Harmony Healthcare Blog

The Dynamics of Quality in the New World of Post-Acute Care

Posted by Holly Harmon on Thu, Oct 01, 2015

free_webinarMerriam-Webster defines dynamic as always active or changing, having or showing a lot of energy, of or relating to energy, motion, or physical force.  What else could better describe quality?

In particular, the quality journey.  Let’s walk through each part of this description, consider how it defines the quality journey and what we can do about it. 


Always active or changing

Think about how quickly resident outcomes or business outcomes can change…for the better or for the worse. 

On an individual level, one day a resident can be doing fine and then the next day experience a sudden change in condition.  The recognition and appropriate response to that change in condition leads to subsequent outcomes – positive or negative.  Positive outcome results if the resident’s needs and preferences are met without experiencing adverse event.  Negative outcome results if the resident experiences an unnecessary hospitalization or untimely resolution of the issue at hand. 

On an organizational level, one day a nursing care center can be performing very well on quality measures and then experience significant staff turnover or other organizational disruption that creates inconsistent care leading to poor performance on quality measures such as increased pressure ulcers, antipsychotic medication use, pain, weight loss and more. 

Recognizing the dynamic nature of healthcare and this quality journey signals the need to have effective organizational systems and processes in place to keep your “finger on the pulse” of your organization’s activities. 

Having or showing a lot of energy

The quality journey is both energizing and exhausting at times.  Putting this journey in perspective helps to minimize the exhausting effect.  For one, it is a journey...without end.  Don’t expect to work hard on one initiative such as antipsychotic medication reduction or healthy financial performance and “be done”.  As noted above, the coinciding dynamic nature is described as always active or changing, thus requires continuous effort and continuous improvement.  Systematic action and systemic change will help to climb along the journey toward higher performance versus revisiting the same problems over and over. 

Second, any and all efforts on the quality journey are contributing to improvement.  Both small and large efforts provide meaning and value.  Even when desired results are not achieved, progress is gained if one learns from that part of the journey.  A win-win! Isn’t that energizing?

Energy, motion or physical force

Quality is not a task.  It is not a responsibility of a committee or a single person.  Coordinated motion and physical force by an entire organization provides fuel and direction for the quality journey. 

The culture of an organization affects how much motion is made on the quality journey.  An organization’s culture is shaped by actions and reactions to various events along the quality journey.  Think about an organization that uses discipline of staff as a first line of defense when desired results are not achieved, such as an annual licensing survey with less than stellar performance or census is not at par.  This punitive response will shape a culture that is rigid, narrow-sighted and fearful.  Does this sound like an environment that can actively engage in the dynamic quality journey?  Rather an organization that uses system and process analysis and performance improvement as a first line of defense when desired results are not achieved will shape a culture that is open, inquisitive and engaged.  How do you think that environment will affect the dynamic quality journey?  What environment do you want to work in?

What to do?

A dynamic quality journey is not only fun and exciting, it is a key path to success in the new world of post-acute care which is evolving to a world where quality and payment are linked in ways never seen before.  Think about Value Based Purchasing, Accountable Care Organizations, Improving Post-Acute Care Transformation (IMPACT) Act, SNF Quality Reporting Program and more.  Recognizing and understanding the dynamics of quality and developing effective strategies to engage on the quality journey to build and sustain positive outcomes is essential.  During my upcoming free webinar on October 21st, we will explore the recently expanded AHCA Quality Initiative which aligns with several national initiatives and is founded on systems based performance improvement.    Register here for my free webinar, AHCA Quality Initiative: Positioning for Success in a Changing World, by clicking here.

In the meantime, think about:

  • What systems and processes shape your organization? How do they support or restrict a dynamic quality journey?
  • Are you confronted with recurring issues? If so, what could be done differently to achieve better results?
  • Is your organization on the road to success in the new world where quality and payment link?
  • What else can be done to advance your quality journey?

 Go forth and be an active and energetic force of dynamic quality! 


ABOUT THE AUTHOR:
Holly Harmon, RN, MBA, LNHA, is the Senior Director of Clinical Services for American Health Care Association (AHCA) in Washington D.C. Holly has over 18 years of experience in healthcare including post-acute care, long term care, residential care, assisted living, independent living services, psychiatric hospital nursing and occupational health nursing. Her background includes working as a CNA, LPN, RN, Nurse Manager, Director of Nursing, Chief Nursing Officer, Executive Director/Administrator and Director of Quality Improvement & Regulatory Affairs at Maine Health Care Association. Holly is a strong advocate of culture change and was one of 17 nurse experts nationwide who consulted on the development of the Nurse Competencies for Nursing Home Culture Change. Holly previously served as President of the statewide Maine Culture Change Coalition/LANE, Maine LANE Co-Convener for the national Advancing Excellence in America’s Nursing Homes Campaign, Co-Chair of the Maine Partnership to Improve Dementia Care in Nursing Homes and Vice-President of American College of Health Care Administrators, Maine Chapter. Holly is a certified Long Term Care Safety Specialist and is an approved trainer.



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Topics: Post-acute care, quality

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