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Shifting the Leadership Paradigm
From Regulatory Compliance to
Performance Excellence
Mike Dodge, Lucy Rogers, Barbara Yody
AHCA Quality Improvement Committee
Team Leaders
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Learning Outcomes
• Articulate the seven leadership themes exemplified
by AHCA/NCAL quality award recipients
• Describe the Quality First goals and new tools.
• Show the resources and information available on
AHCA’s website
• Present performance management and practical
application.
• Highlight the 2011 goals and activities of AHCA’s
Quality Improve Committee
Quality First
Keeping the Promise
Lucy Rogers
Team Leader – Quality First
Quality First: Keeping the Promise
7-5-5 Race for Quality
“Quality is the combination of care and
services that meet or exceed
customer needs and expectations.”
 7 Principles – Added Definitions
 5 Goals - Refined
 5 Tools - New
Seven Principles
 CQI
 Public Disclosure & Accountability
 Patient / Resident Family Rights
 Workforce Excellence
 Public Input & Community Involvement
 Ethical Practices
 Financial Stewardship
Principles
Continuous Quality Improvement (CQI) – This principle encourages a
collaborative approach to quality management that builds upon traditional
quality assurance methods by emphasizing the organization and systems, with a
primary focus on process, and utilizes objective data to analyze and improve
these processes. In long term care CQI incorporates all the components that are
necessary for quality care and services.
Public Disclosure and Accountability – This principle seeks to encourage
transparency of information that is shared with patients, residents and their
families as well as sources of state and federal funding. It also promotes
accountability to meeting – and exceeding – patient needs and expectations,
while simultaneously exhibiting accountability of government funding for the
care provided.
Patient/Resident and Family Rights – This principle embodies the critical
importance for person-centered care and focus on individual outcomes through
services provided. This is exemplified by presenting opportunities to patients
and residents to best determine their care and shape the comfort of their
environment.
Principles
Workforce Excellence – This principle recognizes that a strong organization empowers
leaders and develops and supports a stable, qualified and well-trained workforce that is
engaged and committed to excellence.
Public Input and Community Involvement – This principle recognizes the
interconnectedness of long term care facilities and the community. Facilities should
strive to achieve positive visibility by promoting themselves as health care providers
within the community, becoming involved in issues impacting the community and by
sustaining a robust volunteer program that actively engages individuals of all ages.
Ethical Practices – This principle embodies the belief that all long term care providers
should operate based on a foundation of trust. This includes promoting ethical business
standards, corporate integrity and responsible financial stewardship.
Financial Stewardship – This principle recognizes that the vast majority of long term care
providers rely on government funding (Medicare, Medicaid) to provide quality care and
services – and that our profession must operate in a manner that uses these resources
responsibly. As a profession, we will endeavor to retain appropriate levels of
governmental funding to allow facilities to provide health care and services to those in
need.
Five Vital Signs (Goals)
Improve and Sustain
 Performance in CMS quality measures
 Compliance with federal survey process
 High rates of resident / family
satisfaction
 High staff satisfaction rates
 Leadership / staff retention – reduce
turnover rates
Five Turbo Tools
 AHCA / NCAL Quality Awards
 Advancing Excellence Phase II
 LTC Trend Tracker©
 Resident / Family Satisfaction Surveys
 Staff Satisfaction Surveys
Cold Hard Facts
 Lack of understanding
 Lack of human resources
 Lack of time
 Lack of financial resources
Flowchart For Problem Resolution
NO
YES
Is It Working?
Don’t Mess With It!
YES
Did You Mess
With It?
YOU IDIOT!
NO
Anyone Else
Knows?
NO
Hide It
YES
You’re SCREWED!
NO
YES
Will it Blow Up
In Your Hands?
NO
Can You Blame
Someone Else?
Yes
NO PROBLEM!
Look The Other Way
Quality Improvement Team 4
Goals
 Improve participation in Advancing Excellence
by conducting outreach to state affiliates,
corporate and independent owners.
 Identify key messages to increase participation
in AHCA quality initiatives.
 Obtain survey results / analyze to identify
opportunities to enhance participation.
 Increase Silver and Gold award participation in
2011.
Opportunities
 Determine level of participation
 Determine understanding of tools
 Determine barriers to use
 Determine ways to reach the masses
 Determine ways to generate interest,
enthusiasm and participation
Team Activities
 Identify AHCA’s non participating
Advancing Excellence centers
 Conduct online survey
 Obtain member testimonials for all
initiatives
 Draft article (s) for state affiliate
newsletters
Measurements
Using Five Turbo Tools
 Benchmark using
* Family /resident Satisfaction data
* Associate Satisfaction data
* Advancing Excellence data
* Trend Tracker
* Advancing Excellence data
General Consensus
WIIFM
WIIFM
 Obtain thorough understanding of “what is







happening” in your center
Improve team spirit / participation
Improve associate satisfaction
Decrease turn over / increase retention
Improve family / resident satisfaction
Benchmark your center’s performance
Improve bottom line
Enhance public perception
Honestly….
 Yes, it will take a commitment on part of
leadership.
 Yes, it will take additional resources
initially – human and financial.
 Is it worth it? YES!!!
Regulatory Compliance to
Performance Excellence
Mike Dodge
Team 1 Leader
Shifting the Leadership Paradigm
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Shifting the Leadership Paradigm From
Regulatory Compliance to Performance
Excellence
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AHCA’s DEFINITION OF QUALITY
Quality is
the combination
of care and services
that meet or exceed
customer needs and expectations.
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Why Continuous Quality Improvement
(CQI)?
•
•
•
•
•
Increasing expectations by residents.
Increasing expectations by families.
Increasing expectations by consumer advocates.
Increasing expectations by over-site agencies.
It is the right thing to do.
Long term care consumers are more open in expressing their
expectations. They want safe, effective, timely, efficient, and
equitable care and services provided in a home-like environment
and person-centered culture that maximizes their quality of life.
Bernie Dana. (2008) Developing a Quality Management System: The Foundation for Performance
Excellence in Long Term Care. American Health Care Association
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The Building Blocks to Quality
PHASE I
Commitment
PHASE II
Achievement
PHASE III
Excellence
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A New Way of Thinking
OLD
Regulations
Schedules
Task Oriented
Reactive
“We’ve always done it
this way.”
NEW
Customer Satisfaction
Resident Choice
Systems Oriented
Proactive
“Let’s find a better
way.”
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7 Common Themes
•
•
•
•
•
•
Choose a vision for what can be and then act on it.
Commitment to continuous learning and growth.
Customer expectations define quality standards.
Leaders and managers lead by example.
Employees are satisfied and engaged.
An effective quality management system sustains focus
on performance.
• A structure exists to sustain the center’s quality journey.
Taken from:
Olson, Douglas, Dana, Bernie, Ojibway, Stefanie Mapping the Road to Quality Results
Provider Magazine. April 2005. pp 69-72.
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Create a Vision for Becoming Better
• Begin with the end in mind. – Covey
• Habits are things we repeatedly do. Make your mission a habit.
• Educate ALL stakeholders on your mission.
* Post your mission statement in the facility for all to see.
* Begin with your staff on their 1st day of orientation!
* Educate staff throughout the organization-Get them to tell you!
* Begin all meetings and stand-ups with your Vision and Mission.
* Include Vision and Mission in marketing and advertising material.
• Teamwork is the ability to work together toward a common vision.
• Work to create synergies.
• It is not your way …and not my way…it is a better way! (1 + 1 = 3)
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Vision vs. Mission Statements
VISION
(Your destination)
A vision statement describes where a company wants to go.
Provides direction and purpose. Inspires and unites. A picture of what will be.
Disney’s Vision Statement- “To make people happy.”
MISSION
(Your roadmap)
A mission statement explains how a company will get there.
A broad statement distinguishing you from others. Defines your values.
Why are we here? What do we do? Whom do we serve? What do we stand for?
Starbuck’s Mission Statement- “To establish Starbucks as the premier
purveyor of the finest coffee in the world while maintaining our
uncompromising principles as we grow.”
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Stakeholders
• Who are your primary stakeholders?
▫ Person, organizations, or agencies that have a vested interest in
the performance of your organization.
* Patients/Residents*Advocacy Groups
*Families
*Government Agencies
*Staff
*Funding sources
*Referring Hospitals
*Other care providers
*Physicians
• What are the key requirements and expectations?
*Person-Centered Care
*Safety & Welfare
*Compliance
• How do you learn of these values?
* Surveys
* Face-to-Face
* Regulations
* Community Involvement
*State Associations
*Performance
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Continuous Learning and Growth
• Develop optimal leaders. Individuals who blend extreme
personal humility with intense professional will. – Collins.
• Develop leaders throughout you center - within all rank and file.
• Develop positive habits. A habit is what we repeatedly do.
* The intersect of knowledge, skill, and desire. -Covey
• Learn your talents and develop your weaknesses.
• Become a life long learner-Read, Read, Read!
• Be an agent for change. Encourage CAN DO attitudes and realtime problem-solving.
• Create a culture of education and learning.
• Look to and learn from the best.
• Learn in a variety of venues. (Books and Publications, Internet
Searches, Workshops, Seminars, State & National Association
Meetings, etc)
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Customer Expectations Define Quality
Standards
• Identify your customers and define their requirements
and expectations.
• Start with procedures that identify customer service as
an element within your organization.
• Define customer “service” vs customer “experiences.”
• Survey your customers at least annually (Independent vs
face-to-face vs town hall meetings).
• Listen closely to your customers’ expectations, wants and
needs.
• Incorporate satisfaction survey outcomes into strategic
planning.
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Lead by Example
• Too many leaders lead by title. (Take off the name badge!)
• If you are leading and no-one is following...you are taking a
walk.
• Talk the talk…walk the walk.
• Be more “plow horse” than “show horse”.
• Create a culture of team spirit. (Fishbowl vs. Silo)
• Create an environment of highly effective communication.
▫ Timely responses
▫ Encourage two way communication not just top to bottom
▫ Open and honest communication.
If your actions inspire others to dream more,
learn more, do more and become more,
you are a leader.
John Quincy Adams
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Employees are Engaged
• Make your organization a place where people want to
come to work.
• Define the expectations for your employees up front.
• Create a culture of positive employer-employee relations.
• Maintain an open-door policy and encourage real-time
problem solving.
• Develop staff through effective coaching. Coach for
knowledge  improvement  excellence.
• Hold staff accountable for their actions.
• Conduct Employee Satisfaction Surveys and share the
outcomes.
• Create a culture of employee empowerment.
• Involve employees of all rank and file on Committees, QA
and QI Teams and in company events and activities.
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Continuous Quality Improvement
Systems
• Establish a quality improvement system that will work best for your
organization.
HCANJ (Health Care Association of New Jersey) (2009). (Performance Improvement (PI) Plan and Template
• Link strategic planning and goals with your organizations vision and
mission and core values.
• Self-assessment.
• Face the brutal facts-prioritize areas in need of improvement
• Develop a balanced set of measures.
Customer Satisfaction
Regulations
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Sustaining Quality
• Formal and informal systems to support quality
initiatives.
• Form a Quality Improvement (QI) Team
▫ Key personnel
▫ Commitment of team collaboration
▫ Commitment to improving
• Quality Scoreboard of Key Indicators
▫ Benchmarking
▫ Data Gathering
▫ Analysis (Monthly, Quarterly, Annually, Year-to-Year)
What gets measured…gets improved.
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Begin Your Quality Journey
• Climate survey
▫ Are You Ready for CQI? Facility Assessment Survey.
• System evaluation
▫ Developing a Quality Management System: The Foundation for Performance
Excellence in Long Term Care.
▫ Guidelines for Developing a Quality Management System (QMS) for Long Term
Care Providers.
• Fact Finding/Brutal Facts
▫ Investigation of systems
▫ Prioritizing
• AHCA Quality Award Bronze Application
▫ www.acha.org  Quality Improvement  ACHA Quality Award Program 
Applicant Resources
Performance Management:
A Road to Success
Barbara Yody
Team 3 Leader
Success Stories From the Field
Performance Management
A Road to Success
What gets measured….gets
improved!
Performance Management System



Provides a framework for the quality journey
Relates to all 7 of the Common Themes
Can include the LTC Vital Signs
….. Through a Balanced Scorecard
Performance Management System



Provides a framework for the quality journey
Relates to all 7 of the Common Themes
Can include the LTC Vital Signs
….. Through a Balanced Scorecard
Balanced Scorecards
“ Strategic planning and management system
that aligns business activities to the vision
and strategy of the organization, improve
internal/external communications, and
monitor organization performance against
strategic goals.”
Balanced Scorecard Institute
Balanced Scorecards
Originators: Drs Robert Kaplan & David Norton
– developed a performance measurement
framework that added strategic non-financial
performance measures to the traditional
financial metrics
Goal: to give managers and executives a more
“balanced” view of the organization’s
performance
"To achieve our
vision, how will we
sustain our ability
to change and
improve?"
Measures
Targets
Initiatives
Learning &
Growth
Initiatives
Targets
"To satisfy our
shareholders &
customers, in
which business
processes must
we excel?"
Measures
Internal
Business
Processes
Objectives
Vision
and
Strategy
Objectives
Initiatives
Targets
Measures
"To achieve our
vision, how
should we
appear to our
customers?"
Objectives
Customer
Measures
Targets
Initiatives
"To succeed
financially, how
should we appear
to our
shareholders?"
Objectives
Financial
Balanced Scorecards
Four Perspectives
 Customer



Customer focus – patient-centered care
Customer satisfaction
Financial




Revenue & expenses
Days in A/R
Risk assessment
Cost-benefit data
Balanced Scorecards
Nursing Home Environment
Research literature review revealed 6 key
areas
 facility characteristics & ownership
 resident characteristics
 staffing indicators
 clinical quality indicators
 deficiencies, complaints & enforcement action
 financial indicators
Harrington et a. Gerontologist 2003 Apr; 43 Spec No 2:47-57
AHCA Quality Committee
Team # 3 - Positive Practices & Processes
"How do I get there from here....success
stories from the field"
TEAM
GOAL: To identify, collect and
disseminate examples from the field of the
practical application & execution of empirically
proven best practices in skilled nursing settings
Team 3 – Positive Practices & Results
Survey Results




Objective: Determine support of goal to share
success stories from the field
Audience: State Associations & Quality
Award Examiners
Respondents: 34 State Associations and 54
AHCA Senior & Master Quality Award
Examiners
Core set of questions asked of both
audiences
Is collecting & sharing practical applications a worthwhile
endeavor for AHCA Quality Committee?
Degree in which collecting & sharing stories would benefit
members/profession
Important Tools for Sharing
State Associations
Important Tools for Sharing
AHCA Award Examiners
Priority Areas of Importance
State Assn versus Award Examiners
State Assn - Top Six
1. Pressure ulcers
2. Falls prevention
3. Pain Mngt
4. Customer Satisfaction
5. Staff Satisfaction
6. Restraint Reduction
Examiners – Top Six
1. Customer Satisfaction
2. Pain Mngt
3. Staff Satisfaction
4. Nurse Orientation
5. Pressure ulcers
6. Falls prevention
Survey Conclusions




Interest in sharing practical applications of best
practices
Alignment in what content areas are most important
Agreement in methods of finding the stories from the
field
Agreement in method of sharing the “how-to’s”


AHCA website
Publications
Profile of a Success Story

Requires a Measure



Require an analysis of process steps


Who did what differently?
Includes staff involved & resources needed


Team review of work flow
Requires description of specific process change


Baseline rate or count compared to after improvements
were implemented
Need to express % improvement
Best if staff closest to process works to identify changes
Share learning

Challenges, barriers, advice
What’s Your Story?