Keep the village — he recommends a system
James M. Berklan
If the figures represented a stock chart, David Gifford would be not only a happy man but also a very rich one. The numbers and performance both show upswings.
But they don't reflect a stock's rising value. Just maybe a healthcare profession's.
Gifford isn't a stock trader but rather the director of government and quality relations at the American Health Care Association. In many ways, business has been good for him. Very good, he figures.
“The last five years have been rewarding, and fun to watch,” he told me this week at his group's annual Capitol Hill fly-in event. A record number of members attended to visit their respective lawmakers and impress upon them the importance of supporting long-term care providers.
While persuasion is the full-time pursuit of many of Gifford's AHCA colleagues, his primary job is to give the lobbyists something to crow about.
AHCA insiders say he's done well for them: They've put their necks out by publishing distinct quality-improvement targets, and now they're making progress toward them. There are eight separate goals in the initiative -- in areas ranging from staff stability to customer satisfaction to hospital readmissions and functional outcomes, to name just half. (See today's stories on beating the goal for antipsychotics use and a related item about rehospitalizations, which also hits close to home.)
But Gifford, a medical doctor who once ran the Rhode Island Department of Health, says instead of looking at it as eight separate goals (which, no doubt, it is) he really thinks of the quality inititiave as a pursuit to create systems for improvement. An organized, systematic approach is THE way to become known as a top-rate provider. He swears by it, and the numbers can be lined up to tell a bright story.
Applications for the AHCA/NCAL National Quality Award Program have jumped to 1,070 this year, just 46 behind the all-time high. Moreover, the number of facilities reaching new peaks of quality — Bronze and Silver medalists included — have continued to rise.
Whereas occupancy and payor mix used to be key indicators of judging success, readmission rates and rates of discharge to the community have become just as important, if not more, Gifford points out.
"Until recently, 'quality' was a good thing to do, but there was not really a good business case for it," he points out. "With changes in payment and regulatory matters, they will start to reward quality and performance."
More and more operators are agreeing that they can't — and shouldn't try to — do it alone, GIfford adds. If it takes a village to raise a child, as the folk saying goes, it takes a system to serve a senior.
“When you look at the Quality Awards, which focus on the Baldrige criteria, the Silver and Gold [winners] beat others on every measure,” Gifford notes with pride.
“When we look at high-performing providers, almost all provide the same clinical practices,” he adds. “It's really an organized system and approach that lifts quality.”
He said that one metric that comes heavily into play — and cuts across both Phase I and II results — is staff turnover. This has been consistent but also remains the most ignored by those seeking improvement. Bad move.
“If any metric is a canary in the coal mine, it's turnover,” he points out. “Those with systems to approach it have less turnover. But those who treat it more as a checklist item have more frustration, and then lower scores, among staff.”
With staffing and retention remaining obvious problems through the years, if not decades, why haven't they improved? I asked Gifford.
“No one's ever measured it,” he responded quickly. “When CMS starts measuring it, scores will improve.”
With the government's new Payroll-Based Journal process officially kicking in July 1, we'll start to find out soon just how true that is.
Follow James M. Berklan @JimBerklan.