Staff Receives Certified Eden Associate Status

July, 2007 – Changing Oklahoma’s nursing facilities from institutions to homes is no easy feat, but that is the aim of OFMQ and Medicare’s Nursing Home Quality Initiative (NHQI).  OFMQ works to improve clinical quality of care for nursing home residents and helps facilities evaluate and improve organizational culture.  Culture change engages the entire organization from leadership to staff at all levels in making environmental improvements, changing the way decisions are made and developing more person-centered approaches to care.  These efforts are helping to improve resident and staff satisfaction as well as clinical outcomes and quality of life. 

Lisa Bewley, Nursing Home Project Manager, and Quality Improvement Specialists John Leon, Debara Yellseagle and Diane Henry recently expanded their expertise in culture change when they earned associate certification from The Eden Alternative.  The Eden Alternative is one of many organizations and stakeholders, including the Centers for Medicare & Medicaid Services (CMS), committed to the movement toward person-centered, individualized care in nursing homes.

“In addition to clinical quality improvement, nursing homes are working toward a more holistic approach to care, moving away from an institutional model and becoming more person-centered than ever before,” said Bewley.  “Nursing homes are more comfortable, warm and inviting, and residents have more of a say in their daily lives, such as what and when they eat, when they bathe, and what activities they participate in.  We’re seeing innovative approaches.  For example, some facilities are incorporating animals and children to help alleviate loneliness and depression,” Bewley said. 

Culture Change Has Profound Impact:

Changes in the dining experience:  Increasing and improving food choices, making food available around the clock, involving family and staff, improving dining area aesthetics and making food from scratch.  Results are seen in positive weight gain, lower cost of dietary supplements and improved socialization. 

Learning circles:  An innovative structured conversation that encourages group participation.  Facilities using learning circles report increased communication, stronger relationships, conflict resolution and better understanding of needs from residents and staff. 

A place to call home:  Hallways and corridors have been changed to communities and neighborhoods with personalized accommodations and décor.  Institutional bathing is transforming as homes build spas where residents enjoy plants, bubbles and warm, plush towels. Staff is integrated into a neighborhood rather than rotating through the facility, allowing employees to get to know the residents and accommodate their individual preferences, such as sleep and wake time, activities, meals, even hopes and dreams. 

Workforce Retention:  Employees benefit from the consistent assignment staffing model described above as their relationships with residents develop and flourish over time.  Facilities are implementing mentorship programs for new staff to establish skills and competencies needed for success.  Certified Nurse Assistants (CNAs) are becoming more involved in treatment plans, cross training, setting their own schedules, and participating in morale building activities.  Facilities are implementing new methods of recognizing and rewarding employee success.  In 38 Oklahoma nursing facilities working with OFMQ, employee turnover has decreased an average of 25%.*

“Improving staff satisfaction and retention has a direct impact on costs and quality of care.  “When staff is treated well and allowed to make decisions and offer input, they’re more likely to stick around.  And in turn, residents get better care,” Bewley said.  “These efforts save facilities money in hiring and training and help improve outcomes.”

Clinical Performance Improvement

Oklahoma nursing homes voluntarily join OFMQ in Medicare’s Quality Improvement Program and collect and report performance data.  The latest data show those nursing homes working intensively with OFMQ on quality improvement programs improved chronic pain by 36%, pressure ulcers (bed sores) by 23%, depression by 17% and reduced the use of physical restraints by 18%.*  

*CMS Data, Q204 – Q107