How one SNF landed AHCA's top distinction
This year, our Altercare of Louisville Center for Rehabilitation and Nursing became the first center in Ohio to earn the American Healthcare Association and National Center for Assisted Living's coveted Gold Quality Award. The AHCA/NCAL distinction measures Malcolm Baldrige Criteria and evaluates leadership, strategic planning, customer and staff satisfaction, as well as clinical and financial results. Since the inception of the National Quality Award Program in 1996, only 24 care centers nationally have achieved this level of quality recognition. So how did we do it?
While many of Altercare's 18 independently-owned facilities hold Bronze and Silver level awards, Louisville is the first to advance to Gold. The process is rigorous, and landing at the top merits full team engagement in developing and rolling out creative, measurable patient outcome enhancements.
I believe the ultimate key to our success was Altercare's employee-empowering culture that prioritizes our patients' health and satisfaction. Senior staff and direct-care employees are involved in dialogue on solutions to problems, which are openly brought to the table and addressed. Our organizational vision acknowledges the links between quality, customer service and employee satisfaction. Including all levels of staff in care improvements serves our center, staff and residents well.
Some of the differentiating initiatives that pushed us ahead are endeavors that drove a shift in staff perspective. We found that sometimes aspects of care that may not seem significant on the surface actually can have a meaningful impact on a patient's outcome.
One of the process evaluation tools we found effective is Quality Assurance – Performance Improvement, or QAPI. This approach includes continuous monitoring and assessment cycles:
- Plan – Establishing objectives and goals
- Do – Implementation of the plan and data collection
- Study – Reviewing the results as compared to the goal
- Act – If rework is needed, repeat the prior steps, if no rework is needed, fully implement.
In one case, we applied QAPI to help reduce the incidence of pressure ulcers. The process included senior leadership and frontline staff for each of the three shifts, as well as the medical supply and dietary departments. They shared perspectives on the problem, identified the root causes and brainstormed solutions. Through open discussion, we discovered that residents taking meals in the dining room had better nutrition and hydration intake, as well as improved activity and mobility — leading to better outcomes related to unintentional weight loss, urinary tract infections and pressure ulcer development.
We took a similar approach to improve care for residents with dementia. Once again, we gathered multidisciplinary input, which included engaging residents' families. Family members provided valuable insight into how best to care for their loved ones, which we applied to individual care plans and ultimately reduced antipsychotic medication use. In some cases, this is as simple as knowing a resident's favorite food. Stocking and offering preferred foods, which may deviate from our standard food offerings, has proven extremely effective in calming distressed residents.
Another successful quality care initiative focused on helping residents build a strong rapport and familiarity with day-to-day care providers. By forming a Staff Stability team, we were able to lower staff turnover, shrink the pool of “as needed” employees and increase the hours of part- and full-time employees. This meant that direct care staff were more familiar with the residents under their care and better able to meet their needs, leading to improved satisfaction for everyone. One of the keys to achieving Gold is having the proper mechanisms in place to deploy initiatives via staff who work with patients daily, and ensuring that the direct care teams in turn provide insight to management so any barriers can be removed, and processes fully implemented and maintained.
These efforts are a culmination of many years of quality enhancements. Qualification for the Gold Award is dependent on previous achievement of the Bronze and Silver quality awards. Turnover percentages and The Ohio Department of Health annual inspection results must be better than the state of Ohio averages for three years.
The review process is intense. First, a team of four nationally trained examiners reviewed our application, which was then submitted to a judge to determine whether an on-site visit to the facility was warranted. Three examiners then came to Altercare of Louisville for on-site examination of processes and validation of quality systems. They interviewed senior leadership and also requested more data and information during their visit. I think that is another key to achieving Gold this year: We defined data sets to measure progress at the outset of new initiatives, and invested in the technology needed to help us thoroughly measure, assess and educate our employees.
The examiners also interviewed and questioned direct care staff about key areas of the application such as Vision, Mission, and Core Competencies, where high staff engagement had a positive effect. The examiners also evaluated the direct care staff's involvement in decisions and quality improvement. Once again, our engagement of staff at all levels in quality enhancements proved key. The examiners presented their findings to a judging panel that approved Altercare of Louisville's Gold Quality Award achievement.
While we are extremely thrilled to have received this distinction after rigorous review, we are most proud of the care value that our ongoing, team-focused quest for quality delivers to our residents.
Tom Boyes is VP of Sustainable Clinical Quality at Altercare of Ohio, Inc., Canton, Ohio. Altercare of Louisville provides comprehensive rehabilitation programs and post-acute medical services.