Back at their conference in December, the National Forum on Quality Improvement in Health Care tackled one of the biggest issues facing an aging population: What can we do right now to ensure that we pass on a culture of employee responsibility in long term care to the next generation of caregivers?
During the conference, Planetree Coaching and Consulting presented on one of the building blocks of accountability open communication. Planetree is one of many organizations working to transform the healthcare experience through structured processes that change the way employees interact with clients. They identified both engagement with the families of patients and involving employees in designing the improvement program as key to the success of these processes.
The problem is that front-line employees may not even report to the managers responsible for delivering excellence and respect to their long term care patients. Outsourcing may be a necessity, but often tends to be a weak link in the accountability chain. Currently, there are around 17,000 facilities for long term care in America, estimated by the Family Caregiver Alliance. Between 30 and 40 percent of those facilities end up outsourcing part of their operations. Administrators find that this complex relationship requires a great deal of tending and development, with regularly scheduled monitoring and assessment sessions.
Open communication channels – What it really takes to achieve a culture of accountability is a three way conversation between patients, employees, and management, where all three are able to view themselves as co-fiduciaries. All must come to realize that they share the burden and rewards of stewardship and improving long term care for the entire American population. Sites like the Senior Housing Forum have begun to spring up for precisely this reason. They provide an open an candid space to discuss the most vital and practical issues. The forum has been able to strengthen its underlying co-fiduciary concept by involving employees in daily, practical decisions grounded in ethics. At the same time, senior management and non-patient-facing departments are drawn into conversations where they can realize that their decision have ramifications for organizational ethics and accountability.
Advocacy, education, and outreach – Non-profits like LeadingAge demonstrate the second step toward reaching a population that will be soon, if not already, dealing with these thorny issues. Aligning the financial needs of the business with their patients’ needs in terms of accountability brings all the players to the table with an identifiable goal and common definitions. Performance management software, for example, is a great way to track progress and produce reports that further the needs of communicators.
Resolving conflict of interests – The third step involves finding a way to align the needs and responsibilities of disparate parties within an organization by first identifying conflicts of interest. If theses originate from organizational policies, brainstorm ways to correct it. The Association of American Universities discussed this in detail in their report on addressing institutional conflict of interests. Just by treating employees and patients with respect and listening to their ideas, management can go a long way toward demonstrating the accountability culture they intend to foster. Finally, economic incentives should reward excellence up and down the accountability chain.
In the final analysis, a long term care organizations policies and caregiver behaviors alongside the allocation of resources are the visible and remain the only reliable indications of what they value. These create the organizational culture, whether or not it was intentionally directed that way. An accountability culture spreads from the top down, so consider how health care managers model for employees what they encourage, what they reward, and most of all, what they will tolerate.
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