Taking Healthcare by Storm: Industry Insights with Amy Porter

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Amy Porter, Resource Specialist at Quality Insights.

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This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-ARPA-121324-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

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Hello everyone and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the Medical Director at Quality Insights and today we have the pleasure of speaking with Amy Porter, a dedicated advocate for improving the long term care workforce. Something that is a huge challenge in the United States right now, especially after the COVID pandemic, Amy recently authored a compelling white paper titled staffing solutions for nursing homes, discover how to create a workplace culture, staff won't want to leave.

And in this episode, we'll dive into the innovative program. She helped design. Exploring the current challenges facing their nursing homes, the importance of employee satisfaction, and the strategies that can create a positive workplace culture, something we should all be focused on. So we are going to uncover Amy's insights on enhancing the quality of care in long term care facilities and learn how we can support the professionals who provide it.

Amy, thank you so much for joining us today. Thanks, Dr Storm. It's great to be here. So let's dive in. We know that the long term care workforce has faced significant challenges for many years, but the COVID pandemic basically decimated and exacerbated these issues. Can you provide an overview of the current state of the long term care workforce?

Sure. You know, it's no secret, really, that the healthcare workforce in general is currently in a state of significant strain, and this honestly is a situation that has been building for decades now, but as you mentioned, was really highlighted and accelerated by the COVID 19 pandemic. And during that time, if someone listening wasn't working in it already, we know that there were significant staffing shortages.

There were very high turnover rates and a lot of burnout happening among healthcare workers. And we also know that during the pandemic, long term care facilities experienced some of the most severe job losses in the healthcare sector. And many of these facilities today are still struggling to rebuild their workforce and find innovative ways to recruit, hire and retain the new staff.

So some of the specific staffing challenges. We see in long term care settings include low wages, demanding workloads, and the emotional toll of working in an environment where residents often require intensive, complex care. And the combination of these issues, among others, do make it difficult to attract and retain skilled and qualified staff, which in turn impacts the quality of care and the overall well being of both residents and employees.

And additionally, the increased need for infection prevention and vaccinations has placed even more responsibility on an already Overburdened workforce. So we need to think about how we can address these issues and create innovative solutions that focus on improving workplace culture, providing meaningful support to the frontline staff, and also how we can create pathways for sustainable staffing practices in long term care specifically.

Absolutely. You just described the perfect storm of that that's faced staff in in long term care facilities. So before we talk about the specifics of the program's design and development, can you tell us how many facilities were initially involved in the initiative and where they were located? Yes. So just to sort of lay a little bit of framework here, we ran this particular program kind of as a pilot project, really, because we were doing a lot of innovative approaches and things that we really hadn't seen done before out in the field.

So this was run between January 2023 and June 2024. So during that time span of about a year and a half, we had 55 participating facilities and 63 registered participants total, and that was in the states of Pennsylvania and West Virginia. The bulk of the facilities were located primarily in Pennsylvania, and these are the geographic areas that Quality Insights currently serves as the quality improvement network, quality improvement organization, a lot of words that are short for QINQIO.

And. Being present in this region offered us the capacity to not only offer this program, but also provide in person technical support on an as needed basis to the facilities who are participating. Yeah, that's really great. And I, I feel like, um, yeah, that's interesting that, that many of the facilities were in Pennsylvania.

Um, So can you explain the significance of the Kirkpatrick model? I know we've talked about a lot of quality insights about the Kirkpatrick model. So maybe just briefly explain that in the context of the program's development and how it shaped your approach to assessing the program's effectiveness.

Absolutely. The Kirkpatrick model was really the cornerstone of everything that happened with this program. It was the first brick, if you will, in the house that was built of this program, and that's because the Kirkpatrick model is an evaluation tool, and it really provides a great framework for evaluating training programs.

It. Looks at impact of a program across four different levels, and this is currently CMS is preferred evaluation tool. So, not to belabor all the details of all the different levels, but when we're doing level 1, we're focusing on participant reactions, very basic, more or less, did they like the program?

Did they enjoy what they were doing? While level 4. Is coming over to the highest level of evaluation, and this is where we're really measuring real world results. So, we're looking at things like tangible improvements. And behavior change specifically within an organization as a result of participating in the program.

So, for the nursing home staffing, or the staffing solutions program, this was a level. For program and that was a big deal. So this means that we weren't just looking at whether participants enjoyed the training or gain some new skills, but we really wanted to demonstrate measurable outcomes. And again, that important behavior change piece and this really also gave us.

Some good clear insight into what worked well for the program and where we can look at refining some things for the future. I'm a huge fan of Kirkpatrick. I've written it, written up a few programs and it, I feel like it's a really wonderful tool. So what are the primary outcomes the program aims to achieve and what informed the selection of the specific outcomes?

And a second question. How do you envision these outcomes impacting the overall quality of care in nursing homes? Yeah, that's a great question. And you know, there were, there were really a lot of outcomes, so not to belabor and go into too much detail here, but really the overarching goal of the Staffing Solutions for Nursing Homes program was to enhance staffing stability and resident well being.

At the simplest level, this is really what we wanted to achieve, because we know that when staffing at a nursing home is stable, more consistent care can be provided to the residents. And when you have that, among a host of other things, this positively impacts the quality of care that's delivered in a nursing home.

So, through the Kirkpatrick model, we developed both internal and external outcomes for this program. External outcomes focused on things like customer, market, and industry response. And included things like improving the health of nursing home residents to develop a better public image or reputation within their community, increasing growth of business and improving fiscal bottom line by decreasing citations.

When we looked at the internal outcomes, these focused more on organizational, departmental, team, and individual outcomes, and these were things like improving the work environment, infection control, and resident quality of life. Yeah, that is great. I mean, improving resident quality of life like should be the center of the the wheel, right?

Yeah, absolutely. So data collection is crucial for everything almost in life and for evaluating this program's success. So what types of data were gathered during the program? Where were they, the sources? For the for, um, for these metrics derived and how do these data points contribute to measuring the program's impact?

Yes. So I, I personally really enjoyed the data collection piece of this program. We monitored a lot of different types of data. I mean, beyond even what the nursing homes were collecting and the different things that we were reporting publicly, we were able to capture a lot of data about the program as the participants were completing different courses.

We talk a lot about this in the white paper. Before the purpose, Specifically of talking about what types of data were gathered during the program by the participants. The publicly reported data piece primarily came from Nursing Home Compare. We were looking at things like staff retention, infection control related citations, fiscal stability by remaining open, and star ratings.

Now, the participants submitted data included the completion of a CMS Nursing Home Employee Satisfaction Survey. A joint work assessment and then there were other data pieces that were centered around personal protective equipment or PPE data, resident falls and termination rates and specifically with the termination rates, we were looking at the probationary period for both self and facility terminations.

So we really wanted to paint. We were able to take a broad picture with our data and check several different areas to measure again, what kind of impact the program was making on each of these data points and that also helped us, um, collect the information we needed to see if that behavioral change was happening since this was a level 4 program.

Yeah, I love that about Kirkpatrick. Not only are we are collecting data to see the change in the facility, but we really want to see if people are learning and it's going to be translated to practice. Yes. So, can you describe the program's learning path for participants, the key stages or modules they progress through, and how these components facilitate their development and engagement?

Yeah, sure. So, as I mentioned a little earlier, we ran this program for about. Um, we started the program about a year and a half between January 2023 and June 2024, and we recruited and grouped participants into what we called cohorts, we ran three different cohorts across that year and a half, and each one had a very structured learning path that included all of the different program elements from start program to finish.

So once a participant registered for the Staffing Solutions Program, they were immediately invited to join a CE eligible kickoff webinar. And this is what we used to really set them up with the practical instructions they were going to need. We gave them an opportunity to ask questions, and we also included a short presentation from a subject matter expert, which sometimes would you, Dr.

Storm, on a staffing topic related to long term care settings. Thanks. Then after that kickoff webinar, we released one online course in our Learning Management System, or LMS, each month to the participants. And each of the 3 courses was focused on things like hiring retention strategies from an organizational culture perspective and evidence based staff engagement strategies.

And in designing the courses, we really wanted to be mindful of the fact that. Participants in nursing home settings are very busy people and often they have a lot of demands of their time during the day and not even just clinically, but they're probably also participating in other programs as well. So we wanted to create some space with staffing solutions for them to be able to complete courses and collect and submit the data at a reasonable pace.

And then once the three courses had been released. The program wrapped up with a lessons learned webinar, which really focused on celebrating the achievements of our participants, because this was a pretty weighty program and included another subject matter expert presentation on a staffing relating topic.

And last thing I'll just mention here real quick is that for our nursing home administrators and nursing participants, each portion of this learning path was eligible for continuing education credit. So if a participant completed the whole program, they were eligible for up to six CE contact hours, which was a nice benefit.

Yeah, I think we really need to highlight that that really continuing education credit. They should be offered like this is a substantial commitment. And yes, yeah, definitely. So we know that innovation is key to a program success. So what are the some of the unique approaches or strategies utilized in the program?

And from your perspective, what aspects do you think participants found most enjoyable? There were really several new and unique approaches that we tested out during the Staffing Solutions program. One area that I really believe set Staffing Solutions apart was the integration of the infection control topic with staffing stability.

When we were designing this program, the COVID 19 pandemic was really not very far behind us and There hadn't yet been a whole lot of definitive research published about the connection between infection control and staffing stability. To me, it seems very logical, but when I was trying to find the research back then, this would have been in 2022, I just wasn't finding a whole lot, or what I did find ended with, we need to study this more.

So by taking these early steps to see how. Having a stable workforce directly impacts infection prevention, immunization rates, and overall care quality. I really believe the program helped participants start to make this connection, maybe for the first time, in terms of thinking about how and why having a stable workforce really helps improve that infection prevention piece.

And then other strategies we incorporated included participant centered tools. We had social learning features, staff facing toolkits, and customized professional development opportunities that frontline staff could take advantage of. For instance, and speaking to the staff's toolkit specifically, one of the things we wanted to do.

In having the courses to people, um, offered to people like nursing home administrators, registered nurses, HR directors, and others, we wanted to have a way to help them translate what they were learning to their frontline staff in a way that would really connect with the staff and the type of work that they were doing.

So for the staff toolkits, we would take features of the courses. That the participants were completing and we revamped them to speak the language of frontline staff that way as the participants were going through the courses if they wanted to, they could offer these toolkits to their staff and it was just a easy, immediate way to start implementing some of what they were learning at the staff level overall, what I think really stood out most to participants based on the feedback we received was the program's practical focus.

Having these type of tools and strategies that they could immediately implement to address staffing challenges, improve their workplace culture, and enhance care for residents was something they really appreciated. That's fantastic. And I love the focus on infection control. I think that should be the main focus in nursing homes right now.

I think that's what the pandemic taught us. So I love that aspect of the program. Thank you. So the CMS Nursing Home Employee Satisfaction Survey, it's an important tool. It assesses workplace culture. Can you explain its purpose and share any insights or trends you observed from the survey results regarding the participant experiences in the program?

Absolutely. So, as I mentioned earlier, the CMS Nursing Home Employee Satisfaction Survey was one of the participant facing data pieces that we collected as part of this program. And really, to my surprise, it ended up being the data piece that was the most submitted across the program as a whole. And in short what it is, it's a, it's a paper survey.

You can easily Google it and download it online. It comes with a free data analysis tool that gives a lot of really great information based on the survey results. The survey takes about 15 minutes on average for an employee to complete, and it really allows nursing home leaders to gather feedback from their employees anonymously and help identify areas for improvement.

One of my favorite parts about this survey is how it's organized. Each section of the survey is categorized into five critical areas of employee satisfaction. And as the results are entered into the data tool, uh, there's a, there's a scale rating that starts to develop in the data tool from 0 to 5. So, 0 being low employee satisfaction to 5 being highest employee satisfaction and of the facilities who completed this survey during the program.

We saw. The most opportunities for improvement or the lowest scores in the area of training, which included things like high quality in services and professional development offerings, many times staff felt that they didn't have enough of these types of opportunities. Uh, we also saw lower scores in team building and communication and the area that saw high scores on average was management and leadership.

Those are some great insights, and I I love that you could pinpoint those. Um, it's it's important. Such important insights. So as every week, there's always challenges with every any program. So what challenges did you encounter that hindered full participation and engagement in the program? And what strategies were implemented to address these barriers?

Yes, I think any type of program like this, especially programs that have this many moving parts and pieces, it, you're gonna have challenges. It's just part, part of the process. I would say the three biggest challenges this program faced. We're first of all, the capacity of a participant to really be able to dive in and get the maximum benefit of all that this program had to offer.

It's very challenging when our participants are pulled so many different directions, or maybe when they registered, they thought that they were going to have time to do this. But once they got started. They were overwhelmed with other responsibilities and couldn't finish. So that was one of the big challenges that we ran into.

Secondly, in this particular audience, We, um, had varying levels of technological skill. So some of the participants were able to just hop right into the learning platform, collect and submit their data, navigate to the resources. And we might not ever hear from them from the beginning of the program to the end.

They were just very self sufficient while others who maybe were more technologically, technologically challenged needed some more technical assistance to be able to participate. And depending on how much technical assistance they needed, that became a barrier for some of our participants. And then finally, some of our participants really struggled with lack of leadership buy in if especially they came into the program as a solo participant.

Sometimes they couldn't implement what they were learning or get all of their data collected because they struggled with that leadership buy, buy in piece to give them the green light to proceed with what they needed to do in the program. I mentioned earlier that the program was divided into cohorts and in looking in the data and feedback from the very first cohort.

It really became clear early on that we needed to leverage our quality improvement specialists to personally connect with the participants to help answer questions, assist with the data collection, and then just to serve as another point of contact for the program. And we did leverage this approach in cohorts 2 and 3, and it was absolutely beneficial to engaging the participants.

Thanks. So we were monitoring then feedback from the QISs. We were also looking at feedback we were receiving from the participants as the cohorts progressed. And this was wonderful because as we saw these challenges start to pop up, it created space for us to be able to revise and adjust course content.

Maybe some of how we were explaining the data points, we were able to make those adjustments to help participants be able to navigate the program in a way that really worked best for them. Yeah, I think that flexibility is so very important for the success of any program. So, I'm sure you learned many valuable insights.

Can you share some of the key lessons learned throughout the implementation of the program that might inform future initiatives? Yes, so you already mentioned staying flexible, which is one of the key things we took away from this. But truly, staying adaptable and listening to participants is key. We checked in with the participants regularly and the fact that we could be open to making changes along the way And adjust to their needs really help make the program even more relevant and impactful for everyone involved.

And we also realized that programs like this one that extend across several months are really best received and implemented when you have a team of people from the facility to participate. Um, in our later cohorts, we really encourage the participants to bring along at least one other. person with them to help because it was a lot of work.

And we did have several participants who joined the program on their own. And these most often were the individuals who had the most challenges, either because of the lack of buy in or just their limited capacity to implement the things that they were learning. Yeah, always important. I think to do things as a team if possible.

Um, definitely. So everyone loves to hear success stories. Can you share a few impactful success stories from the participant that I like the program's effectiveness and positive changes they experienced? Yes, I You know, prior to coming to Quality Insights, I was an LPM by trade for, like, 15 years before I came to Quality Insights.

I know how challenging the work environment is and even as we were developing this program with my past work history, I was forecasting that we might have potential challenges with the program just because of the amount of work that was involved. So when we got to the point in the program when we saw facilities really digging in and doing this work and caring about the quality of work that they were doing and finishing the program, I was just ecstatic because I really do appreciate all of the work that these facilities did.

And I just think, I think it highlights that facilities do want to create stable staffing environments at their facility, but they have to have the tools. They have to have the support and the practical resources to be able to make that happen. And I really think. That is one of the key gaps that the nursing home industry has experienced over the decades.

Just the lack of that support in this specific staffing area to be able to make the changes that need to be that need to happen. So, one of my favorite success stories came from a facility. Who had really breezed through the program. They did all the courses, all the data collection and they submitted everything, but even though everything had gone smoothly for them, they were really struggling to implement the join work assessment kit.

That was 1 of the data elements that we had mailed to them. Just the way that that particular assessment was structured just was not a great fit for their facility. And most times in this program, if the facility couldn't make the connection between the data element and what they do, they just want to do it.

That was very normal. But this particular. Facility opted to schedule a call, uh, with their quality improvement specialist and myself, and we spent some time talking about other ways that they might be able to use the kit that we had sent to them. So for them, they were experiencing an extremely high level of turnover among their staff who were in their initial 90 days of employment, so they were able to adjust that assessment kit a bit, and they started using it with their new hires to help open the door of communication with them and try to catch some of those Issues early on before they quit altogether.

And again, to me, that just really summarizes the beauty of having a flexible program where we can be open to making adjustments so that the tools can be relevant to the facility and their unique needs. This particular facility's ability just to be creative and innovate with what was given to them was really inspiring to see.

And I also want to add that we had a couple LPN who joined the program. There were only 2 or 3, but they did an outstanding job with this project. They were, in most cases, frontline staff. They had a desire to see improved staffing in their facility, and they really took it upon themselves to work the program, collect the data, and they consistently completed the program, which I thought was so impressive.

I really think this amplifies the idea that staff want to enjoy their working environment. And if leaders can find staff like this to get on board with them to help make improvements, I really do think we have a shot at improving workplace cultures and staffing stability. Yeah. And again, flexibility is key.

Yes, definitely. So last question, looking ahead, what are the future directions for the program? Are there any plans for expansion, adaption, adaption, or new initiatives that aim to further improve staffing solutions in nursing homes? Yes, we are readily looking for opportunities to expand this program, and we already have done this on a small scale with one of our other projects at Quality Insights that serves behavioral health clinics in West Virginia.

Uh, the program that we designed for that particular project was much simpler. Uh, honestly, it would probably be, More on the scale of a Kirkpatrick level one, like did you like it? Very, very minimal because that was just the capacity that that project had. But moving into the future, we'd really like to continue adapting this content to forecasted needs like staffing stability and patient safety or emergency preparedness, for example.

And I'd also really like to see something like this tailored for use in other kinds of healthcare settings like clinics. Um, I think the goal is just to keep evolving this program so that we can keep helping healthcare workforce, um, keep strengthening the staff, encouraging them and just continuing to make a difference.

I love that. That got me very excited. I will just say I'm a huge fan of patient safety. So anything around patient safety gets me very excited. And I'm just gonna say that I am a huge fan of this program. I feel honored to have participated in it, to continue to participate in it as anything that improves staffing in nursing homes and improve morale and teamwork and give.

nursing home staff joy and meaning in their work is something that I feel is so very important. So Amy Porter, thank you so much for the work you've done and continue to do on this project. Thank you, Dr. Storm. And I really appreciate all that you did to help to support the project as well. So how, just last thing, how can, um, if individuals are interested in learning more about the program, um, how can they have, get more information?

Sure. Uh, individuals who would like more information, it would be fine. If they reached out to me, my email address is aPorter@qualityinsights.org, or you can also visit the Quality Insights website at any time to look at some of the great resources that's offered by our Quinn qio. The web address for that is quality insights.org forward slash quinn.

Again, Amy, thank you so much for joining us. Thank you, Dr. Storm.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.