One of the top questions I’m asked by clients, readers, students, and interested parties everywhere is how can my organization excel in a competitive environment. In other words, how can I build my organization’s value proposition such that the organization becomes the provider of choice in the market? My answer is always thematically the same: Be different in a way that is perceptible and tangible to the market and to the trends in the industry. Think Apple. Apple is constantly rolling forward new technology to feed the trends and its customer base iterations (the changes that occur among its customers as each Apple release begets more desired upgrade on behalf of the users).
Before I give out five rock solid strategies that any SNF can pursue, I need to frame what not to do first or specifically, what won’t work. First, building the organization’s Medicare star number by manipulating the input data on staffing, quality indicators, etc. Waste of time, perilous on a number of levels and ultimately, a no -win unless compliance surveys correlate to the 4 or 5 star level. Second, baiting, paying, cajoling and/or bribing referral sources (discharge planners and physicians). This is fraud and while it may work in the short-run, in the long-run it won’t plus its illegal (for those saying this doesn’t happen, guess again – I see it all the time). Third, marketing and advertising without the requisite pedigree to back it up. All the words and images don’t and won’t work if the product isn’t there and the experience on behalf of residents isn’t good.
On to the strategies. These work for a number of reasons but most importantly, because they are cutting-edge, fit the health policy landscape, and are patient/family centric. Additionally, none of these is expensive, though each requires some investment -just not mega-bucks. Once operative, each is a difference marker and likely, not repeated within a given market area.
- Excel at Food: Institutional food service whether outsourced or produced on-site is the bane of residents and families from a service and quality perspective. Further, it is unnecessarily clinical. The trend is complete de-institutionalization; top to bottom. First, ditch all diets – one general diet is fine and preferred. It is the facility’s job to manage resident weight, health, etc. and special diets just aren’t required. Second, quit modifying food products and fluids chemically or mechanically. Use food to create substitute products with recipes and to modify products for thickness, texture or consistency. Find a culinary school or good chef near your facility for pointers here. Have great food and diets that any resident, under any condition will rave over and the facility will rise immediately to the top of the market, at least in this category.
- Excel at Care Coordination and Advanced Care Planning: Advanced Care Planning is all about helping residents and families make good choices with regard to care and treatment decisions. Healthcare people and especially institutional care sites stink at this. Being great means knowing how to have the right conversation at the right time and having resources available to help people make good decisions. Think of how many dollars can be saved in everything from unnecessary meds, to unnecessary tests, to reduce hospitalizations, ER visits, etc. with proper communication around risks and benefits and individual choices. Likewise, great pre-admission planning and discharge planning wrapped around Advanced Care Planning will lead to fewer hospital re-admissions, more complete care on discharge, faster care on admission (fewer delays in care), and enhanced staff productivity (particularly nursing) as less time is spent on phone calls, communicating non-critical labs, etc. Excel at this and watch hospital referrers, physicians and satisfied residents/families laud your facility.
- Excel at Behavior Management: This is all about reducing unnecessary drugs plus improving the care of behavioral challenged residents. The latter includes the ability to “step-up” your rehab and restorative nursing programming, even for the dementia afflicted. This is all about training and employing the techniques that are available from organizations such as CPI and TCI (Crisis Prevention Institute and Therapeutic Crisis Intervention). Residents become medicated most often for staff convenience and conformity with the institutional environment. Train all care levels and support levels in how and why behavior occurs, make simple changes, and meet as a Behavior Team regularly and watch overall resident behavior decrease, staff confidence rise, crisis and panic reduce and residents and families become happier. Likewise, facilities which become really good at crisis and behavior management become a resource for the community – a center of excellence.
- Get Connected: For a minimal investment, get your facility on the web and if it already is, build its own ap! Develop a patient/family access point with all kinds of information and resources about everything common to resident questions, family concerns, etc. Use Skype as an activity and as an options for families to watch an activity, to talk to the doctor and/or to participate in a therapy session with their loved one. Connect with a local tech school or university for cheap talent maybe, talent which is free as part of an internship.
- Bring it In-House: This strategy requires the most investment dollars but again, not a ton if done right. The more internal capacity/competency that is available on-site, the fewer care transitions the facility will experience. Fewer care transitions = lower risk. Fewer care transitions reduces and/or eliminates, delays in care. The list here is lengthy but any of the limited following are inexpensive (relatively) and simple: I&Rs, mobile x-ray with digital results, on-site swallow studies via FEES, IV starts including PIC lines, fluoroscopy, Doppler studies, EKGs, in-house therapy (non-contracted). Each of these can be a simple, huge improvement and none require a six figure investment or even half of a six figure investment.
Accomplish any of the above, a few of the above or all of the above and communicate and market the same within the facility’s market area and start becoming the provider of choice.