Kevin McElroyThere are good surveys and not-so-good surveys. But one thing is true: Good surveys don’t happen by accident. They are the result of continuous planning, ongoing education, and keeping a razor-sharp focus on quality outcomes.

Especially with regard to the Centers for the Medicare & Medicaid Services Five-Star rating system, a good or bad survey can greatly impact a nursing center’s reputation in the community. And while it may not be rocket science, following some basic steps can help long term and post-acute care providers achieve their desired outcomes: good annual surveys.

Following are some tips for making this happen:

1. There is no such thing as “time to get ready for survey.” If a nursing home’s survey window is open and staff are just starting to review plans, they are already behind the eight-ball. Communities need to be ready for a survey 365 days a year. Think about it—the facility could be surveyed at any time (such as a complaint investigation). A good mantra for the team is, “Doing the right thing for our residents, every day!” Focusing on doing the right thing every day, 365 days a year, and not just because a “survey is coming,” puts the community one step ahead of the rest.

2. First impressions matter. If the surveyors have a good first impression when they walk in the door, it can help set the tone for the entire survey. But if they walk in and the team is not prepared, there are odors, the community is not clean, and the team is not smiling and friendly, that will set the mood for a disappointing survey.

3. Have the survey book updated and ready to go. This is a book that has everything in it the surveyors would want when they walk in the door, such as med pass times, activity calendars, and resident demographics. Unsure about what goes into a survey book? Check with the state nursing home association for a guide. Being prepared and organized will go a long way to starting off on the right foot. Grab a new three-ring binder; get an index together; and make sure the book is neat, organized, and easy to follow.

4. Review the center’s quality indicator/quality measure data. Surveyors are using these data to see where the center is and which residents will be picked for their survey sample, before they even walk through the door. But all nursing homes have access to the exact same information anytime they want it (usually, the minimum data set coordinator can print out copies). Consider pulling and reviewing, on a monthly basis, and as a team, the facility-level and resident-level quality measure reports. They clearly indicate where the weak areas are and which residents may trigger more quality measures that could cause them to be chosen by the survey team for review.

5. Set and communicate goals. Ask 10 people what their idea of a good survey is and there would likely be 10 different answers. In order for a team to move in the same direction, they all have to have a clear picture of what they need to accomplish—be it reducing tags by 50 percent, compared with the previous year; having no quality-of-care or G-level tags; or a deficiency-free survey—set goals that are clear, measureable, and can be understood by everyone on the team. And once the goals are set, beat that drum every moment possible, such as in staff meetings, newsletters, or on banners in the break room. It can’t just be the flavor of the month. If the team sees it is important and not going away, they will notice.

6. Provide year-round education and not just the “minimum requirements” that mandate what must be done. Consider offering continuous-return demonstrations on medication passes or incontinence care. Ensure that the team knows what quality measures are. Consider educating nurse assistants about how to communicate with surveyors. It may sound like a cliché, but it’s true: Knowledge is power. Arm the team with the knowledge they need to reach their survey goals.

7. Audit, Audit, Audit. The entire team should be continuously looking at systems and outcomes. The only way to know how things are going is to look. Give each department head an audit to complete monthly for review during QI meetings. Also, consider holding QI meetings monthly instead of quarterly. Have a “mini mock survey day” where each member of the team focuses on a particular area and reports back at the end of the day. Ask other members of the team (such as the consultant pharmacist) to assist with checks and audits. The idea is to constantly be digging and looking to make sure the systems and procedures are working properly. And remember, using the excuse that there is no time to do this works until there is a deficiency, after which the excuse will no longer work.

These may not be earth-shattering suggestions, but if these basic steps are followed, the entire team will be well on its way to achieving good—and maybe even excellent—survey outcomes. And don’t forget to lean on each other.

While these are just some tried and true tips, other administrators may have their own best practices as well.

If the team is focused on good quality outcomes, it will not only have good surveys, it will also feel good knowing the residents are receiving great care at their community.

Kevin McElroy, CNHA, CASP, is the administrator at Evergreen Living Center in St. Ignace, Mich. He can be reached at