As CMS moves forward on initiatives targeting safety and outcomes, HR can help teams thrive.
In a recent blog, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma detailed her commitment to maximizing safety and quality in long-term care. Her comments have triggered conversations about these issues; and they also present an opportunity for HR to get involved and promote safety and quality care in their organizations.
Verma stated that her agency is “not settling for the status quo.” She said, “I have directed my team…to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes.” She talked about CMS’s “five-part plan to ensure the care provided in America’s nursing homes is of the highest possible quality.” This plan involves strengthened oversight, enhanced enforcement, increased transparency, improved quality, and efforts to put patients over paperwork. She noted, “While we pursue these efforts, we welcome interest and input from all stakeholders, Congress, and our other federal partners. But we have already started executing our plan, and we’ve got our eyes on the future.”
The CMS administrator talked about variations at State Survey Agencies (SSAs). She said, “Residents deserve consistent nursing home quality, regardless of location, so CMS is revising our oversight of SSA performance. We’re examining the way surveyors identify issues such as abuse, facility staffing levels, and dementia care, and we are clarifying expectations regarding when abuse must be reported to the state and law enforcement.” She said that her agency is updating its Nursing Home Compare website to make it easier for consumers to identify instances of non-compliance related to abuse or inappropriate antipsychotic use; and her team is working to arm SSAs with “clearer procedures.”
Elsewhere, among other things, Verma said that CMS is:
- Working on new ways to identify and stop abuse, such as an organizational structure to enhance collaboration across regional staff who work on front lines with providers.
- Exploring possible use of Medicare claims data and associated adverse outcomes or indicators to inform the nursing home survey and oversight process, especially for patients transferred from a nursing home to a hospital.
- Strengthening enforcement policies to hold nursing homes accountable for the care they provide, such as developing new ways to “root out bad actors and repeat offenders.”
- Encouraging SSAs to conduct some unannounced after-hours and weekend inspections to “focus on staffing problems during these times.”
- Enhancing oversight and enforcement of nursing homes that haven’t improved their antipsychotic medication utilization rates for long-stay residents since 2011.
- Asking Congress for the authority to adjust the frequency of mandatory nursing home surveys to “focus more time and resources on…poor performers while continuing efforts to respond to complaints.”
- Developing quality measures that score providers based on patient outcomes, not adherence to processes and investing in programs that focus on key areas of nursing home care “to help achieve higher quality.”
American Health Care Association and National Center for Assisted Living (AHCA/NCAL) President and CEO Mark Parkinson issued a statement regarding the blog. In part, he said, “We understand the need for regulation, but any oversight needs to be focused on person-centered care and providing feedback on areas to improve. If CMS means to convey a focus on helping providers achieve compliance and a shift away from the current punitive survey process in this post, the agency will be an important partner as we continue in this quality improvement journey. Regardless, AHCA maintains an unwavering commitment to further improve the lives of millions of residents in our buildings.”
As key team players, HR professionals can do much to help their teams manage regulatory changes, maintain high-quality care, and remain engaged (instead of burning out). A few opportunities:
Evaluate competencies when you bring new employees on board. Look for opportunities to train workers on soft skills such as communication, time management, conflict resolution, and creativity. Make sure they get adequate training on any equipment or technology they will use; and stress that they won’t be judged negatively if they have questions or want/need additional training.
Implement a consistent, structured interview process throughout the organization based on hiring for patient-focused behaviors and person-centered care. This will help ensure that all employees share a common understanding of and commitment to quality of care and patient safety.
Use performance management software. This automates employee appraisal, goals, and feedback and creates a structured and disciplined process for performance reviews, time/attendance, scheduling, and absenteeism. This can help identify employees who may need help (such as childcare, adult day care, or transportation) and those individuals who show promise as leaders and/or managers.
Keep copies of regulations. Have a notebook or online space with copies of or links to key regulations that staff can access as needed. Make sure employees receive training and education on new regs or changes to old ones that impact their work.
Ultimately, employees who share and embrace a culture of quality person-centered care at all levels are more likely to be effective and productive. They are strong advocates for patients, enjoy job satisfaction and pride in their work, and are positive ambassadors for the organization, as well as mentors for new hires. All of this adds up to an organization that functions well and can adapt more easily to change.
