Do LTC Homes in Ontario or Canada need a 'One Voice' organization?

In the Ontario Long Term Care Network discussion group of LinkedIn, Andréa Catizone posted a link to a blog post: What the Senior Living Industry Can Learn FromThe Evolution of The Hotel Industry. 

Following, are my comments after reading that blog post.

It's an interesting analogy, comparing senior living and nursing homes with hotels/motels but, like most analogies, it limps in some important respects apart from the obvious differences in populations.

1. The hotel/motel industry in the USA is highly competitive as operators try to fill beds that are often empty; every Ontario LTC Home has a rather long waiting list that is largely controlled by the local CCAC which affords special consideration for the most needy, driven in turn by the need for hospitals to vacate beds occupied by non-acute-care patients.

2. The Ontario Long-Term Care Act has resulted in a highly regulated licencing system and corresponding reporting (CIHI, HQO) and inspection systems that ensure, at least in intent, a minimum standard of care and quality of life for residents along with a Residents' Bill of Rights. I don't think that the US hotel system has anything close, does it?

3. The real or imagined need for most Ontario LTC home operators to have a good, strong public relations image has resulted in the quest for accreditation to a standard in certain operational aspects over and above the requirements for a licence from the Ministry. At least one LHIN, I am told, has made accreditation mandatory. Interestingly, a statistical analysis that I did showed no positive correlation between accreditation and regulatory compliance in the 82 homes making up the two LHINs of my study. See LTC Homes and Accreditation, parts 1 and 2 at tcmc Quality Management Serviceson YouTube.

The thing that drove the changes in the USA hotel industry is identified as the interstate highway system. Why? Because it channelled and redirected travellers. I would propose that the equivalent for Ontario seniors is the role played by the CCAC's; that, and the about-to-explode-with-boomers population of seniors. As a result, the change that I anticipate will be the creation of many more for-profit LTC homes as private enterprise sees long waiting lists and a booming senior population as a business opportunity.

The blog ends by asking the question (of US operators), who will step up and create a national "One Voice" organization for all Senior Living operators? The Ontario equivalent is, do seniors' organizations need something beyond OLTCA, OANHSS and the like? It's a good discussion, no doubt, but I don't see the evidence, nor do I hear the public saying that we have an urgent need for one unifying association for Long-Term Care Homes and seniors' care organizations. The pressing discussion in Canada seems to be reported in the latest CMA poll: Canadians want a national strategy for seniors health care:doctors report. 

Does a Speedometer Prevent You From Speeding?

When you drive your car you can avoid being given a ticket for speeding by checking your speedometer and taking your foot off the gas pedal if needed, maybe even touching the brake. You can also be distracted and not look at the speedometer. The mere presence of the speedometer will not guarantee that you do not get a ticket for speeding.

You could even have someone in the back seat (or passenger seat) watching the speedometer and nagging you that you are going too fast and still choose to ignore them.

You can have Required Organizations Practices (or ROPs), Accreditation or Certification Surveys, Quality Committees and regulatory reports, and an annually revised Quality Improvement Plan, but none of these will guarantee regulatory compliance any more than a speedometer because, ultimately, it’s up to the driver.

Who is the driver in your organization? That’s a trick question, isn’t it, because it is not usually one person but a team of key decision makers and influencers, some from the Board of Directors, others from the Board of Management, and probably others as well, like staff who have the respect of their peers when they speak. This group of people, if they are working together as a team, are the influencers with the power to create and nurture a culture of quality in an organization, but only PROVIDED they keep an eye on the dashboard and, as a team, respond appropriately with the pedals.

The question is, are the process owners and managers sufficiently mandated and empowered, trained and resourced, and held accountable to take the actions necessary to enhance the quality management system and foster a culture of quality to prevent the bad stuff happening?

Applying Lean Manufacturing Principles in Healthcare

The Spring 2014 issue of Healthcare Management Forum has an excellent article by Chattergoon, Darling, Devitt and Klassen on taking Lean Six Sigma principles developed by Toyota and others for the manufacturing industry and applying them with great success to Healthcare, in this case the Toronto East General Hospital (TEGH) and, especially, its Emergency Department (ED). From such a leap, it surely must be a relatively small step to applying these same Principles in other Healthcare arenas such as Long-Term Care Homes.

You can read or download the article here:
Creating and sustaining value: Building a culture of continuous improvement

The central message can be summed up in this quotation from the article's abstract: "enabling continuous improvement in an organization is about an entire cultural shift—not just a series of rapid improvement events."

A culture of continuous improvement evolved organically at TEGH in three key phases:

Phase 1: Setting the stage. 

The organization made a commitment to quality and value explicit in its vision and through its strategy, creating a department dedicated to improvement and innovation - the TEGH Improvement System (TIS).

Phase 2: Team-driven performance management. 

The leadership team promoted and modelled a "huddle philosophy",  which allowed units, departments, and programs to identify new improvement opportunities, monitor performance on improvement projects, and sustain gains. The voice of the patient, obtained through interviews and videos, was made a cornerstone of the huddle philosophy.

Phase 3: The daily management system and cross-appointment model.

A daily management system, called Management Made Easy (MME),  was created to allow units, programs, and portfolios to identify and proactively address improvement opportunities before they blew up into large-scale problems. A cross-appointment model was adopted where staff members outside of the TIS team were given weekly-portion appointments to the TIS team to be  coached and acquire experience with the TIS team through involvement on improvement projects. Conversely, TIS team members are also given 'portion' appointments to work on improvement projects in departments such as surgery or medicine, thereby giving coaching exposure to entire teams.

Successes.

TEGH can boast about a number of successes as a result of this culture of continuous improvement, most notably that of having the lowest Emergency Department wait times for admitted patients in Toronto Central LHIN (from being one of the worst) and reduced length of stay for patients with chronic obstructive pulmonary disease by 46% through improved quality-based procedures (QBPs); all this while seeing improved staff satisfaction ratings.

The organization has documented a list of telling "lessons learned". At the top of the list is the need to adapt and translate LEAN improvement principles from their original industrial and manufacturing context to the local situation at TEGH.

You can read or download the entire article here: 

Creating and sustaining value: Building a culture of continuous improvement