The Risk Management Skills Every Leader Must Have<p></p><p>In any business or professional venture, leaders will inevitably encounter risks that present both challenges and opportunities. Possessing the necessary skills to effectively manage, mitigate, and capitalize on risk as it appears is essential for successful leaders regardless of industry.</p><p>In health care, risk management has become even more critical in recent years due to the rapid adoption of advanced technology and increasing concerns regarding patient security and satisfaction. The necessity of contingency plans in case of a cyberattack, natural d​isaster, or other major event became clear in 2020, further cementing the importance of risk management skills for leaders in health care and other industries as well.</p><p>For optimal risk management, leaders should ensure they foster critical skills, including an analytical mind, a solutions-based attitude, relationship-building and communication proficiency, and the ability to thrive under pressure. With these skills, leaders can be more efficient and productive risk managers in their roles.</p><h3>An Analytical Mind</h3><p>Collecting and analyzing data is a big part of risk management, but possessing an analytical mind means leaders can take this practice a step further. Identifying trends in data to assess and predict potential risks is only the beginning; leaders must also be confident enough in their analysis to make strategic decisions, many of which will be difficult or tricky.</p><p>Additional benefits of an analytical mind include an eye for detail, the ability to identify where information is inconclusive or insufficient, and a propensity to see both the larger picture and the day-to-day elements that impact financial or security risks. Leaders who are analytical can more effectively assess, minimize, and capitalize on risk because of these aforementioned tendencies and skills.</p><h3>A Solutions-Based Attitude</h3><p>Natural curiosity and a desire to identify and address the root of an issue are essential for risk management, and leaders who are determined to find and implement effective solutions through continued education, trial and error, and innovation are bound to succeed in managing risk and leading effectively.</p><p>By pursuing solutions to problems as they arise, rather than succumbing to anxiety and avoiding risk altogether, leaders who embrace risk management as a key part of their roles will likely find opportunities within challenges and achieve greater individual and organizational success.</p><h3>Relationship-Building and Communication Skills</h3><p>Effective risk managers understand that strong relationships are cornerstones in business and industry. By building trust through open, honest communication and dedicated connection efforts with key players such as board members, external experts, stakeholders, and more, leaders can ensure they have a cultivated network that can effectively address risks as they arise.</p><p>In order to form strong, lasting connections with other professionals and colleagues for the sake of risk management, leaders must be able to communicate their insights and ideas to a variety of individuals. Creating risk reports and explaining complex methods to individuals with differing levels of experience and know-how is part of the job, so leaders must develop their communication skills accordingly.</p><p>To succeed in building relationships for risk management purposes, leaders need to cultivate strong negotiation skills as well as diplomacy, tact, and public speaking.</p><h3>An Ability to Thrive Under Pressure</h3><p>Managing risk for a business or organization, especially in health care, is a stressful task with a lot of associated responsibility. Successful risk management necessitates effective use of stress as a motivator, meaning that leaders must work to remain as objective and rational as possible without allowing their emotions to interfere with their decision-making process.</p><p>Remaining calm when the stakes are high can be challenging. In fields where lives may be at stake, in addition to financial and security loss, stress levels can be high even without the pressure of assessing, combating, and using the risk involved. The ability to stay level-headed and make informed decisions even when the pressure is high is invaluable to leaders, and while developing this skill takes time, it will certainly prove invaluable to leaders in any industry.</p><h3>Technical Knowledge</h3><p>In addition to soft skills, leaders will also benefit from financial knowledge and other technical skills specific to their industries in their risk management endeavors. By increasing their awareness of relevant factors and trends, leaders can more effectively assess and approach risk daily as well as on a larger scale.</p><p>In health care specifically, leaders should have a fundamental understanding of essential technology and software. From patient databases to billing systems, health care leaders need to know how things work and why their function is critical to optimal performance, care, and risk management.</p><p>Because risk management requires leaders to collaborate with professionals and experts in other fields or specializations, technical knowledge can help provide a bridge that facilitates clear, effective communication between involved parties, promoting greater efficacy in solution generation and implementation. Because risk management is critical to preserving sensitive information, financial security, and optimized operations, leaders must be knowledgeable and open to learning more.</p><p>In any leadership position, risk management is critical for long-term success. For health care professionals, effectively managing risk can improve patient satisfaction, heighten data security, and promote higher standards of innovation, especially regarding technological evolution. Leaders who recognize the importance of risk management in their roles and strive to cultivate necessary skills are more likely to achieve greater success.&#160;</p><p><em>Avi Philipson</em><em> is CEO of Graph Group, an investment firm in the areas of capital, insurance, real estate, and health care.</em></p>2022-12-12T05:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/leadership.jpg" style="BORDER&#58;0px solid;" />ManagementAvi PhilipsonFor optimal risk management, leaders should ensure they foster critical skills. With these skills, leaders can be more efficient and productive risk managers in their roles.
Prevent Technology-Related Minimum Data Set Coding Errors<p>​<img src="/PublishingImages/Headshots/JessieMcGill.jpg" alt="Jessie McGill" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​While a great resource, technology should never replace the clinical decision-making of a licensed nurse or interdisciplinary team (IDT) member. The resident assessment instrument (RAI) process is complex and case-specific; it requires professional expertise to navigate appropriately.</p><p>While technology mishaps can affect anyone, the nurse assessment coordinator (NAC) and the IDT members responsible for coding the minimum data set (MDS) are particularly vulnerable. In addition to the complexities of the process, the software itself can present its own challenges. Inexperience, second-guessing a decision, or being overly trusting of the technology often lead to coding mistakes, which can have an adverse effect on care plans, resident outcomes, survey, and reimbursement. By following these two steps, the NAC and IDT members can reduce the risk of technology-induced errors.</p><p><strong>1. Validate autofill data.</strong><br>When juggling many tasks and multiple deadlines, it can be tempting to just accept as correct information that automatically populates into the MDS, but that poses the risk of inaccurate coding. When signing for an MDS item or section at Z0400, the assessor attests to the accuracy of the coding to best of their knowledge. The attestation statement does not give the assessor a pass if the information is pulled from elsewhere in the electronic health record (EHR).</p><p>Consider the following scenarios&#58;<br></p><ul><li><em>​Delayed data entry.</em><em> </em>Mr. Linden experiences a decline in function and ambulation and meets the criteria for a Significant Change in Status Assessment (SCSA). Upon identification of the decline, the physician orders physical therapy. The NAC sets the assessment reference date (ARD) of the SCSA to capture the first five days of therapy. The facility where Mr. Linden resides is in a Medicaid case-mix state, so capturing five days of therapy is necessary to achieve a rehab case-mix group. The morning after the ARD, the NAC refreshes section O of the MDS module to automatically populate the data with the therapy days, minutes, and modalities from the therapy EHR. The NAC is not aware that the therapy software was down the day before, so the therapist has not yet entered all treatment minutes. The NAC signs the completion of the MDS without double-checking the case-mix score to ensure achievement of a rehab group.</li><li><em>Not using all available data.</em><em> </em>The MDS software pulls information for section G, activities of daily living (ADLs), from the nurse aide electronic documentation. The software is very complex and calculates the Rule of 3 based on the episodes of care documented throughout the seven-day look-back period. The nurse aide documentation reflects that Mrs. Buckthorn did not ambulate during the look-back period. The NAC accepts the auto-populated ADL coding without verification. The NAC also codes Mrs. Buckthorn's restorative programs in section O, which includes a walking program. The documentation supports that Mrs. Buckthorn ambulated with a four-wheeled walker and the restorative aide provided balance support and guided maneuvering for 25 feet in the corridor on six days during the look-back period. The NAC does not recognize the error in the ADL coding in section G and does not consider other supporting documentation in the medical record, observation, or discussion with direct care staff.</li></ul><p></p><p>When using autofill for any MDS item, it is important that the facility has a process to prevent errors. For example, before signing the completion of any auto-filled item, the IDT members must refresh the MDS assessment with any new or updated information, such as the Medicaid number or other data. For any autofill MDS item, the IDT must validate the source of the information—either by the medical record, source document, or a report. Additionally, if the MDS item autofills from one source of supporting data, it is important to also consider all other medical record documentation that would impact coding. For some items, the coder may also need to interview direct care staff to validate the item.</p><p><strong>2. Use clinical decision-making when considering MDS coding suggestions.</strong><br>MDS software and scrubbers are critical tools that can help ensure the integrity and accuracy of the assessment—when used correctly. Such software may automatically check or suggest diagnoses for section I or provide helpful tips on MDS coding. However, the assessor who signs the completion of these MDS items must ensure accuracy based on RAI coding instructions.</p><p>Consider these scenarios&#58;<br></p><ul><li><span><em>Software suggests or automatically checks diagnosis based on diagnosis list.</em></span><em> </em>Mrs. Elderberry admitted nearly three months ago with a diagnosis of pneumonia and a functional decline. The NAC is completing a quarterly assessment on Mrs. Elderberry and just refreshed the diagnoses for section I. The software has checked I2000, indicating an active diagnosis of pneumonia. The NAC checks the diagnosis list and verifies that the physician signed the diagnosis list in the last 60 days and accepts the diagnosis in section I. The NAC failed to follow all the MDS coding instructions for section I, which also requires that the diagnosis must be active during the seven-day look-back period. The NAC must make a clinical decision to determine if the pneumonia diagnosis has a “direct relationship to the resident's current functional, cognitive, or mood or behavior status, medical treatments, nursing monitoring, or risk of death during the 7-day look-back period&quot; (<em>RAI User's Manual</em>, p. I-7). The software cannot make this decision.</li><li><em>Scrubber software suggests changing coding.</em><em> </em>Mr. Spruce recently had a surgical procedure. The documentation during the seven-day look-back period supports the presence of a surgical wound and surgical wound care; however, the NAC only coded M1040E, Surgical wound, and missed coding the surgical wound care at M1200F on the SCSA. Prior to submitting the assessment, the NAC used the scrubber software per the facility policy. It generated 12 alerts, including an alert asking if the resident had received surgical wound care since there was a surgical wound present. The NAC reviews the first several alerts, notes that no changes are needed, and to hurry the process, resolves the remaining alerts without reviewing. The NAC submits the assessment with the error of the omitted surgical wound care.</li></ul><p></p><p>The errors in these scenarios are avoidable. The NAC or IDT members responsible for signing for the item must complete the clinical decision-making process, apply <em>the RAI User's Manual</em> coding instructions, and validate that the coding is correct. Scrubber software is an additional check to supplement the clinician's efforts. One should never apply or ignore software's alerts or suggestions without the clinical decision-making process.</p><p>The bottom line&#58; technology is great, but it cannot replace the need for the clinical decision-making of the human brain.</p><p><em>Jessie McGill, RN, RAC-MT, RAC-MTA, is curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN).​</em></p>2022-12-08T05:00:00Z<img alt="" src="/PublishingImages/Headshots/JessieMcGill.jpg" style="BORDER&#58;0px solid;" />ManagementJessie McGill, RNWhile a great resource, technology should never replace the clinical decision-making of a licensed nurse or interdisciplinary team member.
Supporting Residents with Dementia Through Therapeutic Hospitality and Culinary Wellness<p><img src="/Articles/Guest-Columns/PublishingImages/2022/MindiManuel.jpg" alt="Mindi Manuel" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​With approximately 60 percent of assisted living residents experiencing some form of cognitive impairment or dementia, mealtimes can be challenging for both residents and staff alike. Proper nutrition is essential for older adults—especially those with cognitive impairment—to help them stay strong and healthy, while poor nutrition may lead to undesirable weight loss.</p><p>Having a holistic culinary and therapeutic hospitality program that addresses difficulties with coordination, restlessness, and problems with remembering the process of eating altogether can make a big difference.</p><p><strong>Creating a Supportive Dining Environment</strong><br>Therapeutic hospitality focuses on providing a calm, supportive dining environment that meets the individual needs of every resident. Through evidence-based design that incorporates the science of aging and dementia, the dining experience becomes an easy to navigate social experience. Focus is placed on simple and efficient layouts, appealing colors, lighting, aromas, safe furniture and flooring, and soft sounds to accommodates changes in the five senses and motor and cognitive skills that residents with dementia may experience. This helps reduce agitation and other behaviors among residents and reduces the potential for slips and falls and other risks. Bright shiny floors, for example, are replaced with darker, more muted colors and surfaces that help with visual perception and promote calmness. &#160;</p><p>Tableside choice provides a dignified approach to dining for residents who are no longer able to use a printed menu. This not only empowers residents by allowing them to continue to participate in meal selection, but it also stimulates the senses to signal hunger and increases social engagement. Many residents with dementia have a loss of depth perception which can impact the amount of food consumed.&#160; Use of contrasting plates and tablescapes can provide these residents visual cues that it is a space for dining. Using plate colors that contrast the food items served can increase consumption, with darker foods served on lighter plates and lighter foods served on darker plates. Solid plate colors are preferable to avoid confusion and distraction.</p><p>When possible, having an open kitchen environment and providing exhibition cooking are ideal. Open kitchens help stimulate the appetite as appealing aromas spread throughout the dining room. This also helps stimulate the appetite by reminding residents of the joy of cooking while also providing an opportunity for cognitively stimulating social engagement.</p><p><strong>Providing Nutritious, Appetizing, and Adaptable Meals</strong><br>Adaptive wellness culinary focuses on providing healthy meal options that target overall health and wellness. Meals incorporate foods rich in antioxidants, omega-3s, and vitamins and minerals that provide anti-inflammatory and vascular benefits and support cognitive health. Recipes focus on flavors and textures that will appeal to residents and that celebrate the simple pleasures of eating. Choice is essential. These menu items can be plated and served with utensils for those who are able, and prefer, to be seated. But portable, hand-held options are also available for residents who tend to wander during mealtimes. Menu items can also be portioned into bite-sized pieces, for example, for residents who have difficulty using utensils. Healthy, portable snacks are also available for residents who wander at night or may want a snack between meals. Nearly all menu items can be adapted to meet the varying functional abilities of residents.</p><p><strong>Educating Staff on Holistic Approaches and Care for Individuals with Dementia</strong><br>Onsite training helps educate staff on how to enhance the dining experience for persons with dementia. This training recognizes dining staff as an important part of the care team; dining staff are often the first to recognize changes in residents' behaviors and appetites. The training helps dining staff connect the science behind the disease with the “why&quot; of this approach, which allows them to recognize the signs of dementia and how to apply that knowledge to care, emotional support, engagement, and the comforting strategies offered at the end of life. It emphasizes the importance of a calm, therapeutic dining environment, maintaining quality of life for residents, as well as the importance of nutrition and its link to clinical outcomes. Annual training sessions keep staff up to date on best practices in dementia care to support continuous quality improvement.&#160;</p><p>​With the aging U.S. population, dementia will become a critical health issue within the next 20 years, emphasizing the need for better prevention and care strategies. By implementing a holistic approach to dementia care, we can deliver more effective, compassionate types of care that meets the needs of the individual. This person-centered approach helps residents age with dignity and maintain their independents as long as possible.</p><p>Applying a holistic dementia approach to mealtimes within skilled nursing and assisted living facilities helps shift dining from being a time for feeding to a therapeutic and social activity. It equips staff to nurture residents experiencing sensory changes associated with dementia by using smells, colors, textures, and visual cues. Serving residents at their highest level of function, empowers them to become active participants in their dining experience, prolonging quality of life, and ensuring they will be healthier and better nourished.</p><p>During a time of acute staffing challenges, dining and therapeutic hospitality can also ease stress among staff and build job satisfaction and engagement. Staff become equipped to identify and address the changing nutritional and behavioral needs of residents, and the therapeutic setting eases agitation and disruptive behaviors often associated with cognitive decline, making the dining experience better for staff and residents. More importantly, it achieves a higher level of care that residents and deserve.</p><p><em>Mindi Manuel, MS, RD, CSG, LDN, CDP, is the</em><em> senior manager of clinical support for Sodexo Seniors covering the Pennsylvania market.&#160;</em><em>She is a registered dietitian and a Certified Specialist in Gerontological Nutrition (CSG) and a Certified Dementia Practitioner (CDP).​</em></p><p>​</p>2022-12-05T05:00:00Z<img alt="" src="/Articles/Guest-Columns/PublishingImages/2022/MindiManuel.jpg" style="BORDER&#58;0px solid;" />DementiaMindi ManuelTherapeutic hospitality focuses on providing a calm, supportive dining environment that meets the individual needs of every resident.
A Leader's Responsibility to Fight Compassion Fatigue<p></p><p>Health care professionals are known for their honesty, their ethics, and their trustworthiness. For 20-years running, nurses have received the <a href="https&#58;//news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx" target="_blank">highest ratings in honesty, ethics, and trust</a> than any other profession, according to Gallup's annual polls. They show up with a level of compassion unheard of in most other industries, and that compassion for their patients is what helps to enhance the quality of care.</p><p><img src="/Articles/Guest-Columns/PublishingImages/2022/BentPhilipson.jpg" alt="Bent Philipson" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />At the beginning of the COVID-19 pandemic, nurses didn't let that compassion falter. They sacrificed their time—and sadly for some, their lives—to take care of a growing number of sick patients during an unprecedented time. They worked long hours and double shifts to meet the growing demand for health care workers in short-staffed facilities. They gave up time with their families and exposed themselves to the coronavirus every time they went to work, especially when personal protective equipment was so scarce at the time.</p><p>After weeks, months, and years of this, you can imagine how the exhaustion and overwhelming need to be always-on started chipping away at their compassion. This is the new reality nurses are facing. And if you're a health care executive, this is the reality for <em>your</em> staff.</p><p>What can we do to help fight compassion fatigue in our assisted living communities, long term care centers, and skilled nursing facilities? It is our responsibility as leaders.​<br></p><p><strong>Understanding Compassion Fatigue</strong><br>In order to address compassion fatigue in health care, leaders must understand exactly what compassion fatigue is. In short, it's an extreme malaise that develops from caring for patients throughout their entire care journey. Over time, this “cost of compassion&quot; results in strain and exhaustion. It starts with feelings of discomfort, transitions into stress, and then ends in a state of fatigue, which is much harder to recover from. This is why early detection and preventative measures are so important. If not addressed right away, it can permanently hinder a caregiver's ability to provide compassionate care to patients.</p><p>The extreme empathy nurses feel for patients and their families coupled with the grief they experience on the job leaves them vulnerable to compassion fatigue. They're so enmeshed in their patients' lives and, ultimately, their recoveries, which can lead them to feeling guilt, impotence, anger, or even blaming themselves when a situation doesn't have a happy ending.</p><p><strong>How to Fight Compassion Fatigue&#160;</strong><br>Health care workers are at a unique disadvantage for two reasons. The first is that there hasn't been much global recognition about the negative impacts of working in the industry—until the COVID-19 pandemic. Second, health care staff provide ongoing care to patients and their families and experience trauma on a consistent basis. They can't just walk away from these situations, which makes preventative measures and support even more critical.</p><p><strong>Prioritizing Work/Life Balance</strong><br>COVID-19 not only exacerbated the problem of compassion fatigue, it resulted in a nursing shortage crisis, <a href="https&#58;//www.vox.com/coronavirus-covid19/22763417/us-covid-19-hospitals-nurses-shortage" target="_blank">which hasn't yet resolved itself</a>. The staffing shortage only leads to more compassion fatigue, thus trapping them in a vicious cycle.</p><p>While nurses are viewed as caring and nurturing individuals, many find caring for themselves difficult. Facilities must promote a culture where work/life balance is important and give workers the necessary time to invest in themselves. When your employees have the time to focus on non-work-related activities that make them happy, it helps to alleviate the weight of work they carry on their shoulders every day.</p><p>It's difficult to leave work at work when you work in health care, so as leaders, it's even more important that we not only instill a work/life balance in our facilities, but that we model it as well.</p><p><strong>Ongoing Training/Education</strong><br>A lack of training and ongoing education can be part of the reason why your employees are struggling at work. By giving them strategies for how to better support their patients, communicate with families who are under stress, and deal with complex situations, you're helping equip your employees with the necessary skills to excel.</p><p>Nurses who feel they lack these skills may believe they're incompetent, which leads to more severe anxiety and depression. It's important for leaders to make ongoing training and education a part of their mission, especially when it comes to how to emotionally support patients and families. In skilled nursing facilities and long&#160;term centers, for example, training that's centered around end-of-life care will help prepare employees to feel adept in their roles when these situations arise.</p><p><strong>Workplace Interventions</strong><br>Making workplace interventions available to employees will help lessen the emotional strain that nurses feel. Facilities that implement these interventions <a href="https&#58;//www.frontiersin.org/articles/10.3389/fpubh.2021.679397/full" target="_blank">experience less turnover and generally have happier staff</a> as a result. The sooner we focus on these initiatives, the quicker the health care industry can begin healing itself.</p><p>If your facility currently has no offerings, or your menu of interventions is limited, here are three ideas you can start implementing&#58;<br></p><ul><li><strong>Peer support groups.</strong> No one understands what your employees are going through better than their colleagues. Peer support groups are an easy but meaningful way to address emotional difficulties within your facility.</li><li><strong>On-site counseling.</strong> Peer support groups are impactful, but inviting in a trained therapist or counselor takes mental health support to the next level. Encourage employees to take advantage of these counseling sessions when they're available, and make sure they're accessible to everyone.</li><li><strong>Debriefing sessions.</strong> These sessions are an opportunity to share and explore an employee's thoughts after a certain event has taken place at the facility, usually one that's traumatic or concerning. These are not formal reviews, but rather should lead to genuine conversations with staff and senior leadership.&#160;</li></ul><p></p><p>While compassion fatigue is commonplace in the health care industry, we should not accept it as such. Leaders must step up to the plate and devote their attention to combating compassion fatigue in the workplace. If we don't, we're failing our employees.&#160;</p><p><em>Bent Philipson</em><em> is the founder of Philosophy Care, a consulting firm providing a range of services to skilled nursing facilities throughout New York and New Jersey.</em></p>2022-11-29T05:00:00Z<img alt="" src="/Articles/Guest-Columns/PublishingImages/2022/BentPhilipson.jpg" style="BORDER&#58;0px solid;" />Bent PhilipsonWhat can we do to help fight compassion fatigue in our assisted living communities, long term care centers, and skilled nursing facilities?