Compassion from LTC managers? Only if they want better resident care, lower liability risks
James M. Berklan
A funny thing happened in the making of an analysis of recent insurance claims in the aging services market: a lesson broke out on how to achieve better healthcare and liability outcomes via better management-staff relationships.
The most important element for any resident safety program? How top managers treat the employees/caregivers on their teams.
“We've seen it over and over again,” Bruce Dmytrow told me. “The leadership team is really the driver, the key for any resident safety program. We found that the organizations that are high-performing really care about their staff and residents. I know that sounds very elementary, but it's not elementary.”
Dymtrow is the vice president of Aging Services and National Programs at CNA, the national insurer that is only now widely spreading word about study results shared with some providers in October. He and colleagues examined thousands of client claims — and perhaps most importantly, also included detailed stories about successful operators — in the report “Using evidence to achieve excellence: engage, lead, succeed.”
The average payout for closed claims was $211,709, with for-profits carrying a higher burden ($216,949) than nonprofits ($199,256) both in dollar volume and frequency. For-profits constituted 62% of the bed inventory but were the target of 70.4% of the claims.
But Dmytrow and his team emphasized that trying to incite some sort of for-profit vs. nonprofit battle isn't the way to go. Rather, they chose to focus on the treatment of specific conditions, namely pressure ulcers and falls. They also featured profiles of successful caregiver programs.
The 70-page report is chock full of statistics and numbers about things like frequency of closed claims by allegation (falls at 42.7% and pressure ulcers at 18.6% were the top two); top payout reasons (elopement at $325,561 and failure to follow physician orders at $323.325 led the list); and types of injury (death at 52.7%, fractures at 22.6%, and pressure ulcers at 6.3% were the top three).
Along with the bad and the ugly, study authors also included numerous examples of providers getting it right.
Strong indicators of success were managers showing they cared about staff members and displaying “emotional intelligence” about them. What's emotional intelligence?
“It's being able to lead authentically from yourself,” Dmytrow explained. “Leading your organization in a compassionate way, understanding the needs of your employees, as well as residents. What makes the place a special place to work at every day?”
In other words, if you don't know what your employees need or what makes them want to work at your facility, you're toast.
If it sounds a bit like bowing to overly needy employees or setting unsustainable precedents, think again. Since staff turnover rates can be so high — and consistent assignment to the same residents so important — there is much more to be lost if you continually have to train new employees.
Having the same employees there to observe the same residents day after day is critical to noticing subtle behavior changes. Any elopement or fall risk that can be staved off could mean hundreds of thousands of dollars saved in each instance.
Engaged, consistent staff also will remain committed to more purposeful rounding. Residents will get more frequent visits and in-person inquiries as to whether help is needed for things such as getting to the restroom — not just walk-bys or shouts into a room.
One of the success stories outlined, in fact, uses non-rounding CNAs as hall monitors to head off problems. “It's not always fancy, evidence-based research” that does the trick, one researcher reminded me.
Sometimes, it's simply common-sense, true-to-the-heart attention to co-workers that does it.
Follow James M. Berklan @JimBerklan.