star, the STRIVE study and staffing sheets were selectively used to present “their” data-driven narrative. What was absent from these cases was deep subject matter expertise — but that was my job.
The data story that I was able to tell was far more compelling. The nursing home wasn’t perfect, but with additional data and deeper insight into how it could and could not be aligned, I was able to authentically represent the home in a far more balanced manner.
The nursing home was caring for a unique population (people with mental illness) that necessitated the creation of customized benchmarks. These benchmarks included nursing homes caring for similar types of residents in similar markets. With this insight, I was able to supply meaningful context on the nursing home’s staffing patterns, clinical outcomes and regulatory compliance. Healthcare is not a national industry, nor do all nursing homes care for the same residents, so a completely different perspective emerged once appropriate benchmarks were considered.
To be clear, the need to be your own “data defender” isn’t limited to the courtroom. In our Advisory Services at Zimmet Healthcare Group, we often work with lenders. In a recent project, we were evaluating an operator who was seeking refinancing for a recently acquired portfolio. The Five-Star system and PBJ metrics told a not-so-favorable story. Add to that mix a very concerning regulatory history including SFF candidacy, and on the first pass, the lender didn’t feel positive toward this operator.
However, a deeper, more thoughtful understanding of these nursing homes’ data, in relation to when this operator took over the facilities and in the context of the operator’s regional peer group, revealed a different story.
The nursing homes with the most troubled regulatory history as reported through Five-Star and SFF had performance being principally driven by Cycle 2 and Cycle 3 survey periods. In most markets, that could mean anywhere from a year and a half ago to three-and-a-half years ago. However, for these particularly troubled nursing homes, the average interval between annual surveys was more than 700 days! In other words, the new operator was carrying the negative results of the prior owner and would be doing so for several more years. Putting this and other findings into context significantly changed the perception of the operator’s portfolio, and we were able to establish appropriate and more stable short-term success metrics.
So, how can you be your own data defender?
First, someone in your organization must be anointed the “data czar.” It’s a big responsibility, and it should come with a corner office with views of the mountains — but in reality, a cup of coffee and a sincere thank you might do just fine. If you don’t have the time or talent to fill this role in-house, it can be outsourced. Either way, it is essential.
Secondly, the data czar must ensure the accuracy and integrity of all the data that you produce. Likely you have these processes in place already, but having a centralized view of all your data is an additional layer of protection.
Thirdly, the data czar should periodically examine your complete data profile. What story does the data tell? Does the story have inconsistencies or gaps? Is the story consistent with your marketing messages, accurately describing the care that is being rendered? Do you need additional data sets to tell the story better or more credibly?
Data without subject matter expertise can be weaponized against you, but you can mount a defense by knowing your own data and telling your own story as only you can. If you do, you’ll find that data can guide and protect you while illuminating the path of quality improvement.
Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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