Monthly Archive

Oct. 24, 2006

Two weeks from today, we have the privilege to vote. Exercise it! There is much at stake. Whether you are a red state person, a blue state person, or an orange or purple or chartreuse state person — VOTE. Don’t let anyone label you or predict what you’ll do, most especially don’t let anyone get away with predicting that you will NOT vote. And if you’re coming to our Annual Meeting in San Francisco, use our Web site to find out how to get an absentee ballot.

Remember, Washington is NOT your problem with public policy. Washington is where you send your problems. I mean this! You vote (or not) for the people that make laws. You send them to Washington.

Many of the people you send are good people. In our work in aging services, some policy people understand what good policy is and do the right thing for the right reasons. Others don’t know, but are open to being educated about the right things to do. Others make political decisions instead of policy decisions. Decisions based on campaign contributions or horse trading on votes (remember the bridge to nowhere?) or party-line decisions.

In any event, you have a responsibility to educate policy makers before they come to Washington and keep them grounded in good public policy after they get here.

Although I am admittedly an amateur in judging politicians, I have noticed a few things that I’d like to share with you. There are some questions that go through my mind as I watch these folks in person and on television. These questions are not scientifically validated, nor can they be found in a political science book. I did not get them from wise and experienced political commentators or gurus. Rather, they help me determine whether or not I feel comfortable with a political candidate. Here’s what I ask myself:

1. Have they ever had a real job? When they were young, did they wait tables or clean bedpans or mow lawns or serve as a candy striper? As adults, did they manage other people? Were they in the military? Did they have to meet a payroll? Manage a budget? Decide on a health benefits plan for the people they work with? Did they achieve anything worthwhile? Did they lead a Rotary barbecue or a church mission trip? Have they failed at something and what did they learn from it? Or, have they simply been “groomed” for an elected position? Grooming is great for peacocks, but peacocks don’t make good policy leaders. Yes, we need people who have had real jobs. Don’t send us any more peacocks.
2. Can they empathize about real problems? Ask them if they have a family member with Alzheimer’s disease or know a family who has an autistic child. Has anybody they loved faced cancer or diabetes or alcoholism? Do they know what it’s like to live without health insurance? When you ask about these issues, do you get an answer about welfare cheats or getting Medicaid and the national deficit under control? People without empathy leave me cold. You know it when you feel it. A good public official has great empathy and compassion. You can tell when you talk with one. Politicians without empathy are political animals. We need people — not animals — in public office.
3. Do they give you straight answers? Can they answer questions with “yes” or “no” — or even, “I don’t know, but I’ll find out and get back to you.”? Do they admit past mistakes and say they’ve changed or grown? Do they look you in the eye and have a conversation, or do they only have a canned message? Do they answer questions asked of them or do they “spin” their answers? Can you actually determine what they really said? We can trust straight talkers. I don’t trust “spinners.” Keep your spinners at home. Let them sell used cars or jewelry made from cubic zirconium.
4. Do they look natural? I’m sure you’ve looked into a casket and noticed the deceased has been so made up by the undertaker that the dearly departed doesn’t look like himself or herself (though friends and passers-by will say, “Doesn’t she look natural?”). Well, I am skeptical about hairspray preachers and Botox politicians. After all, hair dye, teeth whitener and cosmetics only get you so far without internal substance based on real experience. We don’t need more well-coiffed talking heads in Washington. We need natural people — inside and out.
5. When was the last time they visited your organization? Did they drop in protected by handlers to make a short photo-op appearance? Or, did they talk with residents and employees? Did they make a speech or have conversations? Did they ask you what you think about important policy issues? Politicians who don’t get out to real places and talk to real people are hothouse plants. Hothouse plants are too insulated from reality and have lost their value as policy leaders. Keep your hothouse plants in your greenhouse. Don’t send them to Washington. There’s enough hot air here already.
6. Do you like them? One of my inner tests of a politician is whether or not I like them. Could I have a good conversation with them over a hamburger on the grill? Do they have long-standing and committed relationships? Can they laugh at themselves? If I disagree with them about politics, religion or sports, do I still like them? Do they view their political opponents as colleagues or as enemies? I figure that if they are genuinely likeable, then they can get along with other leaders enough to create a political climate where problems can get solved. Everybody agrees that there is too much animosity here in Washington. Send us a few more mature people who know how to work together and get things done. Keep your unlikeable people at home. We don’t need more in Washington.

You see, we need real people in elected and appointed office to help us in challenging times. People who have the capacity for empathy, people willing to struggle earnestly with complex problems, people who aren’t owned by special interests, people capable of constructive relationships, people who have a track record of successful leadership where their efforts accomplished something worthwhile. People who have values, values our country was founded on. Elected officials you initially like — then respect!

No, I don’t trust hairspray preachers, Botox politicians, peacocks, spinners and talking heads. Do your part to send the real people to Washington and to your state’s capital. We need real people to help us solve real problems.

LarryWilliam L. Minnix, Jr., D.Min.
President and CEO

Find information on your state and federal elections.

AAHSA
2519 Connecticut Ave NW
Washington DC 20008

Oct. 5, 2006

Last Friday, we participated in an unprecedented quality summit. The purposes of the summit were to draw a baseline on where quality stands in nursing homes, model a new relationship paradigm with stakeholders — some with whom providers have had adversarial relationships — and to take an experimental step in the Quality First journey. The experiment is a campaign called “Advancing Excellence in America’s Nursing Homes” and its mission to improve quality of life for nursing home residents and staff. It is a focused, voluntary, two-year initiative. To clarify up front, this campaign does not replace Quality First. If successful, the campaign and the processes used to advance it will enhance Quality First.

So this is a report on where quality stands today and how we plan to move forward.

Context and History

Four years ago, we, the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care publicly committed to Quality First, a national quality improvement plan to demonstrate excellence and earn public trust. While Quality First covers the total aging services continuum, it was widely recognized that the nursing home sector had been embattled for years and we found ourselves in a “crime and punishment” approach to public oversight. After pointed feedback from policy and consumer leaders, we reasoned that the only way out of this awful dilemma was to take responsibility for quality based on continuous quality improvement (CQI) principles. Quality First was born.

While our members have traditionally delivered quality, good works were overshadowed by isolated bad incidents and bad care or deceptive business practices by a few. Yet, it was evident that quality is achievable, measurable and worthy of public good will. And it is my experience there’s more good care available than we’ve been given credit for. Quality First would enable good providers to shine and the chronically incompetent and ill-motivated to be run out of business. Quality First was designed to build on other quality initiatives like Pioneer Network, Eden and Wellspring, and to complement the Centers for Medicare and Medicaid Services’ (CMS) Nursing Home Quality Initiative of 2001.

In the ensuing four years, we’ve had the opportunity to discuss Quality First with numerous groups — including the Founders of the new campaign. These interactions have led me to six major conclusions about quality:

1. Quality is getting better, though more must be done. Quality measures and process improvements are in their infancy for many of us.
2. Workforce is the key to quality and we must address caregiver needs.
3. We need to understand consumer perceptions and enlist consumer groups to help us fulfill Quality First.
4. We have more collective knowledge than we are effectively using.
5. Many key policy makers don’t really understand the complex issues we face and, therefore, are not making the most constructive policy decisions.
6. All interested parties: consumers, government, providers, professionals and business, must work together better if quality nursing home care is to become the automatic public expectation it should be.

A Definition of Quality

To pursue nursing home quality, we must define it. The Founders of the new campaign drafted the following definition:

We’ll see how well this definition wears over time.

Where Quality Stands

Here are the summary bottom lines from various sources, much of which was expressed at the quality summit.

1. Improvement in nursing homes is evident in several CMS quality measures. Use of restraints and pain management are two examples. No progress is evident in pressure ulcers for a variety of reasons. Refinement of measures will be an ongoing concern.
2. Culture change initiatives are proving successful in improving staff retention, with correlations to quality and cost-effectiveness. While studies are relatively small in scale, it is abundantly clear that respect and effective human resource management can make a major dent in the 70 percent average turnover rate nationally for certified nursing assistants (CNAs). One study reports a rate of 10 percent staff turnover based on culture change. We know that staff turnover rates will never be zero and shouldn’t be because a certain amount of turnover is healthy. But a national average of 70 percent is too high, and culture change helps bring that number down.
3. No one really knows in a collective and disciplined way, how residents and families evaluate the services we offer. Our recent AAHSA Member Value Survey found that two-thirds of our members perform resident satisfaction surveys, but little is known about how those results get reported and used to improve quality. There is no national profile for resident satisfaction. Approximately one-third of our members conduct employee satisfaction surveys, but again, little is known about what changes these surveys generate.
4. The momentum behind Quality First is growing. Two-thirds of AAHSA members have signed the Quality First Covenant. In AAHSA’s recent member survey, approximately half of our members report they are using Quality First to help them improve. Interestingly, approximately one-fourth of those who have not signed the covenant say they, nevertheless, are using Quality First to improve. We have strong anecdotal information about how Quality First is helping to transform organizations. Our Web site is full of Quality First member success stories.
5. National leaders who spoke at last week’s summit are recognizing that quality care is a national responsibility, and that the financing of it needs to be revamped. While no one promised more money, there is general acknowledgment that quality should be defined and paid for adequately, with financial incentives for good care. Emerging themes at the meeting were changes that allow people to stay at home longer, redirection of dollars to follow clients and the potential for technology to improve care and cost.
6. Sen. Charles Grassley (R-Iowa) addressed the summit. He is a skeptic about voluntary self-responsibility initiatives, and stressed his support for strong survey and certification oversight. He reported that there are several hundred chronically bad providers who should be shut down but are not. Sen. Grassley, and those groups who reinforce his view, are our acid test critics. While we disagree with his conclusions about the effectiveness of voluntary initiatives, we have much work to do to prove him wrong. And we agree that the bad apples should be discarded. The issue becomes how to support CMS and the state agencies in accomplishing that objective.

What Should We Do Next?

1. Full steam ahead with Quality First! I believe we are close to the tipping point in its effectiveness. The Quality First Elements need to be embedded in every member’s culture. There is plenty of evidence that this is occurring. Quality First is taking root.
2. Implement consumer and staff satisfaction surveys, use the results for improvement and report findings through annual reports and newsletters.
3. Embrace culture transformation. It is our salvation.
4. If you are a nursing home, sign up for the “Advancing Excellence” campaign. This is a way to show that voluntary efforts can be successful. Your participation will give us reliable, collective national data on improvement.
5. Learn to tell our story better locally and nationally.

At the close of the “Advacing Excellence” summit, I asked one of the dozen or so nursing home residents in attendance how he would “bottom line” the day. He replied, “It looks like if residents and staff are given the respect they deserve, and the people that run these places will train people well and have better communication, we shouldn’t have too many problems.”

Yes, let’s ask the consumer what he or she thinks. It could be enlightening and helpful on this next phase of the Quality First journey. And let’s see what this campaign can teach us about quality improvement, working more collaboratively with other groups and the effects we can have on policy makers. We have a big opportunity and responsibility to lead permanent transformational change. Yes, we are close to a tipping point!

Larry

William L. Minnix, Jr., D.Min.
President and CEO

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AAHSA
2519 Connecticut Ave NW
Washington DC 20008