The Great Plains (Chapter 1)

We arrived to our new destination last week. We had a few days of warm weather to allow us time to make adjustments for winter. It isn’t easy to keep a camper maintained in cold weather. It can be a challenge to keep the interior warm when the walls and floors are so thin, and of course, there is always fear of freezing pipes (followed by water leaks). Last winter, my husband put in a great amount of effort to form a “skirting” around the camper made out of foam board. This made the camper feel warmer, but breaking camp was challenging (we didn’t know what to do with all the wood and foam board), so we were hoping that we could bypass that. This year we are trying something different. We have placed small heaters in the storage compartments (under the camper where most of the water lines run). So far, this is working.

Wookie and I finished our first week at the new assignment. He was so excited to go to work the first day. I could tell that he was looking for familiar faces (all of his friends from the previous assignments). You could see visible disappointment when he didn’t find anyone, but he quickly became busy making new friends. They are very glad to have him here.

This facility is in the midst of turmoil (as are most). The challenges are very different here, though because they do not involve staffing issues. We are very well staffed with clinical and operational teams. However, there has been a lack of direction due to missing leadership components. Without leadership, the staff have been doing the best they can (I am currently providing clinical and operational/administrative oversight). I can see a desire to provide excellent care, and all of the residents are well cared for. The mystery lies in the low CMS star rating. Although there are certain specific criteria that determine the CMS star rating, there is an immense amount of data evaluation that is actually involved to determine the root causes. I have been in enough facilities to know that this rating can be skewed and does not always represent the care that is being provided, so I will focus here first. Digging into data and finding root causes and solutions energizes me, so I am excited to start the project. This staff is providing “top notch” care, and they deserve a rating that reflects that.

I am a transparent leader. I believe that the more that you can appropriately share with your staff, the better they understand the big picture and the end goal. I was surprised to find out that the facilities overall CMS star rating (along with the quality measures, staff rating, and health inspection ratings), had not been shared with the staff. At our morning meeting, I shared this data with them. I presented a high level overview of how our scores compare with the state and national averages and discussed areas of opportunity for positive change. The departmental leaders were incredibly receptive and excited to know that there is a path to better outcomes. They are excited to participate and provide insight into achieving a common goal. It will be a process, but we have chosen a few items to tackle first. Some of the department managers began performing their own research and have already brought me ideas and suggestions to incorporate into our project (I am energized by this, too)!

This type of work takes patience, we will not see results “overnight”. It is often a process that takes several cycles of PDCA to get the desired outcome, and due to reporting time frames, the actual results could be delayed for 3-6 months. I was transparent about that as well. I want the staff to be resilient, so it will be important to celebrate the small wins along the way. For me, the biggest win here will not just be the improved facility outcomes, but the knowledge and experience that the staff will carry with them long past my departure.

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