What is the REAL issue

Watch and listen HERE or read below

At a SNF in Illinois they were running a fall reduction program. They did all the usual things – leaf cutouts on the door of people who were a fall risk, so much training, monitoring call light times, regularly offering help to the bathroom. But the number of falls stayed the same.

I decided to do something a little different and look at a much bigger picture. First, why were they doing the fall reduction program? – the falls were not significantly higher than in other homes in the same company. But the citations and fines were much higher.

This told me that the falls were being reported to the state on complaints far more often than at other facilities with the same number of falls. A quick look at the annual customer service scores showed a big difference there. So in defining the real issue – this was not about falls it was about customer service.

Running a linear regression on the likelihood of complaining to the state compared to different customer service areas allowed us to keep narrowing the focus of our questions until we found the 5 things that had a statistically significant R2– the things most likely to predict whether there would be a complaint.

• Did someone greet you by name when you arrived?
• Were you offered something to eat within 10 minutes of arrival?
• Was your room ready for you when you got here?
• Did you meet at least 2 members of staff (one a manager) within 10 minutes?
• Did someone explain what was going to happen and give you a schedule within 10 minutes?

If those five things were done then that patient was extremely unlikely to make a complaint.

People arrive in a nursing home scared. The arrive confused. They arrive hungry (how many doctors wait till the end of day to write that discharge and the patient misses dinner?)

Letting them know that:

• We know who they are.
• We know how to take care of them.
• We anticipate their needs.
• They know what is going to happen to them next.
• They have points of contact to help them and for escalation.

These things remove fear and uncertainty - and are applicable for almost any service business.

While so much is routine to us – this is the first time in a nursing home for most people and they don’t know what is going to happen. Taking away the uncertainty and fear is a good thing on its own, but it also leads patients to give the benefit of the doubt to staff.

Focusing on these areas led to a huge decrease in complaints – and a decrease in falls. The decrease in falls was because we had gained something very important from new patients - TRUST.

They trusted us and waited for help rather than trying to do things on their own that were not safe.

A lot of math, psychology, and research went into this finding – but there was a simpler way to get to the answer.

ASK A CNA

Julie already did this with every new patient on her unit. When I asked her why and how she had time – she said – “how do I not have time? If I show them that I know who they are and have everything ready - they trust me. Then when I tell them I will be back at 7:15 – they wait till 7:15 with ALL their requests instead of me running up and down the hall answering call lights from panicky new patients trying to take themselves to the bathroom because they don’t know when someone will be there.”

Julie the CNA is a VP of marketing now.

Far too often we jump to a solution based on the perception of a problem.

Fall citations? do a fall reduction program.

We have so much data available, we just have to know how to use it. That means stepping back to ask why and what is the real problem. That means doing the work to see what really is the root cause. And most of all it means not ignoring the best data set and solutions that you have - your front line staff.