Jean Wendland Porter

After spending three days in training as an examiner for a prestigious healthcare quality award, I came away with a better understanding and appreciation of how quality is measured and how it affects our facilities and our goals.

The IMPACT Act of 2014 required the implementation of specific set of measures using standardized assessment data. Those measures are the following:

-Falls with Major Injury
-Spending per Beneficiary
-Discharge to Community
-Preventable Readmission to Hospital within 30 days
-New or worsened pressure injuries
-Assessment of ADLs
-Antipsychotic use, etc.

These are measures that we account for every day, and we track every month and every quarter. They’re not only integral to how we operate, but as caregivers for the most vulnerable population, they’re pretty good indicators of how well we deliver that care. Quality measures are merely a means of measuring whether we’re doing the job we’re entrusted to do.

However, as a new quality examiner, I discovered that there’s a lot more to the quality we deliver than just those measures. Putting “quality” on paper doesn’t necessarily lead to better care in our business; it just shows how well we measure it. Adding to the excellent care that we strive to offer are intangibles that don’t necessarily make it to paper.

Senior leadership plays a huge role in how we deliver healthcare. I’ve been saying for decades that a SNF is only as good as its DON and administrator. Do you have a DON who spends more time in her office than meeting new clients? Does she know the customer and family? Does she lead by example, getting involved with care conferences and med reviews? If not, the quality that you’re offering may not be what you think it is and what you’ve recorded on paper.

What are your processes for delivering care? Are your departments “silo”-ed so that nursing delivers meds and wound treatment, activities does the parties, therapy delivers therapy, and social services see clients and families only during care conferences? If so, your team isn’t interdisciplinary, it’s multidisciplinary and the care suffers.

  • What is the approach for delivery of care? Who meets and greets the new client? Who introduces her to the facility?
  • How does that affect the deployment of care? Does the staff in-service and learn from other departments?
  • Is the learning and education systematic? Or are you just putting out fires?
  • Are the clients identified by room number and diagnosis (my pet peeve)? E.g. The hip fracture in 212 wants lunch. If so, how are those clients being addressed by the staff? They’re not being called “Mrs. 212,” are they?

In order to achieve the level of quality we’re expecting and asserting for ourselves, we need to analyze our processes and ensure that we treat our clients and their families as people and pushing for face-to-face personal care with the highest level of quality we can attain. Whether it’s showing on paper or not, we owe it to our specialized population to give them all that we can offer.