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Focus on the Quality & the Stars Will Come

A profile of Presbyterian Manors

By Laura Kuhn

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Many long term care communities operate with a goal in mind. Maybe it's to achieve a perfect survey, or earn a five-star rating. According to Susan Fry, the Vice President of Clinical Services at Presbyterian Manors at Mid-America, this isn't the way to go. Instead, if you focus all of your efforts on delivering quality care day after day, the rewards will find their way to you.

This approach has certainly worked for Presbyterian Manors. The organization has 17 communities in Kansas and Missouri, the majority of which boast a four- or five-star rating. "To us, the Five-Star Quality Rating System was a nice grading card on what we thought was already our good work," Fry said. "Focus on the quality and the stars will come."

Fry joined the team at Presbyterian Manors seven years ago. She's a self-described "convert" from the acute care setting, where she spent 30 years. A friend of Fry's had heard about the opening at Presbyterian Manors and encouraged her to consider it because the company was looking for someone with multi-campus experience who also knew a lot about nursing processes.

Joining Fry on Presbyterian Manors' staff is Jarene Fluker, the organization's Director of Quality and Risk Analysis. Like Fry, she didn't start out in long-term care. Instead, began her career as a recreational therapist working with people who had developmental disabilities. From there, she moved into management and eventually joined Presbyterian Manors on the disability side in 1994. In 2001, she was named the organization's Director of Quality and Risk Analysis.

Even though they didn't begin their careers in long-term care, both women became familiar with it at a young age. "I started volunteering in long-term care as community service when I was 13," said Fluker. "Back then, if you didn't have anything to do, you went and volunteered!" Fry's grandmother, an LPN, used to take her to the nursing home where she worked and have her spend time with the residents.

Mission-driven

Presbyterian Manors' mission statement is "To provide Christian-based retirement living and health care services through a continuum of care, dedicated to the values of service, respect, dignity, and independence." According to Fry, it's a mission that the employees at Presbyterian Manors hold close to their hearts and something they discovered pairs well with quality initiatives.

"We've always been a very mission-focused organization, but the Quality First initiative from AAHSA gave us something to wrap our arms around in terms of integrating that quality with our mission," Fry said.

The Quality First initiative encourages long-term care communities to adopt seven principles in order to establish a solid motivational foundation for improving quality and resident satisfaction. The seven principles are:

  1. Continuous Quality Improvement
  2. Public Disclosure and Accountability
  3. Patient, Resident and Family Rights
  4. Workplace Excellence
  5. Public Input and Community Involvement
  6. Ethical Practices
  7. Financial Stewardship
"Using Quality First, we began to really focus on hiring quality employees and monitoring what we do on a regular basis," said Fry. "We also use evidence-based practices and standards." Fry added that Presbyterian Manors has a "really good group of Health Services Directors who are very committed to quality, evidence-based practice and high standards. We don't have much turnover in our HSDs."

Tackling challenges

No organization is perfect, of course, and Presbyterian Manors is no exception. One of the organization's communities was recently given only a two-star rating. Fry said that community is now under the guidance of a well-prepared and dedicated HSD who is master's prepared. The HSD also has full support from the corporate level as she works to make the community more focused on outcomes and standards. Ironically, that particular community has the highest resident satisfaction rate of all of the Presbyterian Manors homes. "The residents have argued more than once with a surveyor about the survey results," Fry said.

PRESBYTERIAN MANORS AT A GLANCE

  • 17 not-for-profit retirement communities in Kansas and Missouri
  • The organization has a covenant relationship, but not any kind of fiduciary relationship, with the Presbyterian Church
  • Employ more than 1,800 people and serve more than 2,100 residents
  • To learn more, please visit www.presbyterianmanors.org

A commitment to person-centered care

The Presbyterian Manors communities are united by their commitment to person-centered care, although this means different things at different communities.

"The interesting thing is that because we're in all these different communities, there are different focuses," Fry said. "Person-centered culture takes on a bit of a different look from one community to the next." A good example of this is dining. Residents at some facilities prefer menu dining while others would rather choose their food from a buffet.

The success of Presbyterian Manors' dedication to quality and person-centered care is evident in the communities' census. "We've always been up in the 90s," said Fry.

Collaborative survey preparation

When surveyors arrive at a Presbyterian Manors community, it's highly unlikely that they'll find staff members who aren't prepared for their visit. Presbyterian Manors has five corporate nurses, one of whom focuses exclusively on pre-survey work and best practices. "Her focus is clearly one of the keys to our performance on surveys," Fry said.

The chain also focuses on educating staff members on a continuous basis. Presbyterian Manors has adopted a videoconferencing service that links all of the communities to the home office. This setup allows for a large number of employees to attend in-services. "It's not unusual for us to have 100 people in on an in-service," said Fluker. The sessions are also recorded so that they can be used again and again.

Presbyterian Manors also has a scholarship program that has benefited many of its employees, including a woman who started in the kitchen and was able to obtain the education she needed to become a DON at a community that consistently earns zero-deficiency surveys.

The majority of Presbyterian Manors' communities are located in Kansas, which has already implemented the Quality Indicator Survey, or QIS. "We believe that the QIS has helped us – not at first, though! It was a rough road," said Fry. "The way that the surveyors get their information in the system, we know what the issues are going to be. What we do is monitor those issues on a regular basis and include all of that information in our community QI work. We don't wait for the surveyors to come in and tell us that we have a problem. We're very rarely surprised."

This all-encompassing approach to quality has helped Presbyterian Manors' communities cement their reputation as top-notch places to call home. "We believe that the best advertising is your reputation," Fry said. "Therefore, your reputation should be structured around meeting resident and family needs."