In early August of this year, Maine Veterans’ Homes received the call that staff had been waiting for: Their skilled nursing care center in Scarborough, Maine, had been selected as one of only three centers across the nation to receive the prestigious American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Gold – Excellence in Quality Award.

A center that receives this award joins an extremely elite group of long term care providers in the nation. Gold award recipients are rare nationwide, and Maine Veterans’ Home in Scarborough’s (MVH-Scarborough) selection was the first gold award recipient in Maine and only the second State Veterans’ Home in the nation to have ever achieved this distinction.

Getting Started

Asking MVH-Scarborough Administrator Maureen Carland to look back and reflect on the quality journey of the past few years doesn’t faze her a bit. She is quick to point out that self-reflection, evaluation, and reassessment are part of the center’s corporate culture, and had to become second nature for them to progress on their path to gold.

“When we submitted and then received the Silver – Achievement in Quality Award in 2014, we knew immediately that we would continue on this journey and seek the gold quality award,” Carland says. “That we would continue with the journey was never in question.

We were embracing the Baldrige framework and seeing very real results.”

Having the motivation to go for gold, and being ready for the gold process, turned out to be very different things as the journey from silver to gold itself proved daunting.

“Looking back, I can’t really blame our naiveté,” Carland says. “We simply did not know what we did not know.”

Giving Their Personal Best

As indicated by the extremely low number of recipients—only 31 over 18 years—the gold award process is meant to challenge a center to be the best of the best, and the gold award process often put the MVH-Scarborough leadership team through the wringer emotionally.

MVH-ScarboroughWhen Maine Veterans’ Homes began its quality journey, staff could not imagine the depths of self-examination or the heights of pride in self-discovery that they would experience as a team. “Just like the forging process that purifies the precious metals from which the quality awards get their names, following this quality process from bronze, through silver, and ultimately to gold has put our leadership team through the proverbial fire,” Carland says.

Despite the stress, strain, and long hours required to achieve their goals, the MVH-Scarborough team has never been stronger or more unified.

“We have emerged from this process as stronger, more refined and effective leaders,” she says. “We are better prepared to reach out and engage our staff, our residents, their families, our community partners, and other veterans’ advocates.”

Working Together

Helen Keller once said, “Alone we can do so little…Together we can do so much.” Collaboration is essential to the Baldrige framework, and Carland credits the center’s corporate culture of teamwork as being one of the biggest drivers that enabled them to make it through the gold process.

“Early on we developed a system of 11 governing committees, each with a distinct charter and specialized set of goals that were designed to increase stakeholders’ ownership of center governance as well as increasing communication between all levels of staff in all departments,” Carland says.

To hardwire these changes, they incorporated the governing committees into their Quality Assessment and Performance (QAPI) process. Their motto became ‘Nothing About Me, Without Me,’ and this guiding principle enabled them to develop a corporate culture that made quality improvement the responsibility of all staff in all departments.

The changes the staff at MVH-Scarborough experienced through the quality award process were myriad, and Carland points to a purposeful shift in the framework of their thinking as being the impetus.

“Assess, plan, trial, and reassess has become our modus operandi,” Carland says. “Innovative thinking and strategic planning, once considered a foreign language, have become commonplace.”

Even the corporate vernacular changed. Gone were phrases like “it’s against the regs,” and “we’ve always done it that way.” Taking their place were phrases like “let’s get a learning circle for this,” and “join a committee, and make it happen!” As a result, senior leaders, who are charged with role-modeling for other staff, are much more open to suggestions and collaborative participation.

Empowerment Results

“It was this collaborative spirit that softened our old model of top-down hierarchy and created a much stronger team focus,” Carland says. “Honestly, staff were emboldened by these cultural shifts, and enjoyed knowing that even the smallest suggestions they make would be reported to the QAPI committee, considered, and may be passed on to the board of trustees for implementation.”

MVH-ScarboroughIn all the changes that were implemented during the quality improvement process, Carland points to the bottom-up empowerment as the single most important.

“Staff members really embraced the new reality that they have a say in the future direction of the care process, leadership, design and staffing patterns of the center,” she says.

Providing the highest-quality medical care in a comfortable, respectful and caring environment has long been the hallmark of the Maine Veterans’ Homes ethos, but it was the expansion of the focus to all aspects of the organization that proved truly transformational.

Coming Together

Serving veterans, their spouses, and gold-star parents is a mission that Maine Veterans’ Homes has always viewed as a privilege and a sacred trust that goes far beyond simply providing excellent medical care, Carland says. “We believe an active, varied social life paired with community involvement leads to higher levels of satisfaction and engagement.”

One example of this community involvement is the Maine Vets 5K race put on each of the past four years in the city park across the street from the nursing care center.

“When we began this activity back in 2013, it was mostly for staff and residents, and only about 65 people participated,” Carland says. “This year’s race attracted more than 400 participants, 60 corporate sponsors, and several dozen volunteers. We even had families running together and pushing their loved ones in wheelchairs.”

Another focus of MVH-Scarborough’s approach to activities was to seek out intergenerational activities that would enable residents to mentor young people.

“We have had the Boy Scouts visit, the Navy Sea Cadets volunteered at the Maine Vets 5K, three adorable young ladies came and sang the national anthem at an Immigration and Naturalization ceremony we hosted, and too many more examples to mention,” Carland recalls. Additionally, through its partnership with the local middle school, the center has been able to expose young people to “living history” as they meet with the residents to discuss their military and life experiences.

A Lifelong Journey

When one reaches the end of a journey, it is common to consider the beginning.

“It is certainly clear to us, now, looking back, that we had really no idea what we were undertaking when we began,” Carland says. “But journeys are like that.”

As J.R.R. Tolkien says of journeys, “It’s a dangerous business…going out your front door. You step onto the road, and if you don’t keep your feet, there’s no knowing where you might be swept off to.”

While she often refers to the quality award process as a journey, Carland is quick to point out where that analogy falls down.

“The quality award process is a journey, there is no doubt about that. For many, it might be tempting to view winning the Gold – Excellence in Quality Award as the penultimate accomplishment, representing the end of that journey,” Carland says. “For us at Maine Veterans’ Homes in Scarborough, the gold award really represents the beginning of our journey.” In many ways it’s simple, she says.

“If you are on the wrong road, it doesn’t matter how fast or how far you run—you will never reach your desired destination. I am confident, now, that we are on the right road, and there is no limit to how far we can travel or what we can accomplish—together—as a team.”
Devin Robinson is director, public relations and marketing, Maine Veterans’ Homes, Scarborough, Maine. He can be reached at (800) 278-9494 or