Nursing Home Innovation Highlighted by Federal Agency for Healthcare Research and Quality
“Culture Change” Concept Boosts Resident Satisfaction, Lowers Staff Turnover and Increases Income
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Austin, TX – January 18, 2010 –The November 25, 2009 issue of the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange profiles an innovative program co-directed by Melody Malone, Quality Improvement Consultant, TMF Health Quality Institute, who worked closely with administrators and leaders at Advanced Healthcare Solutions (formerly P&M Healthcare). This large nursing home corporation currently owns and manages over 37 nursing homes in Texas. Seven nursing homes in Advanced Healthcare Solutions’ North Texas region participated in the innovative program to become early adopters of culture change.
With the help of TMF’s consulting services and resources covered under a contract with the Centers for Medicare & Medicaid Services (CMS), Advanced Healthcare Solutions was confident they were ready to begin a culture change journey. The result was far more successful than they imagined. Among the many positive results, the change increased resident satisfaction, improved staff retention and tripled operating income. Advanced Healthcare Solutions’ story became an AHRQ Innovation Profile called “Nursing Homes Create Home-Like, Resident-Focused Environment and Culture, Leading to Better Quality and Financial Performance, Higher Resident Satisfaction, and Lower Staff Turnover.” It shares some useful tips, ideas and lessons learned for nursing home administrators to use at their facilities.
Using culture change, Advanced Healthcare Solutions planned to transform seven early adopter nursing homes into home-like environments that would nurture residents’ spirits as well as their bodies, improve staff satisfaction and retention, and still maintain the financial health of the company. Advanced Healthcare Solutions’ work focused on culture change at homes that were, on average, about 35 years old and leveraged what could be done with limited resources. With the help of TMF’s consulting services and resources from 2005 to 2008, as part of TMF’s contract with CMS (called the 8th Scope of Work), Advanced Healthcare Solutions began their ambitious initiative.
“As is recurrent in the literature about nursing homes undergoing culture change, Advanced Healthcare Solutions’ work also highlights the importance of relationship building and especially the importance of engaging the active involvement of top management,” says Malone. Relationship building and top management that is actively involved in the change were even more important in Advanced Healthcare Solutions’ situation, when remodeling and extensive environmental changes were not possible.
An intensive focus on culture change ideas and activities by the leadership contributed to the seven early adopter homes creating a happier, healthier environment for residents and family members as well as positively impacting the nursing homes’ efficiency. The dollars saved in staff turnover and realized in census and mix allowed the nursing homes to make changes and improvements without major capital investments. Net operating income more than tripled, family satisfaction increased from 59.5 percent to 65 percent in one year, staff satisfaction rose from 58 to 75 percent within a year, and today 30 additional homes with Advanced Healthcare Solutions have begun their journey toward culture change.
Advanced Healthcare Solutions’ efforts demonstrate that creating culture change at seven nursing homes simultaneously is possible without major remodeling of nursing home facilities or large financial investments. However, the rewards can be substantial. For more information about the innovation, go to the AHRQ Innovation Exchange (http://www.innovations.ahrq.gov) and read this profile (http://innovations.ahrq.gov/content.aspx?id=2621).
About TMF Health Quality Institute
TMF Health Quality Institute is an Austin, Texas-based nonprofit consulting company focused on promoting quality health and health care through contacts with federal, state and local governments, as well as private organizations. TMF partners with health care providers in a variety of settings to ensure that every person receives the appropriate care, every time.
About the AHRQ Health Care Innovations Exchange
The Innovations Exchange (http://www.innovations.ahrq.gov/) is a comprehensive program designed to increase the development and adoption of innovations in health care delivery. The Innovations Exchange contains more than 300 searchable Innovation Profiles, 1400 searchable Quality Tools, and numerous resources to support the Agency's mission—to improve the safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of care—with a particular emphasis on reducing disparities in health care and health among racial, ethnic and socioeconomic groups.