Category: Customer service
Posted by Dr. El - February 12, 2020 - Customer service, McKnight's Long-Term Care News
In my first year as a nursing home psychologist, I entered a resident’s room for a session and she invited me to have a seat in her wheelchair, the only surface that was clean and free of belongings. The thought of sitting in a wheelchair freaked me out. Instead, I carried a heavy chair from the day room up and back down the long hallway.
Afterward I contemplated my reflexive fear of that wheelchair. I concluded that my reaction wasn’t about infection control but rather a superstitious belief that I could somehow jinx myself by sitting there. It separated me from her experience and didn’t offer me any protection from the human reality that any one of us could wind up in that chair tomorrow.
I suspect that fear is a primary reason why it’s rare for long-term care leaders to spend a night in their own facilities, despite the wealth of information they could glean about their enterprises from doing so.
Overcoming such apprehensions, trailblazers in this area joined Laura Beck, the Eden Alternative Learning & Development guide, to discuss their experiences with The Sleepover Project on a webinar that is now available on demand here. It will be followed by an upcoming mini-course on how to create a Sleepover Project in other organizations. (Sign up here for the Eden Alternative newsletter to stay informed about the launch date.)
The webinar featured Jill Vitale-Aussem, president and CEO of the Eden Alternative, and Patricia McBride, the VP of Clinical and Compliance at Christian Living Communities/Cappella Living Solutions based out of Denver.
During the course of her career, Vitale-Aussem spent several nights in different LTC facilities in which she has been, variously, a nursing home administrator, CCRC executive director and vice president of operations. McBride convinced her entire leadership team to each spend a night as a resident over one summer.
McBride noted that, with continued promotions, organizational leaders were moving further and further from the day-to-day experience of what it meant to be living and working within the setting. Calling it a “collective empathy experience,” they envisioned this opportunity as a way to increase their understanding of their residents and staff, and to determine what, if any, improvements needed to be made to their facilities. The leaders gleaned more insights through staying one night in their communities than they could have imagined.
For the entire article, visit:
Posted by Dr. El - December 17, 2019 - Customer service, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
I know, I know, that’s not how the word is pronounced. But as soon as I read about the Danish concept of coziness, I got that darn Will Smith song (“Gettin Jiggy With It”) in my head and I can’t get it out.
Hygge (actually pronounced “hyoo-guh”) refers to the creation of a comforting, convivial environment. Think hot cocoa, warm blankets and crackling fireplaces, with loved ones.
It sounds so charming that I resolved to apply hygge to an upcoming vacation. I decided to mix local sightseeing with a few days saved for the pleasures of cooking, reading a book and watching movies with an occasional bowl of popcorn under a comforter with my family. And, of course, I considered how the idea could be applied to long-term care facilities.
Nursing homes, which could generally do with an increased focus on “home” over “nursing,” have many reasons and opportunities to add some hygge.
First and foremost is the chance to “flip the script” about being in a confined environment. Residents who have infrequent opportunities to get outside under the best of circumstances and even fewer chances during inclement weather, often feel depressed or resentful regarding their confinement. Practicing hygge offers a mental shift from a perception of restriction to one of comfort.
Holiday hygge
During the holidays, residents may observe peers going out for day passes and family members arriving for visits. For those without passes or visitors, using hygge concepts can ease their emotional pain in a kind, simple manner that emphasizes their belonging to a group.
While holiday activities such as seasonal movies and Christmas caroling are wonderful, a hygge approach would suggest adding periods of quieter comforts such as lap blankets, a fireplace video and a story read aloud. Some people might enjoy crocheting or drawing during this communal activity. If the kitchen sent up a batch of warm cookies, so much the better.
Staff hygge
Residents may not be the only ones less-than-thrilled about being at the facility on a holiday. While many staff members consider their LTC jobs a calling and are gracious about being of service to elders on Christmas or New Year’s Eve, others may be disgruntled with the holiday shift and may “leak” their emotions to their charges.
A hygge approach can soften staff resentment.
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Posted by Dr. El - July 31, 2019 - Customer service, McKnight's Long-Term Care News
Posing as customers, “secret shoppers” deliver the inside scoop to management about their experiences with various service providers. They can be invaluable to management in all kinds of situations, including long-term care, though there are special challenges there.
Secret shoppers are perhaps best known for retail settings. But they’re also used in hospital settings. A controversial recent New York Times article noted how faux patients arrive in emergency departments with contrived symptoms that allow them to observe the proceedings. The information provided is used to alter procedures and enhance training with the goal of improving customer satisfaction.
According to the article, “Undercover in a Hospital Bed,” personal details that explain poor customer service ratings can leave hospital executives “spellbound.” In one example, a secret shopper reported that staff members were dismissive of patient concerns and squabbled among themselves. Poor teamwork made her doubt the quality of the care she was receiving.
The findings inspired the hospital to create and train employees on new norms of staff behavior, including staying off cell phones and learning more about the lives of the people presenting for care. Obvious long-term care parallels can be assumed, but there’s more.
Reactions
There were a wide variety of comments on the New York Times piece. Hospital insiders affirmed the necessity and benefit of this stealth approach. Others deplored the waste of resources used on the deception. A few pointed to statistics indicating that what customers might consider good service could actually result in poorer clinical care. (Think: I’m so happy they gave me that opioid I wanted.)
Workers fumed that their own opinions weren’t solicited. They were also concerned about superficial fixes such as pushing employees to plaster smiles on their faces without investigating and correcting the reasons that they weren’t smiling in the first place.
My take is that while workers have valuable information regarding the patient experience, they’re not always in a position to reveal it and management isn’t generally receptive to worker commentary. If the leadership team uses the information gleaned from the brief deception of a secret shopper to make underlying changes that positively impact patients and employees, then the strategy is a valuable tool.
Application to LTC
Those interested in the idea will note, however, that it’s easier to pose as a hospital patient than it is to be a mock nursing home resident.
Posted by Dr. El - July 25, 2019 - Business Strategies, Customer service, McKnight's Long-Term Care News
The other day over lunch a colleague said to me, “Imagine how things would change if toileting were a billable service.” I laughed, briefly considered that fanciful notion and continued eating my meal.
As I gave the idea further reflection, however, it might not be as laughable as it first appears.
Consider the following:
Funding
Remuneration for toileting would mean that aides would hold income-generating positions. We’d expect that nursing departments would become fully staffed in order to take advantage of this new funding stream and that compensation for aides would increase.
Respect
We might also anticipate that CNAs would become more highly valued for their services by others in the facility.
Philosophical shift
Direct payment for the tasks of aides would strengthen incentives for employers to support ways for employees to manage their jobs around their lives, which often entail demanding family caregiving responsibilities.
Retention programs/employee benefits
The funds could be used to develop retention efforts such as flexible schedules, onsite daycare, financial contributions to staff education and other employee benefits.
Training
Increased remuneration for personal care would lead to more resources for training and for creating programs that promote the development of CNAs, such as peer mentorships.
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Posted by Dr. El - December 18, 2018 - Communication, Customer service, McKnight's Long-Term Care News
Here’s my latest article on McKnight’s Long-Term Care News:
A study of interactions between families and healthcare providers published in the BMJ this month sparked my interest. It showed that improving communication between the two groups reduced harmful medical errors by 39%.
As if that vast reduction in medical errors weren’t enough, it was caused by harnessing the input of team members who don’t cost facilities a penny. In an era of intense financial pressures for the industry, free team members are a gift that shouldn’t be overlooked.
According to the researchers, the study “indicates that improving communication between families and healthcare providers doesn’t just feel good, it can help improve the safety and quality of care.”
Family strength
In Editor Jim Berklan’s excellent blog postlast month, he points out research that shows that families “don’t know what they’re talking about” when it comes to loved ones’ end-of-life care preferences. (If that’s so, we as experts should be facilitating Care Conversations.)
While family members may fall short on end-of-life wishes, they’re generally more expert than we are on their parents’ medical history and behavior. They know that their father didn’t react well to a particular medication when he took it at home or that Mom is “acting funny,” even if they don’t know why.
I myself have gone to the nursing station with the complaint that a resident is “off” somehow and been dismissed in my concerns, to the detriment of the resident’s health. Over the years, I’ve learned that I should phrase it as a “change in mental status” and to speak in a tone that conveys the depth of my experience and the seriousness of my observations, but basically I’m saying that the resident is “acting funny” and it seems physical, not psychological. I’ve detected sepsis, strokes and other emergencies this way.
If the nurses aren’t receptive to perhaps poorly-phrased information from psychologists, recreation therapists and other non-medical personnel, they may also be missing valuable information from families.
The BMJstudy shows how we can train staff to be more responsive to family input.
Family-centered rounds
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Posted by Dr. El - December 7, 2018 - Business Strategies, Communication, Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I was recently required to take an online training module on burnout for physicians and allied professionals. It was the first time in 20-plus years that I’d received a formal message about self-care from any long-term care institution (aside from yearly staff appreciation barbecues and survey completion parties).
While I was impressed and grateful for the focus on caregiver well-being, a couple of points bothered me.
The questionnaire asked readers to select the phrase they most associated with provider burnout. There were options such as “workplace dissatisfaction” and “challenging patients.” I chose “changes in the healthcare system,” which triggered a pathway specific to that option.
I was guided through a series of vignettes discussing issues old-timers might have trouble with, such as adapting to the electronic medical record. Following the vignettes, helpful strategies were offered to manage stress.
Then came the part I found disturbing: The details of the “changes in the healthcare system” choice included “the emphasis on the healthcare experience of consumers” and “the shift from volume to value.” Let me explain why that irks me.
The experience of healthcare
Regarding consumer experience, most of my direct care team members and I have been very focused over the years on accommodating the needs of residents. It’s become more difficult, however, to maintain care quality and orderly surroundings in a healthcare environment where financial pressures have led to staff reductions and increased turnover amidst higher acuity residents.
Trying to deliver a decent customer experience without the necessary tools is part of the change in the healthcare system that induces my feelings of burnout — not the “new” attention to perceptions of consumers.
I’d be gratified to see a genuine, top-down focus on the healthcare experience of residents and their families — complete with Resident Experience Officers in every long-term care facility (sign me up!). Such an emphasis would realign resources with a mission of care that can stabilize staffing and sustain facilities over time.
Volume to value
“The shift from volume to value” stresses me in a different way.
Part of my role as a psychologist in the “volume” approach has been to aid residents in negotiating their illnesses and treatments.
If necessary, I could help them stop a lucrative but unwanted onslaught of painful medical interventions by fostering communication with their physicians and families.
For the entire article, visit:
Posted by Dr. El - October 24, 2018 - Business Strategies, Customer service, McKnight's Long-Term Care News, Resident care, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
Long-term care success is about steady, reliable relationships. That’s my takeaway after attending two recent conferences that echo my experiences in the field.
The first event delivered the results thus far of an ongoing program that won a coveted grant from the Center for Medicare & Medicaid Services’ Center for Innovation. The OPTIMISTIC project is an effort of Indiana University and local partners, including the University of Indianapolis Center for Aging and Community. OPTIMISTIC is an acronym for Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care.
The model entails placing registered nurses in nursing facilities, as well as giving staff access to nurse practitioners. The nurses function as educational trainers and as resources for the team.
The consistent relationships with these nursing experts produced astounding results, including a 32.6% reduced relative risk of potentially avoidable hospitalizations and a net savings to Medicare of $3.4 million.
The second conference in which I participated was a National Readmission Collaborative event.
Keynote speaker Eric A. Coleman, M.D., discussed research on phone calls following up with patients after discharge from the hospital. While such contacts have been touted as an effective means of identifying and remedying precursors to hospital readmission, patients are often barraged with contacts from various service providers. These well-intentioned efforts thus become annoyances without real value to the patient and their family.
Having one consistent, informed care manager across the healthcare continuum proves more useful and effective, he reports.
As a psychologist, I’m not at all surprised.
For the entire article, visit:
Posted by Dr. El - October 10, 2018 - Communication, Customer service, McKnight's Long-Term Care News, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Observing the customary cacophony at the nursing station, I’d estimate that so-called “alarm fatigue” contributes to more than a few tragedies in long-term care.
Here’s one example that resulted in a lawsuit filing after a resident died when nursing staff ignored the alarm signaling that her ventilator had become disconnected.
That’s why I was so interested in a Stat news article “Anatomy of a Beep,” which focused on collaboration between Medtronic, a medical device company, and Yoko K. Sen, an ambient electronic musician. The feature describes how medical devices came to have the sounds that they do — “alarms that are easily confused and difficult to learn and don’t really tell us what’s wrong” — and efforts to create a more helpful and appealing healthcare soundscape.
While the Medtronic project is geared toward a hospital emergency department with its plethora of health monitors, long-term care operators hoping to avoid alarm-fatigue-related medical catastrophes might take note of their efforts.
Among the many sounds typically competing for the attention of nursing home staff members are ringing telephones, television sets, conversations among staff members, overhead pages, elders calling for help, chair alarms, escalating arguments between residents, completed tube-feed nutrition cycle indicators, noisy nebulizers and oxygen concentrators, exit door and elevator warnings, and call bell signals. Specialized units such as ventilator programs will blare additional alerts.
While some employees are fortunate enough to be able to move to a quieter unit to complete their duties, most must contend with a din they have limited power to change. Researchers have found that noisy healthcare environments can significantly increase workers’ level of distress.
Residents, unless they can independently ambulate, have virtually no ability to escape the hubbub, which can border on an abusive level of noise pollution and can negatively affect their perceptions of their stays. In addition, studies have shown that noise can disrupt sleep and increase the likelihood of delirium.
Consider taking a moment to listen to the soundscape of your facility. Stand by the nursing station, close your eyes and imagine that the sounds are the backdrop for your eight-hour workdays, or your life, 24/7.
Below are some adjustments that can enhance the aural environment:
For the entire article, visit:
Posted by Dr. El - August 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, Inspiration, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
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Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
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Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
For the entire article, visit:
Posted by Dr. El - May 24, 2018 - Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News, Psychology Research Translated
Here’s my latest article on McKnight’s Long-Term Care News:
Earlier this month, I took some much-needed time off to go on a cruise. I came home to a LinkedIn notification about “The big cost of not taking vacation,” reflecting on a CNN article regarding the vast number of vacation days forfeited by Americans. The author notes that people who travel tend to be happier with their jobs and companies than those who don’t.
It got me thinking (and researching) more about burnout and long-term care staffing problems. Certainly one piece of the puzzle is taking scheduled time off in order to refresh and gain perspective.
As I’ve noted in the past, there are many tactics employers can use to decrease burnout and turnover. In The keys to reducing turnover in LTC, I outlined the causes of the alarming rate of staff turnover in LTC, which can range from 55% to 75% for nurses and up to 100% for aides.
Preventing burnout in long-term care addressed training, staff scheduling and other adjustments that have been shown to reduce turnover. In another piece, I focused on ways to make long-term care jobs appealing enough to compete with less stressful jobs in the same salary range.
In my recent perusal of the research, I came upon a study that looked at factors contributing to the levels of anxiety experienced by staff members. The study suggested that the two biggest contributors to staff anxiety were “guilt about the care offered” because it wasn’t up to the standards of the individual workers and the “poor quality of the relationship with the residents’ family.”
Many of the suggestions I’ve offered in the articles noted above can improve the quality of care, but I was intrigued by the notion that improving relationships with residents’ families could have a significant impact on the anxiety levels of workers and thereby reduce burnout and turnover.
For the entire article, visit:
