My Story (175-175-175): from the many to one. Extracted from my books.
At a skilled nursing facility, I took on, which was decertified and called “Death Valley” by the surveyors, there were 207 beds with plummeting occupancy. It had 175 patients that did not want to be there, 175 families who did not want to come there, and 175 employees who did not want to work there—quite a big undertaking. Within five days of taking over without even an administrator’s license, a ninety-three-year-old contracted patient drowned in the whirlpool while a foreign therapist charted behind a privacy screen. The next day I was on TV trying to explain the accident, which the attorney general called neglect and criminal abuse. My attitude of “I am going to fix this mess” and a forgiving family got me through to the next big problem. Actually, after that and for the next six months it got worse: 200 percent turnover, 25 percent absenteeism, 50 percent absenteeism on weekends, theft of patients’ valuables, air conditioning that broke down for two weeks. Surveyors were there every day with their humidity and temperature thermometers, just waiting to shut us down.
My staff was made up of legal or illegal immigrants who weren’t properly trained nor effective but wanted what I wanted. I had Polish bed makers, Mexican housekeepers, Filipino LPNs, East Indian night staff, Black American CNAs, white RNs, Hispanic dietary staff, many of whom were probably not legal aliens. Not a team, but a group of workers focused on paychecks and their departments, not on the patients. I found out that I didn’t have the quick fix and probably made things worse by doing nothing but reacting to family, patient, staff complaints. Even an ineffective leader sometimes does nothing and becomes a leader. During a snowstorm that November, only half the staff showed up for work and for seventy-two hours the facility ran better without troublemakers and thieves. Since the Director of Nursing didn’t show up and my assistant director o nursing was on the phone wanting direction, I suggested that they organize as teams and focus on priorities, such as feeding, dressing, medications, treatments, etc. When I got there the ADON and lead aide had organized the staff into teams and were performing as they never had before. Priorities were done first and busywork was shelved.
After the snowstorm, it dawned on me that before the storm all of the staff only worked half a day; and after, half the staff got more done in a day than they did in a week before. Quite an eye-opener, so much so I decided we were not going back to the old ineffective departmental structure but were going to stay with the teams set up in my absence. To do this required that I know what the root cause of the complacency and apathy in our team. Teams have been a part of my whole life growing up competing for a position being the smallest on the field or floor. So, I decided to become a nurses’ aide, a housekeeper, a dietary aide, a maintenance man, a social worker for each shift for a day to learn the obstacles to quaiity.
After contacting scabies and giving them to my wife it finally dawned on me that we had tribes not teams. From that time on “we many” would work as one for a common goal … “Serve our patients is to serve our soul”. The rest is history. In conclusion, this epiphany changed my view of the infrastructure of nursing homes. As teams only focused on the patients’ priority problems and organized to implement the care plan interventions, we achieved efficiency and effectiveness never before attained.
Productivity was based on outcomes we could get reimbursed for and quality was a byproduct of our control of the processes. By our next QUIP (quality incentive payment) and annual survey we were recertified, and received a clean survey with five of the six stars of quality awarded exemplary providers, which meant more money for better quality.
