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Learn MoreLong-term care facilities are busily working to ensure compliance with the third and final phase of the Centers for Medicare and Medicaid (CMS) Final Rule—Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities. More specifically they are doubling down on their QAPI (Quality Assurance and Performance Improvement) and assessment plans to make those as comprehensive as possible.
The goal is to be ready for review and assessment, but there could be one big problem: Does everyone on staff know what’s in those documents? If not, much of this hard work is likely going to waste. Why? Because surveyors don’t just talk to administrative staff and supervisors when they visit facilities. In fact, they often seek out frontline staff first to get a sense of how well a facility is operating when it comes to hands-on patient care and service delivery.
“One of the first things they may do when they walk into a facility is go talk to a CNA or housekeeper and talk to them about their role in quality assurance,” says Ellen Kuebrich, Senior Director of Business Development at HealthStream. “It’s very clear that's where surveyors are finding a lot of their initial information about the efficacy of a program. It’s not whether or not that staff is being trained, but more about whether that training is effective and whether they feel comfortable doing their job.”
Part of the problem is that sometimes a competency program gets knotted up with employee training. Successfully completing a training should be the floor for competency, not the ceiling—the employee actually needs to do the work over time in order to improve performance and achieve a desired comfort level. Trouble is, sometimes supervisors equate having a training regimen with a skill set that is not yet in place.
“A lot of times when you talk to administrative staff, they're able to explain to you exactly what the QAPI [Quality Assurance and Performance Improvement] program is, what it consists of, and how it's implemented,” notes Tracey Cooley, RN, BSN, a master trainer and surveyor and Vice President of Training at HealthStream. “But when you start talking to frontline staff, and by that, I mean laundry staff, dietary staff, housekeeping, maintenance, CNAs and direct-care nurses, they'll say, ‘That’s performance improvement.’ That's a key indicator that there's not an effective program in place.”
And if those staffers are consistently saying that specific things aren’t happening, that’s a good indication that competency is not being achieved. Next step? Go back to the earlier stages of the Final Rule and look at the tools CMS provided, namely the facility assessment that was required for phase two, Kuebrich says.
“Let's remember what the purpose of the facility assessment was,” Kuebrich says. “It was intended to make sure the facility has the resources needed to take care for the people it admits. Competent staff is a resource that should absolutely be considered in conjunction with a changing resident population. The first thing I would do is pull out the facility assessment and look at the analysis of everybody brought into the building over the last six to 12 months.”
When that’s done, she recommends drilling down to look for:
Afterwards, it is necessary to tabulate how often these populations are being treated or admitted. Once a facility does that, then it can better assess what services to provide, how much and what type of staff it needs, and how that workforce should be scheduled, she predicts.
“What competencies do those staff need to be able to provide these services to take care of these residents? And then what physical resources do we need to be able to do our jobs here? This is a very relevant document that should be considered as you look at competencies,” Kuebrich says. “In your QAPI program, find areas where you're not performing as well as you would like, or that are not up to the current standard of care. Look at the competencies associated with that area of care. It's rare that you find a failure on the floor and it's all systemic. It's maybe some gaps in your competency program, or you don’t have the right training cogent or delivery mechanism.
For instance, she adds, “it could be as simple as someone not wanting a sheet telling them how to do something, but rather they want a supervisor to show them, to provide a demonstration.”
Learn more about how long-term direct care administrators can improve their competency program in our comprehensive online courses
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's Provider Credentialing, privileging, & enrollment solutions.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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