Working-the-floor hazards

In my first facility in Glendale, AZ, I was eager to prove myself as the best leader my staff had ever seen.  One problem with that was … that I wasn’t.  But, I’m getting ahead of myself.  In my AIT program (Administrator in Training) I learned as much as I could about the departments I was to oversee.  But, I failed to dive deep enough into the nooks and crannies of the facility which resulted in insecurity in me, the new leader, when it came to supervising department heads and holding them accountable and teaching them.

So, instead of investing in building a relationship of trust with my department heads who could then, in turn, do the same with their staff, I felt much more comfortable working out on the floor with the line staff.  I would show how much I cared for them and the residents by staying out of my office and walking around.  I would be visible.  I would get to know everyone by name.  I would get to know their lives.  It didn’t occur to me at the time but my department heads resented my behavior.  I’m saying they resented me being visible and out of my office.  We all should do that.  The ED who’s stuck in his office all day becomes out of touch, ineffective, and won’t be employed very long.

BUT … what they resented was that I was spending the necessary time to hold them accountable, invest in our relationship, and help them succeed.  Some of them felt like I was ‘going over their head’ or ‘undermining’ them.  What I learned, the hard way, was that when the ‘line staff’ feel so comfortable with you/me as the administrator, that can threaten their direct supervisor’s relationship with them.  And, their supervisor (your department head) feels it and trusts you less.

It happened to me.  Don’t let it happen to you.

Of course we should know everyone by name.  We should have an open door.  But, we should direct them to talk to their supervisors first before rushing in to solve problems.  And, we should make time, at least once a week, to have a meaningful status review with each department head.  That tweak to my management approach made a huge difference in my effectiveness and results in my next two facilities.

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Tail wagging the dog …

A very troubling sign indeed.  For those of you well-versed in the CMS 5 star rating system for skilled nursing facilities, after reading this I’ll bet you say, ‘I didn’t see this coming.’

A nursing home administrator recently told me that his census was in the decline.  It didn’t fall off a cliff.  It’s been a gradual fall.  From an average occupancy rate of about 94%, he’s down to about 73%.  His Medicare census is also down about 33%.  His building is a leader in its market.  What happened?  A major side effect of the 5 star rating system.  Here’s the story …

A relatively new 50-ish bed, all private room facility in the market was unhappy with its low star rating.  The Quality Measure component was killing them. (For a 5 star rating system introduction, check this out.) They reasoned that since the 14 day MDS data was hurting their score, they would simply discharge their Medicare patients on day 14.  Their new message to the market, ‘We have beautiful private rooms and we get you home faster than anyone else.’

Of course they don’t mention …

  • the harm they cause by sending patients home too soon.
  • They don’t publicize what percent of their discharges end up in the hospital again.
  • They don’t emphasize that these medicare patients are being cheated out of their rightful benefit of receiving therapy/care so that they heal fully before going home.

Nope.  Instead, they are sucking the long-term care patients out of the market and everyone else is suffering.  What’s an administrator to do?  How do you compete with that?  We came up with a game plan to go on offense in his market.  The good news is there’s quite a bit he will do and he’ll be fine.  The point of this post is to call attention to UNINTENDED CONSEQUENCES.  I’m sure CMS did not intend for this side effect of the 5 star rating system.  This story proves again that ‘we perform according to how we’re measured.’  A primary concern, therefore, as a leader is to be sure that your measures and rewards promotes the type of behavior you want.  Unfortunately, clairvoyance, isn’t bestowed with title of ‘Leader,’ so we have to be attentive and willing to change our measures/rewards as we discover these things.

Will CMS change the measure to avoid this side effect?  I hope so …

2 Questions

If you’re looking to transform your facility’s culture, 2 questions will turbo charge the change … regardless of where you’re trying to take your organization.  Training your staff (and rewarding and holding them accountable) to consistently ask these 2 questions will have an IMMEDIATE impact on your residents, patients, and outside community … guaranteed!

The impact of training your entire staff to ask these 2 questions CONSISTENTLY will yield the following results:

  • Improved resident/patient satisfaction
  • Reduced call lights
  • Reduced call light wait time
  • Prevented accidents
  • Increased Census

It’s a win-win and a no-brainer.  2 Questions to turbo charge your culture change efforts.  Good luck!