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Best practices for communicating with stakeholders in post-acute care

It’s a challenging time in healthcare, and not just in acute care. Daily news stories chronical the failures of post-acute facilities due to staffing shortages, inability to manage risk and quality gaps.

Isn’t it time to take back control of the narrative, to put what’s “right” back into healthcare?

Whether you are an acute, subacute or post-acute provider, partnership matters to your ability to deliver a quality patient experience. When a patient has joint replacement surgery, they’re not just focused on the hospital experience. They’re also counting on an accurate diagnosis, the right treatment plan, the most qualified provider to deliver that treatment, pre-testing and pre-op to help them get ready for surgery.

They want to know that their rehabilitation and home health providers will keep them safe post-op and on track for a quality clinical outcome after surgery. Seamless communication between all these caregivers across the care continuum is essential.

With the Centers for Medicare and Medicaid Services (CMS) now reimbursing for episodes of care, providers who work together in the best interest of the patient to reduce cost and improve quality will be rewarded while those who don’t will face stiff financial penalties.

For successful partnerships, post-acute care facilities must be able to demonstrate value to potential acute care provider partners. Are they easy to access? Excellent communicators? Partners expect a seamless patient and family experience and consistent delivery of quality outcomes.

Likewise, hospitals want to refer to post-acute providers who excel at preventing readmissions and ensuring patient safety and quality. Success is all about communication with caregivers, patients, families and particularly with employees.

PARTNER TO HIRE RIGHT

In any healthcare setting, quality frontline staff are the backbone of an ability to deliver on its promise of quality care and experience to patients. You won’t find those individuals just anywhere. Use these tactics to recruit high performers.

  • Fill the pipeline. Start with an outreach to local middle schools and high schools for presentations on a career in healthcare. Also, are you partnering effectively with community colleges in your area?

    To attract certified nurse’s assistants (CNAs) and licensed practical nurses (LPNs), promote the opportunity to earn clinical hours of experience in your organization with quality preceptors. Make sure your organization is the first choice of employment for new graduates based on your great first impression during training.
  • Screen for the “engagement gene.” Looking for employees that care deeply about their work? Ask open-ended questions that identify applicants with great communication skills (e.g., “describe a situation where you were able to effectively communicate a difficult or unpleasant idea to a superior”) and a team focus (e.g., “describe a team experience you found rewarding”).
  • Identify the best fit for the team. Do you partner with your best employees to identify great new hires? New hires are only successful if their peers help them to excel. After a candidate has been vetted by human resources and his prospective leader, ask high-performing team members to complete a peer interview and evaluate the candidate for cultural fit.

    Be sure to provide training for this important role and always accept the decision of the peer interviewer. It’s this process of peers selecting new members of their team that creates an investment in their ultimate success, reducing early turnover.

Employee rounding and training improved certified nurse assitant retntion by 8 percent.
These tactics work in every type of provider environment. For example,
a South Carolina hospice cut turnover from 75 percent to 18 percent over
12 months resulting in $2.4 million in savings. A Texas-based skilled
nursing facility improved CNA retention by 8 percent saving $972,000.

Source: Texas-based Skilled Nursing Facility System

  • Assign a preceptor. The best preceptor may not be your best clinician or individual with the longest tenure. Find someone who is invested in the success of the mentee, has patience for new learners and is seen as a high performer by the rest of the team.
  • Focus on retention. It’s expensive to recruit and train employees, so once you’ve hired right, demonstrate your partnership with them. Round on employees consistently to identify what is working well, who to recognize and tool/ equipment needs. Then ask for ideas to improve processes. Recognize employees for great contributions and meet with them after 30 and 90 days to re-recruit them.

Specific questions at 30 and 90 days focus on harvesting new ideas from those with a fresh eyes perspective, recognizing team members that were helpful in onboarding and identifying risk factors that may cause someone to leave the organization. Use Leadership Development Institutes to equip leaders with the leadership skills they need to excel.

In one post-acute care facility Studer Group coached that was struggling with high turnover, caregivers with long tenure said they stayed because of their passion for post-acute care, their respect for coworkers and scheduling flexibility. Some also wanted opportunities for advancement. Find out what your employees value to ensure you deliver on what they want.

PARTNER TO MITIGATE RISK

Falls among older Americans are the number one cause of injury and death from injury. One out of every four people 65 years or older falls annually, resulting in 2.8 million emergency department visits.

These falls also result in $31 billion in direct medical costs, not to mention lawsuits. These long-term care claims are on the rise, too. They arise from a perfect storm of a patient’s mental state, lack of provider communication with patients and their families, and a failure of explanations about risk factors, prevention and patient choices that contribute to those risks.

To reduce costs and keep patients safe, partner with your staff to communicate your organization’s commitment to avoiding and mitigating risks. Best practices include:

  • Using key words with patients and families. For example, “We’re concerned about the risk of a fall for your mom while she’s here, so we are placing her in a low bed. We will proactively toilet her as we round to reduce the risk of falling. You can help by asking for assistance when helping her to the bathroom, encouraging her use of slip resistant socks and keeping the bedrails in the up position.”

    Understanding how patient choices contribute to increased risks can help families persuade loved ones to follow staff recommendations like using a walker versus a cane for better support and removing rugs and cords in the home.

    When a large California-based hospice trained staff to use key words and also began rounding consistently on employees, patient survey ratings on “helpfulness of staff who arranged care” jumped from the 10th to the 59th percentile over six quarters. Likewise, patient ratings for pain control jumped from the 20th to the 95th percentile over 13 months.
  • Rounding hourly on patients. The goal of rounding on a patient or resident and his family is to both receive and give information. Best practice is to round hourly in hospitals and every two hours in rehab and skilled nursing facilities.

    Also, patient care boards are an effective way to track important information for patients and residents such as caregiver names, dates and times for activities and visits. For those with memory challenges, this can provide essential information that comforts the patient or resident and their family.

PARTNER FOR GROWTH

Once you’ve laid the foundation for quality care by hiring and retaining an engaged, skilled staff — and trained them to communicate effectively with patients and families — you’re ready to grow your organization.

What’s the best way to drive growth? Identify organizations along the care continuum in your community that refer patients to you or accept referrals from you. Think out-of-the-box.

Sometimes that means opening a dialogue with local partners where you may have been reluctant to refer in the past to speak frankly about challenges and brainstorm solutions. (Read about the experience of St. David’s Georgetown Hospital in “Improving Quality and Patient Experience through Partnership” on page 6.)

Communication and partnership are the themes that drive excellence across the continuum. Both are essential to the delivery of quality care and a world-class patient experience. When you hardwire these best practices in your organization, your organization will reap the benefits of these collaborative partnerships.

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