Thursday, January 31, 2008

Something to do during stand-up

During the daily stand-up meeting (a.k.a. department head), assign each person to go 2 or 3 tasks in the facility that will only take 5-7 minutes total to complete. Tasks could include returning an empty oxygen tank to the tank holder out back, cleaning up a messy sink area, helping a CNA with rounds, or getting a resident a cup of coffee. Put each task on a card and have each person draw a couple. Everybody participates -- no exceptions. This will do a lot for improving staff morale.

If Nordstrom ran your nursing home

Nordstrom's is a chain of upscale department stores famous for their customer service. They only have one rule for employees: "Use your best judgment". Let's play a quick game of what-if and imagine Nordstrom being hired to run a nursing home (this is just the ICF wing; Disney can run the skilled hall). Residents would be able to participate in the activities of their choosing, and it wouldn't just be groups like church and bingo. Nurses wouldn't have superfluous charting, aides wouldn't be assigned useless tasks like putting ice in water pitchers that everyone knows are never drank out of. Aides would pretty much run the place, in fact, and nobody would have a problem with it. There would be fewer med passes. Administration would never be in the office, and all the meetings would be condensed into one. There would be hot coffee and fruit for visitors to enjoy, and of course the residents would be partaking as well. Mutual cooperation between everyone would foster a genuine element of customer service, with customers being all stakeholders and not just visitors and residents. But now it's time to return to reality. What can you do today to bring the nursing home just a little bit closer to Nordstrom's?

Monday, January 28, 2008

Following up with new employees

You need to meet with new employees either 30 or 90 days after they are hired. You still need to meet with them informally on a regular basis before this point in time, however. This needs to be a quick little 5 or 10 minute sit-down meeting where you work on these 4 vital questions:
1. Now that you've been here for a while, how do we compare to what we claimed to be when we hired you?
2. What are we doing that's good? Who here has been helpful to you?
3. At the last place you worked, what were they doing that we could do here to make things better?
4. Is there anything here you don't like? What can we do to make things better?
After this meeting, continue to meet with your staff. If the employee has any answers to ideas 3 or 4 that deserve recognition or reward, make sure they get it.

Saturday, January 26, 2008

Random thoughts on customer service

Nursing homes typically give a horrible initial impression, simply because, well, that's just how they are. How can you fix it? I'm not talking about what to get rid of (except for the a-hole staff), but rather what can you add. How can you make your staff more friendly? What can you do to foster relationships between families and staff? How can your on-hold messages be changed so that callers get to hear something other than really bad advertising for the facility? Honestly, who cares about the bingo schedule? Get some ideas from other industries at

Friday, January 25, 2008

Yesterday's MDS 3.0 Conference Call

I didn't have a chance to listen in on the MDS 3.0 open door forum yesterday; I was urgently called out of town to deal with a pressing issue during the same time as the conference call. However, the topics that were discussed were posted online at
You can check out the results of the pilot projects and validation studies, which are now finished.

Tuesday, January 22, 2008

Open Letter to CEOs
is one management consultant's advice to all corporate executives. Although not directly applicable to nursing homes, or even healthcare, a lot of the same principles still apply, like, "If you want to see things change immediately, stop being an asshole". Check it out and apply it today.

MDS 3.0 Special Open Door Forum

CMS is having an open door forum at their Baltimore office on Thursday to allow providers to give their 2 cents worth on MDS 3.0. However, it will be presented as a teleconference as well, since there were more people interested in participating than there were seats. You can register at the CMS website. If you don't want to, or can't, take the call, check back here on Thursday afternoon and I'll post the highlights. Otherwise, you can download an audio recording of the teleconference after January 30 at

Sunday, January 20, 2008

Thanks to the Tennessee State Veterans Home, Murfressboro

Recently, I've had the opportunity to observe operations at the Tennessee State Veteran's Home in Murfressboro. Initially, I expected the worst. TSVH has gotten loads of bad press in the media, as they had 8 immediate jeopardies on their last survey. However, I was pleasantly suprised to find out that the facility was actually one of the best I have ever been in. I would especially like to commend the staff on the North Wing, which is the secure dementia unit. Robin Ronewicz, Gail Fish, and Annah Jones are truly exceptional staff members, and Diane Williams is one of the best house supervisors I have ever had the pleasure to meet. I would again like to express to them my thanks for the great work they do. I sent the administrator of the nursing home a short email expressing my kudos, and the staff couldn't believe that somebody would actually publically thank them as it had never happened before. I would like to present everybody out there with two pieces of advice: (1) Thank your staff, thank them often, because you have absolutely no idea how underappreciated they feel, and (2) Bad survey results don't necessarily mean that a facility is bad. Judge a nursing home by how compassionate and caring the nurses and techs are.

Friday, January 18, 2008

Random recognition

Starting today, send an employee a thank-you card to their house. In it, say something along the lines of, "On behalf of the residents and your co-workers, I would like to thank you for the hard work you do. It is really appreciated, much more so than you can ever know." Have the administrator and the person's department head to sign it. Everybody should get one at random at least once during the year.

Thursday, January 17, 2008

CMS SNF Open Door Forum Conference Call -- 1/17/08

CMS has an open door forum conference call for nursing homes once a month, where providers have the opportunity to give feedback on proposed changes to CMS law and policies, as well as get general questions on billing and survey issues answered. Here is a highlight of today's call for those of you who didn't chance to listen in.
1. After May 23, 2008 do not use the old legacy codes with your NPI # when submitting claims.
2. Due to a computer glitch that some of the fiscal intermediaries had, if you had denials on a no-pay bill at the end of the fiscal year, don't split it but instead resubmit.
3. AAPC offers CEUs to certified coders who complete any webinar or course sponsered by CMS or a carrier.
4. MDS 2.0 has had revisions as follows: (Chap. 3)I2J, I3, K2A, K3, L1E, M4, M4G, M5E, (App B).
5. MDS 3.0 will have a conference in Baltimore on January 24; it will also be presented via conference call at the same time. They will discuss the draft version and how the pilots went.
6. MACs (Medicare Modernization Act Contractors) will replace FIs and carriers. Meridian Services, Trailblazer, Wisconsin Physician Services, Highmark, and Palmetto have been awarded contracts for regions 3, 4, 5, 12, and 1, respectively. MACs for regions 2, 7, and 13 have not yet been awarded.
7. The therapy cap still remains at $1810/yr, but Congress is allowing the exception process to continue out through July 31, 2008.
8. Next Open Door Forum conference call will be on February 28, from 2-3 EST.

Monday, January 14, 2008

7 Questions to Ask Nurses

The next time you're out making walking rounds, ask a nurse these 7 questions on patient safety:
1. Have there been any near-misses that nearly resulted in resident harm?
2. Have there been any incidents recently where a resident was harmed?
3. What things do you think will cause another resident to be harmed?
4. What can we do to prevent the next adverse event?
5. Can you think of a way the system here doesn't work?
6. What specifically can administration do to make the work you do safer?
7. What are we doing that works?

Website for QI in LTC
has some really nice QI stuff. The website's title is "Problem-Oriented Best Practices". Topics include ethics, geriatric syndromes, nutrition, organization and administration, medication prescribing practices, and preventive practices. Good stuff!

Friday, January 11, 2008

5 ideas on communication

Here are some simple things you can do to improve communication in your facility:
1. Ask the employees what is going great on their unit
2. Bring an employee to the daily stand-up (also known as department head meeting), introduce them, and spotlight their successes
3. Let the residents know how good you know the direct care staff is -- be specific
4. When you speak at staff meetings, base everything around a story. If you need to talk about the importance of fall prevention, for instance, begin with the story of a resident who suffered undesirable consequences as the result of a preventable fall.
5. Have a communication board on each unit. Each week, have a white piece of paper titled, "What's Happening This Week". Keep it factual, short, and sweet. To quote Quint Studer from page 224 of Hardwiring Excellence, "We learned that employees define quality communication in terms of quick wins on what they really need to know about. Newsletters that feature executives in suits just don't do it."

Tuesday, January 1, 2008

Free CNA videos online has free training videos for CNAs on the survey process. is a online video based CNA course. This is a great resource for new CNA classes or for staff development.