The Illinois LANE Critical Access
Nursing Home Pilot Project
Susan Gardiner, RN, BSN, LNHA
Director of Clinical Services, Illinois Council on Long Term Care
Lisa Bridwell, BA
Quality Improvement Facilitator, IFMC-IL
Illinois Quality Improvement Organization
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Advancing Excellence in
America’s Nursing Homes
Making Nursing Homes Better Places
to Live, Work and Visit!
Campaign Overview
•Largest coalition of nursing home
stakeholders
•Voluntary for nursing homes
•Based on measurement of meaningful goals
•National coalition of 29 organizations
•Initially a two-year campaign started in 2006,
incorporated in 2010!
www.nhqualitycampaign.org
What the Campaign Does
• Provides free, practical and evidence-based
resources to support quality improvement efforts
in America’s nursing homes.
• Committed to providing support to those on the
frontlines of nursing home care.
• Promotes open communication and
transparency among families, residents, and
nursing home staff.
www.nhqualitycampaign.org
11 Founding Organizations
• Alliance for Quality Nursing Home Care
• American Association of Homes and Services for the Aging
(AAHSA)
• American Association of Nurse Assessment Coordinators (AANAC)
• American College of Health Care Administrators (ACHCA)
• American Health Care Association (AHCA)
• American Medical Directors Association (AMDA)
• Centers for Medicare & Medicaid Services (CMS) and its
contractors, the Quality Improvement Organizations (QIOs) and
State Survey Agencies
• National Association of Health Care Assistants (NAHCA)
• NCCNHR: National Consumer Voice for Long Term Care
• The Commonwealth Fund
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• The Evangelical Lutheran Good Samaritan Society
www.nhqualitycampaign.org
Campaign Benefits
•
•
•
•
•
Focuses on meaningful issues
Drives nursing homes to a culture of QI
Increases staff retention and focus
Improves customer satisfaction
Saves money due to improved quality and staff
retention
• Prepares for Pay-for-Performance
• Brings stakeholders to the table
• Complements other initiatives
www.nhqualitycampaign.org
How the Campaign Works
National
Steering
Committee
• Policy
• Framework
• Resources
Statewide
LANES
NURSING
HOME
• Local
Leadership and
Guidance
• Recruitment
• Education
• Focus on
Meaningful
Issues
• Implementation
of Interventions
Local Area Networks of Excellence (LANEs)
• Learning networks
• Coalitions of nursing home stakeholders
• Partnerships
• Collaborative
Diverse organizations, often with different
agendas, come together to improve quality
of care and life for residents.
www.nhqualitycampaign.org
Illinois LANE Members
HCCI
LSN
IDPH
CMS
IPC
IFMC-IL
Healthcare Council of Illinois
Life Services Network
Illinois Department of Public Health
Centers for Medicare & Medicaid
Illinois Pioneer Coalition
Quality Improvement Organization
for Illinois
Illinois Department of Aging: Ombudsman
www.nhqualitycampaign.org
LANE Roles and Responsibilities
• Provides statewide leadership to coalition of
stakeholders
• Raises and maintain awareness about the campaign
• Recruits nursing homes
• Provides technical assistance
• Communicates key campaign messages
• Acts as a “change agent” to improve the lives of
those living and working in nursing homes
www.nhqualitycampaign.org
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Resources
1
2
Purpose of the CANH Project
• To improve care in selected nursing
homes
• To strengthen LANEs
• To develop a model of nursing home
improvement that can be used across
the country
www.nhqualitycampaign.org
Critical Access Nursing Home Project
Critical- Access Nursing Homes (CANHs) are in
inner city neighborhoods serving largely minority
communities of generally low socio-economic
status.
Why are they termed “critical”?
• The community depends on these nursing homes to
provide post-acute and long-term care services. Not
having high quality nursing homes close to where people
live complicates discharges from local hospitals and
forces elderly residents to go to more distant nursing
homes far from family and friends.
www.nhqualitycampaign.org
Locations of CANH Project
•
•
•
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Chicago, IL
E. Chicago, IN
Cleveland, OH
Macon, GA
CANH Faculty:
Barbara Frank and Cathie Brady B & F Consulting, Carol
Benner Leading Age, Dr. David Smith Drexel University
© B & F Consulting, Inc.
www.BandFConsultingInc.com
www.nhqualitycampaign.org
Illinois LANE
Illinois LANE Co-Conveners are:
IFMC – IL (Illinois Quality Improvement Organization)
Lisa Bridwell lbridwell@ilqio.sdps.org
800-386-6431
IPC
(Illinois Pioneer Coalition)
Enza Levy elevy@qtctherapy.com
www.nhqualitycampaign.org
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Critical Access Nursing Homes
An Initiative of Advancing Excellence in Partnership with
the Illinois LANE
Staff Stability:
The Foundation
for Clinical Improvement
Learning Session One
November 16, 2010
Facilitated by
Cathie Brady & Barbara Frank
B&F Consulting
www.nhqualitycampaign.org
Staff
Stability
Improved
Quality and
Satisfaction
Better
Census and
Revenue
CANH’s Three Goals
• Help each nursing home get better stability and
outcomes
• Form “mutual aid” and collaboration among
nursing homes
• Strengthen collaboration among state agencies
and organizations as they learn so they can help
nursing homes in similar positions
What a difference management makes!
Five Management Practices Associated with
Low-Turnover, High Attendance and High
Performance:
High
quality
leadership
at all levels
of the
organization
Valuing staff
day-to-day in
policy and
practice, word
and deed
High
performance,
high
commitment
HR policies
Work systems
aligned with
and serving
organizational
goals
Sufficiency
of staff and
resources to
care
humanely
Orientation Meeting 9/2010
Audience: Corporate Leaders Administrators and
DON’s
Content:
• See the value in collaboration with each other
• Build relationships with LANE members and state
agencies so they can be seen as a resource
• Attendance and scheduling PPT
• Recruitment and hiring PPT
From Data to Knowledge to Action
Exercise: Floor Leadership
How two Charge nurses start their day
“I gather my staff in the
morning and I tell them
‘we have to work
together. We’re like sticks.
If we work apart, each of
us can be broken. If we
stick together, we can’t be
broken. We’ve got to stick
together to get the work
done. And let’s have fun
doing it.’ Then I just pitch
in and we get through the
day.”
“I am overwhelmed by what
I have to do when we’re
working short. If I start
doing the CNA's job, I’ll
never get all my meds
passed and my charting
done. It’s just too much. I’m
not going to do the personal
care. I just keep my focus on
my work and get as much
done as I can.”
Learning Session One November 2010
CANH Faculty overview
– Staff stability; foundation for clinical improvement
 Impact on resident outcomes

Impact on survey results

Impact on staff, injuries etc.

Better Jobs, Better Care
November 2011 Action Items
Outcome of Drill Down Group Activities
•Absenteeism/Tardiness
•Staff’s lack of policy knowledge
•Staff to Staff to communication
Relationships Closest to the Resident Matter Most
Interdisciplinary and
Interdepartmental Collaboration
Charge Nurses
CNAs
Quality of work
Residents
Quality of care
© B&F Consulting Inc. 2011 www.BandFConsultingInc.com
Dimensions of Relational Coordination
Interdisciplinary ~ Interdepartmental
Across Shifts and Days
Communication
Frequent
Timely
Accurate
Problem-solving
Relationship
Shared Goals
Shared
Knowledge
Mutual Respect
© B&F Consulting Inc. 2011
www.BandFConsultingInc.com
January 2011 Learning Session Two
• Positive chain of leadership
• Systems that support relationships
• Valuing your staff
• “All Hands on Deck”
LANE Support Updates (Between Learning Sessions 1-2)
• Focus Groups addressing New Hires
• One Facility utilized LANE member to conduct focus groups to
gather information of why employees separate in the first 90
days.
• Developed a cheat sheet to help new employees
• Increased awareness/attention to the needs of new hires
• Preceptor Program/Consistent Assignment
• Another Facility incorporated information from the orientation
meeting in their preceptor program and as they develop their
strategy for consistent assignments
• Implementation of Call Out Log Information at STAND UPS
• One facility used this information to follow up with those who
called off to communicate she cares if they were sick and
identify any future potential issues that my cause future call
offs.
LANE Support Updates (Between Learning Sessions 1-2)
• Development of an Employee focused Survey
addressing attendance/absenteeism
• Exercise: If it was a perfect world…….
• Unintended [positive] outcomes:
– One facility realized the need to in-service on
their policies after ranking their staff
– “Caught You Caring” develops
– Increased attention to communication among
staff and residents
Assignments and Goals
• Move toward changing hours for department head lunch
• Involve leadership with All Hands on Deck to promote teamwork
• Establish nurse manager meetings to provide feedback on challenges
they face
• On site follow-up by LANE
• Building upon existing Quality Improvement rounding program
• Orientation practices and identifying the qualities of a good trainer or
mentor
And then the snow fell……
March 2011 Learning Session Three
• Systems and People Development presentation
• Key messages:
– Improvements in staff stability and engagement lead to
improved quality and satisfaction resulting in better
census and resources for more improvement
–
Relationships closest to the resident matter most
Accomplishments
Improved morale
Increased leadership from charge nurses
Improved attendance
Tracking call-offs; report brought to stand-up meeting
Interview process: skills and qualities
Monthly turnover tracking
Reports of tremendous teamwork during blizzard
Accomplishments
Met census goals and decreased readmissions
Implemented consistent assignments and as a result
call-offs decreased
Extending orientation on a case-by-case basis
Implemented Family Satisfaction Survey
Summary of Barriers
•
•
•
•
•
•
•
•
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Survey response rates
Loss of project leader
Administrator and key management staff turnover
Process for obtaining and financial support for special programs (gift
cards etc.)
Pathways of communication up the chain of command up to and
including corporate
Mechanism for direct care staff to communicate directly with corporate
staff
Slowed or stalled data collection
No overlap between shifts
Internal struggles between management staff
May 2011 Learning Session Four
Two Events
Leadership Meeting
• Corporate Leaders/DON/Administrator- retrospective review
discussed successes/barriers resulting overwhelming support from
Corporate
• Corporate leaders working with facility managers on solutions to
barriers.
Learning Session
• Follow up from Leadership Meeting frontline staff moving forward and
working on additional data driven goals. (Clinical and Organizational
Goals)
Overall Goals
Outside organizations reporting improved resident
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care
A Model for Change
Outcomes
Care Planning
Person-centered
Care
Organizational Workplace
Practices
Second, Care for the Residents
Communication
IDT Care Planning
Critical Thinking
Problem-Solving
MDS/Data Collection
Individualized/
Person-centered
Care
Monitoring
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Third, Do it the Best Way We Can…
Performance
Improvement
Quality
Assurance
Structure
Process
Outcomes
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Quality
Assurance
• Reactive
• Single episode
• Organizational mistake
• Prevents something from
happening again
• Sometimes anecdotal
• Retrospective
• Monitoring based on audit
• Sometimes punitive
Performance
Improvement
• Proactive
• Aggregate Data
• Organizational process
• Improves overall
performance
• Always measureable
• Concurrent
• Monitoring is continuous
• Positive change
www.nhqualitycampaign.org
Thank You!