Advancing Excellence Initiative with the Illinois LANE Preserving Critical Access Nursing Homes

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Advancing Excellence Initiativewith the Illinois
LANE Preserving Critical Access Nursing Homes

• Telling Our StoryFrom Nursing Home in Need to
  Nursing Home in the Lead
• Alden Princeton

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Key Areas of Action

• Call-offs
• Tardiness
• New employee retention
• Decreasing facility acquired pressure ulcers

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Background Information

• During the calendar year 2010, 10 complaint
  surveys with a total of 8 findings, last
  complaint 12/2010 yielded 5 tags
• Policies and procedures not being consistently
  followed by facility staff
• History of negative survey outcomes, including
  F314
• Poor customer service attitudes among some staff
• No formal daily communication process

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Call-offs and Tardiness

• Where we started
• Chaotic, very loud!!
• Limited professionalism-Including Dress Code!
• misunderstanding of grace period-being late
• Questionable reasons for call-offs or no reason
  provided at all
• Issues with nursing scheduler
• Increase in overtime (both scheduled and
  utilized)
• First tracking period
• 800 tardies in two week period/ All Departments
• Average of 7-9 times per employee per pay period
• 35 call-offs per month (nursing department only)

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What We Did

• Daily stand-up and stand-down meetings initiated
  immediately
• Administrator initiated Call In Log and reviewed
  all call-offs and tardy data for trending and
  root cause
• Staff were creating overtime for one another
• Why were people calling off-Have to call Laura
• Re-Interviewed current staff, placed on 30 day
  corrective action plan if needed.
• Clarified language in union contract
• Lots and Lots of in-servicing and education

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What We Did continued

• Clearly communicated expectations, with
  discipline as necessary.
• Reviewed AMS code of conduct, labor laws
• Answered all staff questions, Thats the way
  we've always done it!!Doesnt make it right!
• Following extensive education, facility
  administrative and management staff strictly
  enforced policies and held staff accountable

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Accomplishments!

• The pay period ending 9/17/2011
• Yielded only 26 tardies for all facility staff!!
• As of 9/23/2011
• Average call-offs for the month of September were
  six!!

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Retention

• Overall retention was historically good, however,
  new hires were leaving at a very high rate, due
  to the attitudes of long standing staff
• Lack of Team Work from Seasoned Employees
• Bullying of new hires
• Staff attitudes- Ive seen Administrators and
  DONs come and go
• Youll never make it

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What We Did

• Changes to orientation
• Initiated a day-long core orientation day with
  refreshments and lunch
• In addition to orientation shadowing staff
• During daily stand-up meetings, managers are
  informed of all new hires
• Managers make it a point to go meet and greet new
  hires and discuss how their orientation is
  progressing/ Get to know them!
• During daily stand-down meetings, managers
  provide an updated report on the new hires
• This change has generated a tremendous amount of
  positive feedback! New employees feel valued
• New hires given a survey at the end of their
  orientation asking for suggestions for
  improvement

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Actual Comments from Orientation Surveys
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Pressure Ulcers

• Where we were
• Facility Acquired in 2010 was 80 YIKES!!!
• January of 2011, we had 11 facility acquired
• in just one month!
• Then along came Advancing Excellence!!!

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What We Did

• Instituted Rock and Roll Rounds
• Every 2 hours 8 a.m. to 8 p.m.
• Manager involvement/QA Environment tools
• Beyond turning and repositioning
• Continence checks
• Exercising
• Ambulating
• Off Loading
• AAROM/PROM
• Splint Quality Assurance
• Non-punitive approach

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Where We Are Now

• Pressure Ulcers
• February 6
• March 1 Staff now running to
  Clinical Support
• April 0 Supervisor for more
  Zinc Oxide!!!!
• May 2
• June 1 Staff reporting every
  little skin issue!!!
• July 3
• August O
• Sept. 1
• Total of 25- All Healing, non necrotic
• Regulatory Compliance
• As of today, only 3 complaint surveys with NO
  findings
• Princetons Annual survey resulted in only 5
  minor tags requiring only desk review by IDPH-
  nothing in skin!!!

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Work-In-Progress

• Interview process based on corporate core values
  and mission statement.
• Administrator involvement in all interviews
• Exit interviews-data analysis
• Staff development-staff satisfaction survey
• Continuous efforts to develop meaningful staff
  recognition
• Thank you goodie basket
• Dessert with the managers
• Public praise/Lunch with Laura
• Certificates of Recognition
• Personalized cards with scratch off lottery
  tickets

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Lessons Learned

• Absolute importance of a collaborative
  partnership/ Unified front from all managers
• Consistency and fairness
• Dont let things fall through the cracks
• Follow the process and it will result in
  continued positive clinical outcomes

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Importance of Corporate Support

• Dear Alden Management Services..

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For More Information

• Advancing Excellence www.nhqualitycampaign.org
• LANE  LBridwell_at_ilqio.sdps.org
• Alden Princeton Laura Kelly pr_administrator_at_alde
  ngroup.org