The Big Picture: A lesson on making reform work

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All sides agree things never should have reached this point. Too often, the product appears to be substandard. Regulatory oversight tends to be heavy-handed, if not harmful.

Keeping committed professionals is a growing challenge. Union issues abound. And countless previous efforts to address shortcomings have been stymied by intransigence, subterfuge or politics. But finally, there's reason for optimism. A new, quality-driven approach promises to uproot the systemic flaws that have defined its past. And for millions of people, there is guarded optimism that change for the better may finally happen. In fact, many are beginning to ask out loud why it took so long for some commonsense reforms to be put in place -- at Chicago's public schools.
Admit it: You thought I was talking about nursing homes, right?
I don't blame you. In reality, both have faced their share of challenges. And both appear to be undergoing change for the better. But the unique way in which reform is being enacted in Chicago's schools offers lessons for long-term care providers and policy-makers to consider.
Under Chicago's relatively simple initiative, 15% of the city's best schools are about to receive unprecedented autonomy. It's part of a larger plan to free well-run operations from a crippling bureaucracy that envelops the nation's third-largest school system.
The reform effort has two immediate goals. One is to reward facilities that have met agreed upon objectives (for schools, the benchmarks are student achievement and sound management). A second goal is to allow regulators to focus their efforts where it's really needed: on under-performers.
The district's "autonomy list" of 85 schools is actually a counterpoint to its "probation list." Principals at the 212 schools in the latter category have seen many of their powers removed, in the hope that tighter regional supervision will spur them to better performance. Some of these principals have themselves been removed.
School officials say they hope the remaining 3,000 schools between these two extremes will be motivated to aspire to the rewards of the autonomy list, or to at least avoid probation.
Imagine if something similar were put in place for nursing homes. The top 15% of facilities -- more than 2,000 centers -- might receive inspections once every four years, rather than each year (assuming they meet certain benchmarks). They would also get a payment increase for Medicaid and Medicare services.
Meanwhile, the worst performing 15% would be put on probation. As a starting point, operators would get a decrease in Medicaid and Medicare payments. And if they don't shape up after two years probation, the facility loses its license. Simple as that.
Think those kinds of carrots and sticks might spur quality improvements?
John O'Connor
Vice President
McKnight's Long-Term Care News