Times are going to get harder, a lot harder for skilled nursing facility (SNF) providers. Fewer dollars are available to meet rising demand. A good number of small- to medium-sized SNFs already operate under razor-thin margins. They must use what available resources they have not only to deliver quality care but to address greater regulatory and legal scrutiny.

Under conditions such as these, the industry as a whole, and facilities in particular, must rethink how they operate. Successful SNFs are the ones that can get the most out of the resources at their disposal.
They can do this by becoming high-performing organizations (HPOs).

HPOs are companies that use continuous improvement (CI) to streamline business processes while simultaneously enabling employees to reach their maximum potential. While CI originated in manufacturing, it is being embraced across a wide range of service-oriented businesses, particularly health care.

Becoming an HPO starts with management recognizing that the environment for skilled nursing has changed, and uncertainty is now the norm.

A high-performing skilled nursing environment is not one with fewer people, it’s one where people and processes work in sync toward clear and defined goals. Because people are at the center of HPOs, getting them to embrace HPO principles and culture is critical. This can be a particular challenge with SNFs, where the lion’s share of education dollars goes to compliance and clinical training.

The thought of spending precious resources on management/operational learning is tough to accept. But the benefits, particularly in the short term, can be substantial.

By simply identifying and eliminating activities that provide no value to a process, or by removing duplication of efforts, facilities can realize fairly significant cost savings.

There are many things to consider when deciding to become a high-performing skilled nursing organization.

Having a well-designed strategy is essential. Other critical steps include:
  • Establish performance goals at all levels—individual, team, department, and company.n Focus on outcomes (not simply inputs and outputs) at all levels of care.
  • Implement a process for “rolling up” care quality information.
  • Use visual tools to track and display activities, goals, and results.
  • Treat audits as CI learning opportunities.
  • Align care-related meetings (interdisciplinary teams, utilization review, and continuous quality improvement) to outcomes.
  • Use data analytics to guide and drive outcomes.
  • Take risk management seriously.
  • Build an adaptive work culture.
The HPO that is able to utilize people effectively achieves significant operational success—lower liability claims/costs, reduced worker comp costs, higher employee morale and fewer sick days, and a reduction in clinical errors.

Farrar Tilney IV is a long term care management consultant based outside of Los Angeles. He can be reached at ftilney4@gmail.com.