Clint Maun, CSP

The healthcare profession is dramatically changing. These changes cause us to "pause" and look at the delivery of our services. It is important to continue providing services 24 hours a day to all customers. However, all 24 hours are not equal in terms of their importance to the customer or us related to reimbursement/regulatory issues. We're suggesting that an organization must create a view on their facility that is different from the past.

In today's healthcare organizations, 6 a.m. to 1 p.m. sets up the attitude for the remainder of the day. In other words, if you can set up and deliver services effectively in the first 7 hours, it will make a vast difference in the final seventeen. We're not suggesting that the final 17 hours don't matter. We are saying that the first 7 hours are critical to the delivery of an entire day of care for nursing home residents. In addition, those 7 hours at the beginning of the day affects regulatory compliance and reimbursement issues.

In those first 7 hours there are many issues to address. In fact, 4 of the 7 hours are spent in pre, post and the actual dining experiences for residents. Two of the three meals for the day are delivered in those 7 hours. However, many facilities are wearing out those 7 hours. Besides the fact they have two dining experiences for the day, they also have crammed into that time frame issues such as:

1. Housekeeping activities.
2. Activity programs.
3. A majority of the therapy programs.
4. Maintenance projects that could be reassigned.
5. Vendors selling.
6. Corporate officials and regional management team member visits.
7. Care plans conferences, department head meetings and specific departmental meetings.
8. In-services taking employees away from the floor.

And the list goes on & on....

We're pointing out that, 1) most of the regulatory issues of a critical nature that affect us will happen in those 7 hours, and 2) a considerable amount of our PPS Medicare reimbursement paperwork and other related reimbursement for delivery of service occurs in those 7 hours. If we're not going to take care of and protect those 7 hours, we're not going to have success. Many administrators and DONs are stuck in their office doing paperwork or attending group meetings during that critical period of time. We believe they should be on the floor assuring the first 7 hours are successfully implemented. Then we can conduct meetings, in-services, conferences, paperwork, etc. in the afternoon.

We also must look at how we access the entire day of stay. If everyone is in bed either by their own choosing or our choosing by 7:00 or 7:30 p.m., isn't that by default the start of the night shift? We're not suggesting you begin the night shift then, we're suggesting you should merely look at the issue. If the day doesn't start off well, but we're in the middle of passing the baton for the shift report between the night shift and the morning shift at 7:00 a.m., is that functional any longer? Are we taking a half hour in some cases, for "mud wrestling" to occur during that half hour period of time when it's more effective to have considered an reengineered start up of the shift?

It's important to note as we provide consulting and speaking on this issue, that this has occurred because of the one word in healthcare that has to be eliminated. We for years operated under concerns about the four-letter word, "fair". People worry about, "that's not fair because I don't get the same days off as they do", "that's not fair because I've got a different care load than someone else", "that's not fair because I didn't get off at Christmas time and the other person did", "that's not fair because I have more files to work on than the other person", etc. These problems must go away if we're to be successful. Different members of the team have different responsibilities to complete based upon the needs of the organization and our customers. It also includes the fact we now have an unfair reimbursement system under PPS.

The facility is paid for care differently based upon the various needs of the patients. This differentiating concept causes us to look at how we operate the organization. While it's true many facilities don't need an entire, total reengineering to be successful, they do need to take a strong look at how they're going about delivering the services in the most cost efficient and effective manner. The list mentioned above is designed for the organization to take a look at the critical factors affecting their ability to be successful.

Is it possible to run maintenance projects at a different time or on weekends? Could we change the housekeeping activity or in-service schedules to more appropriately affect the delivery of services? Are we going to be available during the critical times of the day so we can ensure the important items are completed as necessary? Can we look at issues of relationships with vendors and corporate or regional staff to determine the most effective time to meet with them? Can we reengineer our paperwork and meeting times effectively when it's less critical? These questions are up to individual facilities to review.

This article is not designed to change everything. Rather, it's designed to motivate people to take a hard look at the fact that 7 hours do set up 17 for success and it's never been more apparent than it is in today's healthcare facility.

For more information on reengineering your workday, click here.