For three years, Administrator Maryruth Butler and her 90 employees and 23 volunteers worked to get the Louisville, Ky.-based Kindred Healthcare-owned Kindred Nursing and Rehabilitation - Mountain Valley in Kellogg, Idaho, to the highest rung of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) National Quality Award ladder.
Three times they received feedback from master examiners on how to improve on an already strong performance, but for the years 2008-2010 they did not hear the magic words that the Gold was theirs.

That all changed this year when Butler and her team became the one AHCA/NCAL gold recipient for 2011, the first time such an award was given to an Idaho skilled nursing facility or a Kindred residence.

“We became better,” Butler says, crediting the examiner feedback on areas to improve upon with helping to show everyone at Mountain Valley in what direction they needed to go.

“They gave us a different look from their lens, and the feedback proved an opportunity for improvement,” Butler says.
Some of the specific areas where Butler’s team learned to change for the better included customer satisfaction surveys. Feedback from the 2008 award application said the center did not segment customers in an efficient way, dividing people between short and long stays for instance.
“We had a 36 percent response rate in 2008” to customer satisfaction surveys, Butler says. “That made us ask if we even had actionable information from so few returned surveys.”
To get better, the team made the survey a more important part of interactions with families and pushed harder for responses. The result was a 92 percent customer survey response in 2010. “This is feedback we could use for performance improvement,” Butler says.
This feedback led to more changes in unexpected areas. The male population in the facility let it be known that the interior decoration was too feminine. Like in many homes, Mountain Valley’s 68 beds were majority female, but the men felt they needed a more masculine touch.
“The short-termers wanted a place to get a beer. So from the feedback we created a type of a man cave, with a pool table, and no flowers,” Butler says. The activity program also added a poker night.
These shifts to satisfy residents were a microcosm of how the facility was improving its chances to be a gold recipient, Butler notes. “Every year we got better,” she says. 

Staff Buy In To Effort

Other facilities looking for advice on how to tackle the mammoth task of reaching Gold status should take Butler’s words to heart.
“It really does seem a bit overwhelming,” she says, referring to the voluminous application process. Putting into words all of the systems and processes employed at the facility; of what staff do on a daily basis; and how to involve nurses, doctors, and all employees in the documentation effort is quite a task.
“It is amazing how workers become joyful in telling our story,” Butler says.
At first it seemed like the application process was for senior staff like her to tackle, but as time went on, everyone took ownership. “When we sent the application off to AHCA, it was like sending my daughter off to college all over again,” she says.
Butler has been administrator for 10 years and worked a total of 15 at Mountain Valley. She is a local woman, having grown up and been educated in the area. She has noted some changes in what her work entails, especially over the past five years or so with the changing face of skilled nursing care.
First off, resident stays are shorter, and the people are sicker. “What we are dealing with in skilled nursing facilities today is what they used to deal with in hospitals. And, in turn, the assisted living facilities used to be what skilled nursing dealt with,” she says.
Being in rural America also poses challenges, with the major hospital centers a good distance away, making transportation and logistics that much more important, Butler adds.
Together, the work her facility achieves on a daily basis has left Mountain Valley as a model for all long term care facilities to emulate, and it got that way because Butler, her staff, and the facility’s entire care community paid attention to the details by first listening and learning.
“It’s not just about talking the talk, but walking the walk,” Butler says. It is Mountain Valley’s “walk” that turned to Gold in 2011.

A Record Of Achievement

It’s not like Mountain Valley was unaccustomed to being honored for its high-level work in caring for its frail and elderly residents.
The facility won the AHCA/NCAL Bronze award in 2005 and Silver award (the only Idaho facility to ever reach that level) in 2007, before focusing on the journey to Gold, culminating in this year’s achievement.
“In 2010, our center was one of only 173 in the nation and the only Idaho center to be ranked by U.S. News and World Report as ‘Best Nursing Homes in the Nation,’” Butler says.
“Also, for 2010-2011 we received the Idaho Health Care Association quality award based on 2010 quality outcomes in our activity program, improved and sustained over a six-year period … and in 2011 for our customer satisfaction outcomes rating in the top 10 percent of the nation as ranked by My InnerView.”
The honors didn’t stop there.
Mountain Valley staff won the state of Idaho’s Skilled Nursing Employee of the Year for 2010 and 2011, plus the state’s Resident of the Year for 2011 and Volunteer of the Year for 2010. 

What Defines The AHCA/NCAL Award Program

The AHCA/NCAL National Quality Award Program has three progressive step levels. Applications are judged by trained examiners who provide feedback on opportunities for improvement to support continuous learning. Facilities must achieve an award at each level to progress to the next level. 

Bronze: Commitment To Quality

Bronze applicants begin their quality journey by developing an organizational profile, including vision and mission statements, an awareness of their environment and customers’ expectations, and a demonstration of their ability to improve a process. 

Silver: Achievement in Quality

These applicants demonstrate a level of achievement in their quality journey through good performance outcomes that have evolved from how they embrace the core values and concepts of visionary leadership, focus on the future, resident-focused excellence, management by innovation, and focus on results and creating value. 

Gold: Excellence in Quality

Gold applicants must show superior performance over time that is based on their systematic approaches to leadership, strategic planning, focus on customers, measurement, analysis and knowledge management, workforce focus, process management, and results. These applicants address the complete Health Care Criteria for Performance Excellence.

Mary Ousley Receives Quality Honor

AHCA/NCAL has named Mary Ousley recipient of its 2011 Friends of Quality Award. She was scheduled to receive the award during the association’s annual convention in Las Vegas in September.
 Mary Ousley
Ousley works for the Centers for Medicare & Medicaid Services (CMS) as the advisory provider representative to the agency’s policy and regulatory development of OBRA 1987 Survey, Certification, Enforcement, and Medicare.
“In the field of expertise in quality care, Mary Ousley is second to none,” said Gov. Mark Parkinson, president and chief executive officer of AHCA/NCAL. “Our profession has made advancements in quality that simply would not be possible without her knowledge and commitment,” he said.
The AHCA/NCAL award is given to a person or organization that has made a significant national contribution to advancing quality performances in the long term care field. Recipients must consistently advocate for quality approaches, while demonstrating the ability to educate and advocate for a systems approach to quality improvement, among other requirements.
Ousley has also sat on the CMS and Quality Improvement Organization’s Nursing Facility Technical Expert Panel on the development and implementation of a quality improvement model for long term care.
She currently is on the technical expert panel for the standards and regulatory development of Section 6102 Quality Assurance & Performance Improvement of the Patient Protection & Affordable Care Act.
Over the previous two decades, Ousley has been appointed and made recommendations for the U.S. General Accounting Office Health Policy Advisory Committee, the Joint Commission, and the National Commission on Nursing and has frequently provided congressional testimony regarding health care policy.