HCAD 302 exam 3
Steps in managing personal development
1.Develop a personal vision 2.Planning you personal development 3.Starting the improvement process 4.Recording personal development 5.Review and revising PDPs (personal development plan)
The Four Discplines of Execution
1.Focus on the wildly important goal (WIG)-focus on less to accomplish more 2.Act on the lead measures-Success is based on lag and lead 3.Keep a compelling scoreboard (engagement) •Best designed by who?(the players)-people play differently when they are keeping score. People perform best when they are emotional engaged. 4.Create a cadence of accountability-Regular and frequent team meetings *This is how to set up a winnable game *No more than 20 mins. What are the one or two most important things I can do this Week. When the teams they have a direct on the goal they see it as winning. *How you play the game, weekly meetings lasting no longer than 20 mins, and what can i do this week. Lag vs Lead Lag measures: •What's already happened (can't predict future)•Past data •Helps track progress •Can be more accurate than leading indicators •Can help avoid larger problems•Ex: staff turnover, # of admits in past month Lead measures: •Could help indicate a lag measure •Predict future outcomes•Identify problems early •Often based on assumptions (subjective) •Ex: staff call-ins, time missed at work, revamped onboarding program
Operational Performance
Accountability •An obligation or willingness to accept responsibility or to account for one's actions •The essence of accountability is answerability •Obligation to answer questions regarding decisions and/or actions Alignment-on the same page, moving in the same direction Measuring performance-actual ways to measure this. Dashboard is used. Tells you overall how your org is doing
What are the six steps in the annual survey? What is one piece of info a surveyor may request within one hour? What is one piece of info a surveyor may request within four hours? What is one piece of info a surveyor may request by the end of the first day? What is one piece of info a surveyor may request within 24 hours?
1. Surveyors complete off-site preparation 2. Entrance/Entrance Conference 3. Initial Review 4. Resident Sample Selection 5. Informational gathering 6. Potential citation review/Exit conference · Schedule of Medication Administration time · Administration packet · Provide each surveyor with access to all resident electronic health records · Completed Medicare/Medicaid Application (CMS-671).
Scope and Severity Grid
If one of the F-tags listed below is given to a site, AND the Scope and Severity level for that tag is one of the shaded boxes (peach) within the Scope and Severity grid, that constitutes Substandard Quality of Care (higher fines and fees for nursing homes). •483.10 Resident Rights: F550, F558, F559, F561, F565, F584 •483.12 Freedom from Abuse, Neglect, and Exploitation: F600-F610 (entire section) •483.24 Quality of Life: F675-F680 (entire section) •483.25 Quality of Care: F684-F700 (entire section) •483.40 Behavioral Health Services: F742-F745 •483.45 Pharmacy Services: F757-F760 •483.70 Administration: F850 •483.80 Infection Control: F883 Immediate Jeopardy - IJ - does NOT correspond to the I or the J on the grid Often accompanied by a fine ("Civil Monetary Penalty" [CMP]) F880-Infection control most widely given citation IJ-refers to the whole row of immediate jeopardy for resident health or safety
Four Quandrants of Time Managment
Important and urgent matters: Emergencies/Employee Crisis Ex: health department survey or shortage in staff caused by weather or other crisis Important Although not immediate: -Planning for improvements Ex:donor relationship development or implimentation of an employee retention program Not important but routinely happen in senior care orgs: -Distraction/Interruptions Ex:Employee socialization routine, scheduled meetings Not essential or immediate: Busy work/Time wasting Ex: Internet surfing, Completing duplicative resident forms, certain calls, texts or emails *Slack time-open a part of your day so if something comes up you can use that time for that.
F Tag 880 F Tag 580 F Tag 758 Casper Report
Infection Control ranked 2nd. Handwashing to improve Notify of changes Free From Unnecessary Psychotropic Meds/PRN Use Community Assessment For Public Health Emergency Respond -Helps identify issues for quality improvement and issues for state survey *Number ranked F tage 884 is reporting to national health safety networks
POC Tips
Keep in mind that it is: •A legal document •A formal statement informing state & federal agency of actions taken to correct deficiency •Is publicly posted- do not use staff names, only titles Include a disclaimer at the beginning •(EXAMPLE) This Plan of Correction constitutes this facility's written allegation of compliance for the deficiencies cited. However, submission of this Plan of Correction is not an admission that a deficiency exists or that one was cited correctly. This Plan of Correction is submitted to meet requirements established by state and federal law. Be realistic Be specific •Avoid general statements •Avoid abbreviations/initials Common mistakes: missing signature page, ensuring each tag has a POC, correction dates, who is responsible, blanket policies
What is personal Development
Personal Development=self actualization is that includes in a broad need for professional development (highest one). Is when you as a person decide to develop some of the skills, quality, and traits that are available for you Personal development=growth today brings success tomorrow. Quality and traits. Finding traits in me that are positives and make them even greater Maslow's Hierachy of Needs: -Safety Needs:Feeling safe from potentionally dangerous physical and psychological situations and events. Security of health, work, money, routine and familarity. -Love and Belonging: Affiliation, feeling part of a group-family, socially and/or at work. Giving and recieving turst, acceptance, affection and love. -Esteem Needs:Feeling competent. Self-esteem and self-respect. The respect of others, family, socially and at work. -Cognitive Needs: The desire for knowledge and to understand. The need for meaning and predictability. -Aesthetic Needs: The need for beauty and order, creativity, design, and art. -Self-actualization: Reaching full potential. Becoming everything one is capable of becoming.
PDCA: Plan-Do-Check-Act
Plan: plan the change or improvement Do: conduct a pilot test of the change Check: gather data about the pilot change to ensure it was successful Act: Are you implementing on a broader scale (check book)
Duty: Advocacy and Public Policy
Public Service *State licensure boards -Common professional categories of board members: representatives of consumers, higher education, relevant trade associations, professional societies *National Association of Long Term Care Administrator Boards (NAB) *Public advisory boards Corporate citizen *"How a company exercises its rights, obligations, privileges, and overall corporate responsibility within our local and global environments" Civic/service organizations *Main types: academia, charities, clubs, community foundations, consumer organizations Your duty to be advocate and follower public policies Good stewardship and represented (corp citizen) Civic-means service and giving back like being on a CHAASE board
RFOD stands for: If you had a SNF in Eau Claire, who would your RFOD be? CMS' Five-Star quality ratings for the health inspection domain are based on the relative performance of facilities within a state. This helps to · 5-star rating: the top ________% in each state · The middle ________% of facilities receive a rating of two, three, or four stars, with an equal number in each rating category. · The bottom _________% receive a one-star rating. Annual surveys occur within a ________ to ________ month period (generally).
Regional Field Operations Director Janell Hoyt Control for variation between states 10%, 70%, and 20% 9-15 months
Who fills out the Entrance Conference worksheet? After the initial review, the resident sample is selected. _____% of the total sample is preselected by MDS data, and ______% of the sample is selected by surveyors What are critical element pathways used for? The Statement of Deficiency (SOD)/2567 form is issued within ____ business days of survey exit.
Surveyor 70%,30% A guidance for surveyors and what they should be looking at: 1.A timeline of care. 2. Immediate and long-term outcomes 10
People
Teams •Diverse perspectives & skills •Team composition •Task force vs. committee-refrain committee to task force, its time limited and people will more likely to join it. *It is also a good practice to make sure that a team works as a task force focused on a specfic project and does not turn into an ongoing committee. Task force is better for time limited processes Engagement •How does issue/challenge relate to mission, vision, & values? •How does overall strategic planning connect with problem-solving processes? •What are the roles of team members/staff? Communication •Stakeholders •Internal/external communication •Effectively managing teams •Technology
Problem Identification
The Five Whys •Uses "counter-measures" rather than "solutions" -Counter measure: dealing with the problem and not just the symptom *More robust than solutions *Likely prevent problem from recurring -Solution may just deal with a symptom •Review 5 Whys document in Canvas
Complaint Survey
Can be generated by anyone •Staff •Residents •Family members •Previous staff/residents/families •Sometimes self-reports Same process as annual but with (usually) limited scope •Will look at your investigation process •Your site should have strong grievance & incident report processes •Sustainable solutions should be in place •Focused survey but CAN do further investigation •Be aware of disgruntled staff/residents/families - potentially alert RFOD (regional field operations director)
Current Directions
Core exam around 100 qs Core ( 55 qs) You can take two exams within a year and get a discount if do it within the year score over 82% in multiple lines of services Career ladder is what we are more used to. Talking about past model. Progression and advancement in upward direction Career Latus-Lateral movements,up down,side to side etc movement always in the direction of growth and development, collection of positive and relative experiences
DECIDE
D = define the problem E = establish the criteria C = consider all the alternatives I = Identify the best alternative D = develop and implement a plan of action E = evaluate and monitor solution and feedback
Technology
•A critical factor •Efficient •Future
Evidence-Based Decision Making
•A process for evaluation •Benchmarking with self and others •Communicating decisions to solicit input and outcomes •Evaluating systems and acknowledging breakdowns
Scope & Severity
•A system of rating the seriousness of deficiencies •Deficiency = a regulatory requirement that survey finds is not being met •National system used by all state survey agencies & CMS •For each deficiency, survey team determines the level of harm to the resident(s) involved and the scope of the problem (e.g., how many residents affected) •Alphabetical scope & severity value (A through L) assigned to the deficiency *********************************************************** •Isolated = deficiency included a very small # of residents/limited number of staff OR situation occurred only occasionally. •Pattern = This column is chosen when more than a few residents are affected, more than a limited number of staff are involved, or there are repeat occurrences. The rule of thumb for this column is 75%. If a deficient practice affects more than 3 residents but less than 75% of the nursing home population, it generally will be considered a "Pattern." •Widespread = A problem affects many residents or if there is systemic failure in a facility. So the deficiency would be listed as Ftag. So, your Ftag would state what the deficiency is. Do not talk about scope and severity yet unless its Jeopardy (Exit conference) Looking at the level of harm to the residents and but also the scope of the problem. Scope and severity are alphabetically
Plan of Correction
•Analyze SOD •Perform a Root Cause Analysis • •Organization responds to SOD •Org. has 10 days to submit an acceptable POC •5 elements: 1.Address how corrective action will be accomplished 2.Address how facility will identify other residents having the potential to be affected by the same deficient practice 3.Address what measures will be put in place/systemic changes made to ensure deficient practice will not recur 4.Indicate how facility plans to monitor performance to ensure solutions are sustained 5.Include dates when corrective action will be completed
Quality Models
•Baldrige -dedicated to performance excellance -Raises awareness about the importance of performance excellance in driving the U.S. and global economy -Provides organizational assessment tools and criteria. The organization has a wide variety of products available on their website -Educates leaders in businesses, schools, healthcare organizatioins, and government and nonprofit agencies about the practices of best in cass orgs. -Recognizes national roles models and honors them with only presidential award for performance excellance. •Six Sigma 1.Define 2.Measure 3.Analyze 4.Improve 5.Control -Goal is an increased performance and decrease in the process variation •Lean process of variation. -Lean management core idea:max customer value while minimizing waste 1.Identify and define value 2.Map the value stream 3.Create smooth flow 4.Pull based on customer demand 5.Strive for perfection Defects Overproduction Waiting Nonutilized talent Transport Inventory Motion Extra processing
Statement of Deficiency (SOD)-CMS 2567
•CMS 2567 form •Sent to facility w/in 10 business days of survey exit
What is professional development?
•Continuing education & career training •Purpose: to give professionals the opportunity to learn & apply new knowledge and skills that can help in their job and further their career •Helpful for individual and their employer *It makes your compnay more valuable •Examples: •Conferences •Online Training Course •Webinar •Reading a book •Shadowing someone •Completinng your Ces •Continuing your education requirement in a 2 year period
Commitment to "Lifelong Learning"
•Corporate culture of lifelong learning starts with the leader •Professional development plan *Flexibility and relevance *Leader > technocrat *Advocacy *Transparency •Informatics and predictive analytics *Emotional intelligence (EI) and emotional quotient (EQ) •Formal education •Professional continuing education PDP can be used for professionally and personally. Focus on being a leader, not a technocrat (managing tech) EI (Emotional Intelligence)-is guiding and thinking or behavior how aware of we of other feelings EQ the measure of that, EI in action
Culture of Continuous Improvement
•Do you ever find yourself or others using the phrase "We've always done it that way"? •Most people prefer certainty and the familiar •Continuously improving = Continuously changing!
Why is professional development important?
•In the general workforce, 1/3 of employees report doing nothing to upgrade/improve their current skill set •Benefits: *Expands your knowledge base *Boosts confidence & credibility *Increases earning potential & hireability *Can provide networking opportunities *Keeps professionals current on industry trends *Can open the door to future career changes *We already have a leg up for competition *More valuable to company and earn more money *Asking them to pay for NAB exam *Professional development helps you network, open doors for future career and changes and keeps you current
Carrer Entry: Resident Care/Assisted Living
•No federal licensure (currently) •Educational preparation *Administrator-in-training (AIT) program *Certificate program *Degree and practical experience *Most states require at least high school diploma or GED *State requirements •Practicum *Advised - not generally mandated •Examination *Not all states require because not all states require licensure Need to know the difference of career ladder-imply always moving up, career latus-can move sideways and up and down Look at MN and WI requirements No fed licensure exam for this because its coming more prevalent Don't have one in WI. ( don't have AL director lincense) MN has an Assisted living director license Some only need a HS diploma to run an AL
Problem-solving models
•PDCA (PDSA, FOCUS-PDSA) •DECIDE •Problem Identification •The Five Whys
PDSA / FOCUS-PDSA
•PDCA later modified to PDSA -Plan, do, study, act Another variation:FOCUS-PDSA •Find a process to improve •Organize an effort to work on the improvement •Clarify knowledge of the process •Understand process variation (need to be able to measure what the problem is) •Select a strategy for the improvement
Personal Development
•Physical wellness *Taking care of body, sleep, and exercise •Social/emotional wellness *friendships and your feelings making sure you are in a good place mentally. meaningful social connections •Spiritual wellness *touch with one's inner Value and beliefs
Professional Associations
•Professional associations-Professional association is a collection of professionals who work towards the common goal of promoting and improving the medical profession with which they are associated. •American College of Health Care Administrators (ACHCA) •American College of Healthcare Executives (ACHE) •Related disciplines They serve the individuals (professional associations) Primarily long-term care admin (ACHCA) Mostly leaders in acute care (ACHE) Empower staff to be a part of orgs Director of nursing or chief clinical officer=National Association of Director of Nursing in Long-Term Care (NADONA) and American Association of Directors of Nursing Services (AADNS) Medical Director=American Medical Directors Association (AMDA) and American Geriatrics Society (AGS) Cheift financial officer=Healthcare Financial Management Association (HFMA) and Long Term Care Finance Association (LTCFA) Info Tech= National Association for the Support of Long-Term Care (NASL) HR=American Society for Healthcare Human Resource Administration and Society for Human Resource Management (SHRM) Dinning Services=Association of Nutrition and Food service Professionals (ANFP) Facilities maintance=American Society for Healthcare Engineering (ASHE)
Career Entry: Home- and Community-Based Services
•Qualifications required/expected for leader varies greatly Sample areas of service •Home health agency/hospice •Adult day care program/center •Geriatric care •Home modification MN has an Assisted living director license Some only need a HS diploma to run an AL Home and health based services are home health agencies (medical or personal care) •Supportive Home Care. Non-medical, help with ADLs. •Home Health Care. Skilled care like a nurse, PT/OT. hospice (inpatient/outpatient), and adult day care programs
Teaching and Guiding
•Teacher others-whether its in the classroom or in the workplace, or through a professional network-is also a form of self-education and professional development •Mentor-describes someone who is a positive, guiding influence in the life of another-usually younger's-person's life. •Preceptor-guides residency student during their administrative residency
Fishbone Diagram
•Visual method of cause-and-effect brainstorming to ID possible causes •Sorts ideas into useful areas/categories 1.Agree on problem statement (effect) 2.Brainstorm major categories of the problem 3.Write the categories of causes as branches 4.Brainstorm all possible causes of the problem 5.There's a doc on canvas to look at
Traditional State Survey AKA Annual Survey (Every 9-15 months
1.Surveyors complete off-site preparation •Analyze sources of info available about the facility individually (no required offsite prep team meeting) 2.Entrance/Entrance Conference •Team coordinator introduces themselves & survey team, requests to see NHA and/or DON •Requests a place to work •Schedule entrance conference with NHA/DON •Request info needed immediately •Request info needed within one hour •Request info needed within four hours •Request info needed by end of first day •Request info needed within 24 hours 3.Initial review •Majority of team conducts initial review of all residents through interviews & observation •No formal tour process •~8 hours •Usually no formal staff interviews during this time 4.Resident Sample Selection •Based on on-site interviews and off-site data analysis •Based on facility census (~20% of facility census) •70% of total sample = MDS pre-selected residents •30% of sample = surveyor-selected residents •Maximum sample size is 35 residents 5.Informational Gathering •Systematic approach to gathering info necessary to make decisions as to whether the site is meeting requirements •Critical Element (CE) Pathways •Staff usually interviewed at this time 6.Potential Citation Review/Exit Conference •Team conducts final meeting •Discuss findings •Discuss potential non-compliance •Determine potential citations •Survey team meets with NH staff to share results of survey •Exit Conference with NHA, DON, Resident Council President, 0-2 interested residents if applicable, & ombudsman (and any others the leadership team invites) •Report potential findings of non-compliance w/ facts •Report preliminary findings, avoiding scope/severity unless IJ •Advise provider that findings are preliminary- will receive SOD (statement of defiency) Surveyors work off entrance If you look back at the entrance worksheet, you can see here's what they need right away. Here's within 1 hour. So, look at that, and look what kind of info they would be requesting for you They use critical element pathways which is a guidance of what they should be looking at DON can cover for NHA if not present in the building
Trade Associations
A trade association forms to address the collective needs of provider organaziations in similar lines of service. It typically advocates on the behalf of the association's members regarding P &P. A trade association differs from a professional society in that it represents the interests of member organization not thoses of individuals. •American Health Care Association (AHCA) •Argentum •LeadingAge •National Adult Day Services Association (NADSA) •National Affordable Housing Management Association (NAHMA) •National Association of Home Care and Hospice (NAHC) •National Hospice and Palliative Care Organization (NHPCO) Serve the org (trade associations) For post acute care providers and the biggest one in the nations (AHCA) For AL (Argentum) For AHCA, just smaller
Career Entry for Nursing Home Administrator
Licensure •Required in all 50 states + D.C. *Federal mandate: amendments made in 1967 to the: social security act •To be licensed: *Educational preparation *Most states: Bachelor's degree *Some states add expectation/preference for focus of degree *Most programs like HCAD are in college of business, health professions, public health, or arts & sciences *Administrative residency/internship/AIT (administer in training) *Preceptor qualifications-hold a NHA license in good standing or had license for a minimum of certain years or got a certain score on their licensure eam *Length varies by state-WI requires 2000 hours *Passage of the Core NAB Exam & NHA LOS NAB exam *Guided by current domains of practice (How many?) 4 and they are care, services, and support, operations, environment and quality, and leadership and strategy *Most states require a separate state exam •May only practice in the jurisdiction it is issued - but most states have provisions that make it possible for a licensee to move from one jurisdiction to another with minimal disruption *Reciprocity-is bidirectional acceptance of a licensee from another jurisdiction; one board accepts licensees from another state if the recognition is mutual *Endorsement-Occurs when licensure board reviews an application submitted by a person who holds a license in good standing from another juridiction's board and determines that they meet all the expected requirements for a license *Equivalency-happens when a board accepts the NAB's HSE quality and fullfillling its licensure requirements for any postacute service line. NAB-accredited programs: curriculum, faculty qualifications, resources, institutional support, provider community support, strategic plan, graduation rate, student performance on NAB exams, impact of alumni in the field Even if you don't want to be admin still takes an exam, makes you more hireable -all jurisdictions have to have a license to be a admin -WI is highest in requiring 2,000, one of the largest -Nab exam qs fall into the domain of practices and there is four -most states require a separate exam -Most states have provisions without retaking the exam again in different state, don't let in lapse so you don't have to take it again In one of these things: Reciprocity (look up) We are a NAB accredited program, we have to get reaccredited every 5 years (university) Most require a bachelors degree
