There is a moment in the spotlight for long term and post-acute care centers who achieve the AHCA/NCAL Gold Quality Award. For most award recipients, that moment is literal: standing on stage at the association’s annual Convention & Expo in front of thousands of their peers celebrating the achievement.
As moments in the spotlight do, it will end. The lights will dim and the music will fade, and life returns to its normal routine. It is in that routine—the everyday functions and systems—that the true award-winning moments take place for Gold Quality Award recipients. It is within the daily actions, clinical practices, and systematic changes that the impact of what it means to have achieved a Gold Quality Award from AHCA/NCAL are truly visible. There is a life after gold, and it is marked not by spotlights but by persistent, incremental improvements.
The AHCA/NCAL Quality Award program is a progressive program built on the foundation of the Baldrige Criteria for Performance Excellence. Moving from Bronze to Silver to Gold, centers demonstrate a commitment to sustainable organizational and process results. Ultimately, centers that achieve the esteemed Gold Quality Award must prove high levels of performance over time in the areas of leadership, strategic planning, customer, workforce, operations, and knowledge management.
To date, there have been only 49 centers in the nation that have achieved the AHCA/NCAL Gold Quality Award. Two of these centers are Burgess Square Healthcare & Rehab Centre in Westmont, Illinois, and Mountain Valley of Cascadia in Kellogg, Idaho.
Burgess Square Healthcare & Rehab Centre, a 2020 Gold Quality Award recipient, was the first skilled nursing center in Illinois to achieve the AHCA/NCAL Gold Quality Award, and it did so under the leadership of KJ Petersen, Administrator. Its continued success is supported by Nathan Tiwald, Assistant Administrator, who joined the center’s leadership team the same year it was awarded the Gold Quality Award.
Mountain Valley of Cascadia achieved its Gold Quality Award in 2011 under the leadership of then-Administrator Maryruth Butler, who is now President of Northern Healthcare, a division of Mountain Valley’s parent company, Cascadia Healthcare. Emilee Kulin, the current Mountain Valley Administrator, has led the center through a revived ACHA/NCAL Quality Award journey, achieving a second round of Bronze and Silver Quality Awards and with hopeful sights set on a future second Gold Quality Award.
While both of these centers share their status as prestigious Gold Quality Award recipients, they share another quality, too: the perspective that there is no way to reflect on their journey to achieving the Gold with a clear moment of “before” and “after.” Rather, both centers note a continuous and persistent”process of reflection and incremental changes.
“It’s almost like a muscle that we’ve been exercising for years,” explained Tiwald. “We were, and continue to, develop a framework for continual improvement. In the Quality Award journey, we developed some practices that now exist because of organizational muscle memory. It’s part of who we are and how we provide care.”
Burgess Square achieved its Gold Quality Award in 2020, a year that the world will forever associate with the outbreak of the COVID-19 pandemic. In the years preceding its Gold award, Burgess Square was actively exercising the deployment of several practices that ultimately bolstered its achievement. One such practice was creating a system for staff communication that actively incorporated feedback from nursing staff and other direct care workers.
“We implemented routine, scheduled meetings in which there’s a freedom for staff at any and every level to share their ideas,” said Petersen. “They are the ones on the floors doing the work and doing the jobs day in and day out. They know which processes are working and ways to improve the ones that are not.”
This encouragement for communication and innovation from all staff paid off in a major way during the pandemic and continues to prove meaningful during the current workforce crisis. Throughout the pandemic, Burgess Square was able to maintain the great majority of its workforce and eliminated the need to partner with external staffing agencies. Using that process for communication continues to serve as the primary tool for success in other cases, including Burgess Square’s recent rollout of their new vitals machines.
“We deployed these new systems to the floors, and we’re in the process of testing them,” said Petersen. “The staff are using them, and we systematically collect their feedback. Then we implement small changes, test those, and solicit feedback again. It’s efficient for everyone because we are solving the obstacles as they arise. It ends up helping us better serve our patients because the team is constantly improving.”
This outcome—developing systems in which centers can continuously enhance and improve their own operational processes—is exactly what AHCA/NCAL hoped for with its Quality Award program.
“Participation in the Quality Award Program is a way for an organization to invest in itself,” said Urvi Patel, Senior Director of Quality Improvement at AHCA/NCAL. “It is not simply about the award, but rather it is focused on helping organizations generate sustainable systematic process that enable them to face a variety of challenges proactively.”
The readiness of a center to roll out a new technology, or change protocols during the midst of a pandemic, or simply learn to trust the processes a center puts in place is, in many ways, the goal of the Quality Award journey. At the same time, there are many other areas in which a center must demonstrate excellence. These areas range from clinical practices to operational efficiencies, including reducing food waste, average call light responses, completing fire drills, wound healing, successful discharge to the community, antipsychotic use rates, 30-day rehospitalization rates, and more.
Mountain Valley of Cascadia saw changes in both their operational efficiencies and measures of certain clinical outcomes due in large part to changes they made during their quality journey. In 2018, Mountain Valley became a certified behavioral unit. To ensure successful outcomes for their residents, the center needed a psychiatrist to support them. Given its rural location and the fact that Mountain Valley did not have a psychiatrist on staff, their best option was to hire a doctor who lived in Boise, an 8-hour drive from Kellogg.
Using the tools the center learned by going through the Quality Award application process, Mountain Valley submitted grant applications and ultimately received around $70,000 in grants. These funds were used to invest in a telehealth system to enable their psychiatrist to work directly with individuals with no geographic limitations. The center again leaned on an iterative process for rolling out its all-new telehealth system, assessing its effectiveness for residents and staff, and developing policies and procedures, such as cleaning protocols, to ensure its success.
“We were one of the first buildings to implement telehealth care,” said Kulin. “As a result, when the pandemic hit, we were miles ahead of everyone else. It was great proof that what we learned going through the Baldrige framework continues to help us improve.”
The pandemic provided an unparalleled backdrop against which many centers felt the efficacy—or lack thereof—of their ability to implement changes. At Mountain Valley, in addition to providing telehealth services, the center quickly adapted their existing infection control procedures to account for additional requirements to prevent the spread of COVID-19. “We adapted quickly to using our cell phones to text one another to eliminate common surfaces,” Kulin said. “We got sanitizing boxes to clean our devices, and we communicated the constant changes with the team using a private Facebook group, a platform we knew many of our staff were already using. We always had infection control in our center, but we quickly took it to the next level with success due, in part, to our familiarity with how to implement new changes as a result of the Quality Award journey.”
When Mountain Valley completed its state and federal infection control survey, the center ended up citation free.
“I have a hard time delineating between quality care, the quality award journey, our application responses to program criteria, and what we’ve instilled as part of the DNA of Mountain Valley,” said Butler. “It’s hard to determine where one component stops and the other one starts. It’s all so fluid and part of who we were and what the center continues to be.”
Encouraging centers to continuously improve goes beyond an award. It speaks to the core values of providing quality care to the people who need it most.
To learn more about the AHCA/NCAL Quality Awards program, visit www.ahcancal.org.