Management, employees strive for commendation
October 1, 1999 5 minutes read
Management, employees strive for commendation
How one agency got a pleasant survey surprise
If you have experience with Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) surveys, you might think a survey is a survey is a survey. But in an era of consolidation in the home care industry, mergers and buyouts can make your past experience practically moot.
Take what happened at American Home Patient in Seattle. The five-office agency is part of a national company based in Brentwood, TN that has more than 400 branches. All five offices in the northwest region were purchased in late 1997.
Regional Vice President Jeff Wall, who owned one of the home care agencies American Home Patient bought, had some experience with Joint Commission surveys and some experience with infusion therapy. But Wall, a pharmacist, was not familiar with the respiratory and home equipment elements of home care. When the new combined agency was surveyed last December, he wasn’t sure he would perform as well as he had in the past.
"I had gone through three or four surveys before," Wall recalls. "And we always got commendations. But this was new to me, and it was a relatively new company." And yet Wall and American Home Patient did earn commendation at its last survey. "When we got it, I have to admit I was pretty surprised," he says.
Wall knew that from an infusion therapy standpoint, the agency was well prepared for a survey. "We have long-term employees in the Seattle office who have been here for every survey I’ve gone through," Wall says. "I think that was one key to our success. We do the same thing every day, and when survey time comes, it isn’t as if we have to start operating in a different way."
Not that the infusion staff didn’t have to prepare, adds Wall, "but the most we had to do was inspect our processes and look at our operations — as our experience told us the surveyor would."
How the other parts of the agency would perform during survey was of greater concern to Wall, who had little experience in some of the areas the surveyor would look at. Lucky for him, however, American Home Patient had a regional quality manager for the medical equipment side of the agency that from the date of the merger made regular visits to all the branches. "Without that, I really don’t think that medical equipment and respiratory therapy would have done as well as they did."
The visits came at least quarterly, and increased to every month as the survey date approached.
Wall says the relationship between this manager and the employees was positive and collegial. "They had a healthy and constructive interaction," he notes. "The manager had a way of helping us to raise the bar without seeming like the police."
He also thinks the good corporate policies, procedures, and processes were a help to those areas of the business. "When disparate businesses come together — and you hear stories about this — you just don’t expect things to mesh as well as they did."
Starting from scratch
The five branches all had to change policies and procedures on the merger date, Aug. 1, 1997 — less than 18 months from survey. Through inservice sessions, Wall and his management team gave the employees a rundown of all of the new policies and procedures. "That might have helped us to do well in our survey. This information was all fresh in the minds of our employees. Sometimes it helps that you have to learn new things, to work through the minutiae."
Wall also notes that because of the mergers, there were new state regulations that applied to various parts of the business, meaning that the pharmacists and nurse managers had to be on top of state law. Again, this may have helped the agency do well in the survey.
While the staff were learning new policies and procedures, the management team at the five branches was busy going through every page of the JCAHO survey manual and the patient medical records. Nursing, pharmacy, nutrition, medical records, and human resources staff joined key employees in each department, such as the equipment coordinator and warehouse manager. Beginning in August 1998, that group met every two weeks, reviewing policies and procedures and comparing them to Joint Commission standards. "We made sure there was a policy for every standard," says Wall.
Each biweekly meeting lasted 60 to 90 minutes. Part of it was spent going over policies, and another part was spent setting goals for the next meeting. The meetings were run by the director of nursing with assistance from the Seattle branch manager. Wall, however, did participate in some of the meetings. But he left the accountability and direction of the effort up to the managers.
Those meetings did turned up some problem areas. The Tacoma branch office, for instance, had significant problems. "There were employees quitting because they thought the survey would go badly in December," Wall recalls.
He hired a new branch manager who spent the next three months brining in new staff, training them, checking and updating equipment, and reviewing processes in terms of Food and Drug Administration compliance. "That branch was a big hole for us, but he really cleaned it up. He really motivated that group of people."
There were other problems uncovered, too. "You can always find something if you look hard enough," Wall says. For instance, he says that although he and staff members thought they were following the rules, their review showed a misinterpretation of some regulations. "We never had pharmacists doing drug histories for our tube feeders," Wall says. "We always had dietitians taking care of those patients. But that had changed since our last survey, and we had to change our procedures."
Wall’s past experience with JCAHO surveyors made him pretty comfortable with the process. "They are reasonable and professional," he says.
There were three surveyors for the five locations — a pharmacy surveyor was there for three days, a nurse for two days, and an equipment surveyor for three days. Some areas overlapped — for instance, IV pumps were looked at by both equipment management and pharmacy surveyors.
Wall and the regional quality improvement manager were with the surveyors throughout the process. "By what we weren’t doing wrong, I knew we were doing well," he says. "But I also knew that by the time the exit interview came And there were. There were some personnel background checks that had not been returned from the state capital in Olympia; a notation was not in the personnel records. "We had documented that we had resubmitted the request for the check and still hadn't gotten it, which saved us on that issue. That would have been a real red flag otherwise."
Still, there wasn't much that the surveyor found wrong, and the five branches were granted accreditation with commendation. Wall thinks there are several reasons why American Home Patient had such a stellar performance.
"First, we try to make our quality improvement practical," he says. "I don't want to spend time, money, or energy to just pacify some surveyor. I want there to be a practical element to every quality improvement project we do."
To make sure that he achieves that goal, Wall prefers to take his projects from the people who do the work, and he gives financial incentives to his staff for filling out performance improvement forms.
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