Nursing Home Quality Improvement
To improve and sustain systems of person-centered care that result in positive resident outcomes and a rewarding job experience for staff, nursing homes need a resident focus, empowered and well-trained staff, strong leadership, data informed practice, and effective interdisciplinary teamwork within a just culture. These key concepts are embodied in the following organizational areas which include tools and resources to help you improve and strengthen your systems of care.
The ACE Best Practices, a summary of recommendations and lessons learned from nursing homes participating in the last ACE series, provides excellent information on leadership presence, staff stability, consistent assignment, huddles, antipsychotic medications, hospital readmissions, and falls/mobility/alarms.
The Nursing Home Quality Care Collaborative Change Package is intended for nursing homes participating in the National Nursing Home Quality Care Collaborative (NNHQCC) to improve care for the millions of nursing home residents across the country. This change package focuses on the successful practices of high-performing nursing homes including two South Carolina facilities, NHC Healthcare – Anderson and NHC Healthcare – Parklane.
Consistent or dedicated assignment means that the same nursing assistants and nurses care for the same residents every day that they work. On-going consistent assignments are the foundation for high quality individualized care and effective teamwork. When frontline staff know the resident and their baseline, they can anticipate needs and detect early acute changes. When frontline staff work on the same teams with the same residents each day, they can problem solve in real time to implement interventions more easily and quickly. Research shows that the consistent assignment of nurses and nursing assistants improves clinical outcomes of residents as well as workforce outcomes such as staff attendance and satisfaction. Dedicated assignments transform caregiving tasks into relationship-based care.
Tools and Resources
Determination of Resident Acuity Level and Process for Fair Assignment
This tip sheet outlines a process to determine resident acuity level and tips for ensuring fair assignment.
Advancing Excellence Consistent Assignment Goal
The Advancing Excellence (AE) in America’s Nursing Homes website includes consistent assignment as one of nine goals. Experts have developed a tracking tool for tracking consistent assignment and resources including a video on the impact of consistent staff assignment in nursing homes. Click here to access this information.
Strong leadership skills are the foundation for providing quality care in nursing homes. Kuzes and Pozner in their book, The Leadership Challenge, describe the five practices found in dynamic leadership.
- Model the way
- Inspire a shared vision
- Challenge the process
- Enable others to act
- Encourage the heart
High performing nursing homes have strong leaders that use these practices. In the tools and resources that follow, you will find simple methods to use in your facility that embody these practices.
Tools and Resources
All Hands on Deck
This model for leadership to check in and help the frontline during busiest times is from Meeting the Leadership Challenge in Long-Term Care: What You Do Matters by David Farrell, Cathie Brady, and Barbara Frank. It is an excellent way to reduce staff stress through active support and involvement. Facilities that implement All Hands on Deck report great success and enhanced teamwork across all staff levels.
Everyone Stands Up Together
Everyone Stands Up Together takes the management team’s morning stand-up meeting out to where staff closest to the resident work so that CNAs, nurses, and managers meet at the same time to share information needed by everyone.
Staff stability is key to providing quality care in nursing homes. Where there is high turnover, resident outcomes suffer and staff are disadvantaged in multiple ways. Good hiring practices, attendance policies, scheduling methods, and assignment practices are effective methods to stabilize staff.
Tools and Resources
Hiring Well: Key Questions David Farrell Asks in Initial Interviews
David Farrell shares his interview questions that gather critical information for making informed hiring decisions.
Providing On the Job Support for Newly Hired Nursing Assistants
A large percentage of nursing assistants quit during the first three to six months on the job citing lack of support as the primary reason. Strong orientation of sufficient length and continued support within a stable team are key to reducing turnover of new hires.
Attendance, Scheduling, and Assignments
This is a comprehensive summary of the content found in the Staff Stability Toolkit prepared by B&F Consulting for HealthCentric Advisors. It includes effective attendance policies and practices, scheduling methods, assignment practices, and a positive chain of leadership.
Advancing Excellence Staff Stability Goal
The Advancing Excellence (AE) in America’s Nursing Home website includes staff stability as one of nine goals. Experts have developed a tracking tool for tracking monthly turnover rates for nursing assistants, registered nurses, and licensed practical nurses as well as processes related to staff stability. Resources include job satisfaction scales and measurements. This website includes multiple other tools and resources to assist with orientation programs and creating a culture of retention. Click here to access this information.
Teamwork and Real Time Problem-Solving
Teamwork is critical to positive outcomes for both residents and staff. When staff work together to problem solve in real time, resident needs can be anticipated and challenges responded to quickly. Staff feel supported and better care is achievable when staff members know that “pitching-in” and working together are part of their culture.
Tools and Resources
Huddles are an excellent way to communicate information quickly while ensuring that the right staff are present who can respond to challenges.