Self-justification for small agencies — part 3
February 1, 1999 5 minutes read
Self-justification for small agencies — part 3
Facts go a long way in proving an agency’s merit
When it comes to securing a future for your agency within your hospital’s health care continuum, agency size doesn’t count. Planning does. Whether you have 20 nurses or 200, when going before the hospital administration it’s important to have a clear idea of what your agency does for the hospital and readily available facts to back you up.
M. Darlene Hall, RN, executive director of Topeka, KS-based Stormont-Vail Home Health and Hospice, heads up a small hospital-based home health agency and oversees the operation of about 50 nurses in four branches in the northern part of the state. Her philosophy throughout her 14 years in home care is to seize every opportunity to boast about her agency.
Hall, who reports to the hospital’s vice president, says she is fortunate in having a home-health-friendly hospital administration. Still, she believes that communication has been and will continue to be essential to an ongoing, positive working relationship.
"When I’m in a meeting with directors or the administration, I never miss a chance to mention something we’ve done that’s quite good," she says. "I’m on the national board of directors for the National Home Care Association, and I make it a point of sharing updates with my vice president, too."
It’s not just the hospital’s senior management that receives her attention. Hall also makes it a point to keep the physicians informed of agency doings and speaks regularly at doctors’ meetings. She says that too many physicians are poorly informed about what home health has to offer and what their responsibilities are regarding patient referrals. To counter their misconceptions, she prefers meeting one-on-one with physicians interested in home care.
"I talk to the doctors at their meetings but I’ve found they’re not very responsive in groups," she says. "I go ahead and put up information in the lounges on what their responsibilities are, and with the ones who are more interested, I make an appointment to visit them in their offices and talk with them individually."
Hall supplements her talks with information, making sure that doctors and the members of the administration receive updated copies of her agency’s publications. She also passes out a laminated list of doctor’s responsibilities in referring patients to home care. "I don’t kid myself. Probably a lot of these are filed in the circular file, but at least I try," she says.
Teamwork promotes value
Teamwork within her agency is another factor Hall says has been instrumental in proving the value of home care. "We have a lot of camaraderie and a lot of pride in the service we provide. I think this pours over to the administration, and they recognize that home care is a good thing."
Much of this sense of pride can be attributed to the compartmentalization that Hall has instituted within her agency. "I have people who are experts in a particular area," she says, mentioning that her staff include a diabetic nurse, a social worker, a psychiatric nurse, and an infusion therapist — all of whom are certified. "The team approach is a good one because it translates into the fact that even though everyone has to be competent in all areas before they’re allowed to do anything, that people interested in a particular area will do a better job at it."
Making sure her agency is an integral and valuable part of the hospital’s health care continuum extends beyond the hospital for Hall, and she takes every opportunity to speak to "groups like the auxiliary groups, retired state and city employees. It’s important to educate people on what your abilities are."
She also charges agency directors with keeping hospital administration abreast of legislative issues related to home health. "[Agency directors] need to keep current. They need to be involved with their state organization so they know exactly what’s going on. I subscribe to home health newsletters from the surrounding states. I’ve found that to be very informative as to what might be headed our way," she explains.
Hard data are also instrumental in convincing hospital administrators, typically concerned with the bottom line, that your agency is critical to the community’s quality of health care. Jo Burdick, RN, MSN, executive director of MeritCare Home Care, in Fargo, ND, believes patient satisfaction goes a long way toward promoting a health care agency to its own hospital. But backing up that with statistical data is better still.
Do a study, she suggests, and use specific examples "to show how you can be valuable. Our system, for example, requires anyone who is ventilator-dependent to go into intermediate ICU if they are admitted. Previously, my agency had been caring for that patient at home for another specific thing and whereas we were doing it for $300 a day, the charges were $1,800 a day in ICU."
Her approach is to update her immediate boss monthly: "It behooves the director to have as much information as possible together. We have a good track record, and I like to point that out that we have 15% more referrals every year and while physicians are still referring to us, we had fewer visits this year than last. We want to make [hospital administrators] see that we are preparing for a managed care environment."
OASIS data collection, Burdick believes, will be valuable in the long run for compiling the statistics she likes to show hospital administration. Saying that home care really hasn’t had a tool to compile this type data, Burdick notes that OASIS "will be a good way for any agency to put together outcome criteria for the hospital and to say this is how we do what we do and how we save you money. You really want them to see that we’ll go out and solve problems for [them]."
Information from OASIS collection can be used in a report similar to Hall’s compilation. About a year ago, Hall began the lengthy process of gathering information, 100 pages in all, "defining home care, our structural basis, and what areas of expertise and what teams we have so the administrators know what we’re capable of doing. We want them to know what we’re about."
With the finished data in hand, Hall made up a number of spiral-bound notebooks and dispensed them to each of the hospital’s vice presidents as well as the board of directors, which she explains, as a medical center board knows very little about home care. This handbook is treated as a living document and periodic updates are sent out. To date, it has been a "great tool for people who are needing to know a little about us and what we do. It’s been very good in giving people that understanding."
Whatever an agency’s method, both Hall and Burdick believe that once hospital administrators understand home care’s function, it will maintain a hospital-affiliated agency.
"If the hospital has a true understanding of continuum care and is committed to it, then it only makes sense to have your own agency," Burdick says. "It’s a system of thinking whereby if the agency’s patients do well, then the hospitals do as well."
Sources
• M. Darlene Hall, RN, Executive Director, Stormont-Vail Home Health and Hospice, 833 Garfield St., Topeka, KS 66604. Telephone: (785) 354-6000.
• Jo Burdick, RN, MSN, Executive Director, MeritCare Home Care, 720 Fourth St., Route 103, Fargo, ND 58122. Telephone: (701) 234-4892.
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