Tuesday, April 29, 2008

Culture change on the cheap

CMS and the Pioneer Network had a culture change conference earlier this month and now the presentations are online at http://www.pioneernetwork.net/news-and-events/creating-home-presentations.html. The most interesting one is "Low Cost Practical Solutions", which has some very good ideas on how to make things better with a minimum of both money and effort. Take a look.

Sunday, April 27, 2008

Focus on the money part deux

There are quite a few nursing homes that like to limit supplies in a well-intended effort to contain costs. This practice is pound foolish and penny stupid. Not only does it decrease employee morale and directly affect resident care in a negative way, but it is a waste of time and energy that most administrators don't have to begin with. Assuming that with volume discounts, an incontinence brief will run you anywhere from about 30 to 50 cents each. Limiting how many briefs can be used per day will save you a dollar, maybe a buck fifty, per day per resident. Maximizing the RUG score by educating CNAs on their part and by ensuring that MDS nurses are credentialed will increase your revenue by a minimum of several dollars per day per resident. I'm not in any way saying you should try to defraud third party payors, but you should go to great lengths to make sure that your assessments are as accurate as possible. In short, go after the many big fish instead of concentrating on the few small fish that are out there in the sea of finance.

Wednesday, April 23, 2008

Preparing for LSC inspection

http://www.healthynh.com/nhha/nh_hospitals/ruralhealth/cah%20downloads/LSC%20Survey%20Form.pdf
is the form that surveyors use to ensure compliance with the Life Safety Code. Perhaps you could find it useful when preparing for inspections.

Thursday, April 17, 2008

3 thoughts about employee behavior

1. 90+% of the time, folks do the best they know how under the given circumstances
2. There are four primary goals of behavior: Power, revenge, attention, and display of inadequacy
3. http://www.paraprofessional.org/publications/coaching_supervision/ has "Coaching Supervision" pdf files for free (Normally $99 through AHCA)

Tuesday, April 15, 2008

Nursing Homes: Focus on the Bottom Line!!!

You may be thoroughly convinced otherwise, but I think that nursing homes don't think enough about making money. Reimbursement is typically something that only the front office and the administrator are concerned about, but I would encourage you to get every single member of your staff in a money mindset. Teach them how nursing home finance works. Make sure that CNAs understand (I mean *really* understand) how the ADL and restorative documentation that they are responsible for raise the RUG levels. It is imperative that everyone in the facility appreciate the MDS. Insist that anyone who so much as breathes on the MDS gets certified so that they know what they are doing. Have an inservice for the licensed nurses on what they have to chart for skilled residents, and why. Conduct an open-house meeting as you are preparing the annual budget. Share your projections with all staff and get their feedback. By getting everyone in a money mindset, not only are you helping the facility but you are helping them. Although unconventional, it is empowerment at its best, because everyone can see that they are making a difference in the one thing that seems to matter most to corporate owners -- making a profit.

Wednesday, April 9, 2008

Free videos for staff development

I've found some really good videos online on how to do nursing stuff, and of course they're free. They would make an excellent tool for a cash-strapped staff development office.
http://saddleback.edu/alfa/vid_index.aspx
http://lib2.hacc.edu/nursing/nursing103/

Thursday, April 3, 2008

Book Review: Quality Management Integration in Long Term Care

I was initially quite excited to get this book and it came with the full blessing of AHCA. After reading it, though, I am rather disappointed. I was expecting a book that actually explained practical applications of quality improvement in nursing homes, and this book was not that at all. It is a discourse explaining the need for quality improvement along with a very broad based overview of some statistical tools. It is not at all practical and seems to be geared more for students in a college-based NHA training program. I am not as enthusiastic about interviewing residents, staff, and families about quality as the authors, mainly because I feel that most folks in the nursing home are petrified of retribution and will tend to give answers that they think administration wants to hear. One bright spot of the book, however, is chapter 4, "Internal Critical Issues", which discusses barriers to quality improvement. Overall, the only truly good thing about the book is that it doesn't reference Allen's opus magnum which I detest. Although I commend the authors for being one of the very few to write a book on such an vital topic, I really have a hard time recommending it. A better QI text is "Quality and Performance Improvement in Healthcare", published by AHIMA, because it is extremely practical and does talk about long term care at length.