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The innovative strategies that won Comer Health and Rehabilitation an AHCA Gold Quality Award

For long-term-care facilities, the American Health Care Association (AHCA) Gold Quality Award is a coveted prize. It recognizes superior quality of care and is a rare honor. Since the Award’s inception in 1996, no more than a handful of facilities have earned it each year. This year, Comer Health and Rehabilitation (Comer) received it. We had a conversation with Comer administrator John “Bo” Dalton to find out how the organization achieved such a sought-after recognition, and what they learned along the way.

  1. Walk me through your Quality Award journey, specifically your journey from Silver Achievement in Quality to Gold Excellence in Quality.

I worked alongside the director of nurses (DON) during the initial application process for our gold and silver awards. worked to find the largest opportunities for improvement and determined how we, as an organization, were going to implement new strategies to approach the improvement process. The biggest thing we had to do at Comer was show continuous improvement and learning among staff.

Thus, at Comer, we ingrained continual improvement and education into our culture. We did not want to become complacent just because we had already gotten to a certain threshold of quality. This took commitment from administrators, DONs, and senior leaders. We all followed the award application criteria and really dug into why we were applying and what we wanted to get out of the process. Although we ultimately wanted to receive the Gold Award, our true desire was to do better for our patients. We wanted to improve their quality of care and deliver excellent outcomes. Once everyone in the organization bought into this mindset, we saw a real cultural change. Environmental services, dietary services, nursing staff, and everyone else began asking how they could help us achieve gold.

If there was one thing that was going to place us at silver rather than gold, it was our associate engagement—or lack thereof. We developed strategic initiatives that helped us overcome this concern. One specific initiative we executed was introducing Town Hall meetings. Town Hall meetings, as opposed to in-service meetings, invite everyone from dietary to housekeeping, nursing, and beyond. The idea here is to provide associates with an open forum where they can ask questions and provide feedback, rather than simply going over what needs to be worked on and re-hashing what has been brought up in prior meetings. The Town Hall meetings prompted associates to discuss what they were working on and how it tied back to the gold application.

Once this initiative was implemented, I was blown away by how well our employees were engaged and how much it empowered their own learning and improvement journeys. I always find myself wondering, as a leader, whether or not I have prepared my associates well enough for a site visit, and I constantly wonder how well they know the material related to our site visit. When it came to it, through our various initiatives centered around associate engagement, our staff always showed up prepared and ready to provide an exceptional experience to their patients. My biggest takeaway from this process was understanding just how important the engagement of your staff can be, and how much it can impact the care your organization provides.

  1. What impact did this application process have on customer and employee satisfaction? 

We have increased our customer-feedback and employee-satisfaction scores every year for the past three years. We have incorporated this in our Quality Assurance Improvement Program. Each year we sit down and review our employee-satisfaction data to determine opportunities for improvement. Last year we scored higher than in the prior two years, but we wanted to focus on areas where we were stagnant or lower-scoring in comparison. We broke the data down and found that our five lowest-scoring areas all linked back to communication.

We began working diligently to improve communication through various strategic initiatives. The first, mentioned above, was providing associates with a voice through our Town Hall meetings. We also created an open-door policy for both patients and associates to air and discuss concerns and ideas for improvement. We made sure to create a safe and comfortable environment in the DON office for this reason—for example, in the office, we always have candy available so that staff can come during their breaks to grab some candy and talk a little bit. These internal changes helped us see increases in our scores related to communication.

  1. Why is employee and customer loyalty so important in the current healthcare landscape?

There is so much competition in today’s healthcare landscape—within a 20-mile radius there are anywhere from six to 10 competing skilled-nursing facilities that staff could choose to look to for employment. We know it’s crucial to build relationships with our staff and create a family-like environment. If our staff members do not feel like they are appreciated or do not feel like they are a part of our Comer family, it would be easy for them to hop to another facility. Our family environment has been continually building for years, and we have begun to see a decrease in our turnover rate. In fact, our average tenure is now up to almost seven years. The happiness of our associates flows over to the care of our patients—if you have happy staff, your patients are sure to notice, because staff members are excited to go to work each day and provide high-quality care.

We offer short-term rehab to some patients. This is one of those services where we especially want them to have a good outcome and quality of care. Providing healthy outcomes to short-term rehab patients is a top priority, as it helps reduce the amount of repeat visits they have, and can lower the number of patients that need to come back for long-term care. In addition, we want to ensure that we provide an excellent experience and that we are committed to strengthening the relationships with these patients, because we know that our interactions with a short-term rehab patient now could be the reason that they choose our facility over a competitor when they begin to seek out long-term care options.

  1. Having achieved a Gold Award, what about that journey led to innovation for employees and customers?

By listening to the voice of our associates we have lowered our turnover rate from 75% to 35%, all within the last 18 months. One example of how we have done this is through our CNA Champion Program. Before implementing this program, we noticed that community members were getting CNA-certified and then were leaving our organization to work with a competitor. We asked our associates why they were not staying at Comer, and we found out that during orientation, the new CNAs had many questions but never knew whom to ask and/or didn’t feel comfortable asking our nurses. This is why we developed our CNA Champion Program.

This program makes sure that at least one CNA who is tenured, well respected on the floor, and always setting a good example is available to answer questions and address concerns that the recently certified CNAs may have. This program has helped us reduce our CNA turnover by reducing their confusion, getting them acclimated to the building, and making them feel like they are a part of the Comer family.

  1. What is one piece of advice you can share with others who are interested in pursuing, or are currently pursuing, the Quality Award?

My advice would be to embrace the journey. It has made such an impact on me, and it has helped me understand all aspects of how skilled-nursing facilities operate. It’s also crucial to always set the tone of continuous learning and improvement—you can never allow your organization to become complacent. It is so easy to get caught up in the day-to-day activities of your job, and you can easily lose focus, so you must continually remind yourself to keep moving and pushing forward.

Being on this journey—keeping everyone within our organization engaged, and discussing it with our associates—has really set a common goal for everyone. It is this common goal that has really led to our success. Embrace the journey, really take it on, and eventually the results will come.

Comer has worked hard to achieve the coveted AHCA Gold Quality Award. Bo Dalton has spoken to the importance of receiving this award, as well as the importance of continued learning and its role in improving the experience of associates, patients, and residents. We leave you with one last statement from Bo:

“You want to make sure it is important to you, and your organization, to have excellent outcomes. Not understanding or believing in the importance of excellent outcomes can be detrimental to your business, especially if you begin to see or hear negative comments out there. Following the quality journey has allowed us to achieve the excellent outcomes, quality measures, and five-star ratings our business needs to be successful. However, we need to keep building on this in years to come—we know our continued improvement will be a major factor in the placement decisions of our future customers, patients, and residents.”