Cooperative Project Addresses Quality at Rural Nursing Homes

Oct. 23, 2009
Tobie H. Olsan, Ph.D., M.P.A., R.N.

Studies show that older adults in underserved and rural communities bear a disproportionate share of illnesses and disabilities compared to their counterparts in urban areas. But a University of Rochester School of Nursing researcher believes that increasing networking opportunities and introducing advanced quality improvement (QI) methods to nursing and other staff at homes in these areas may remedy this disparity.

Tobie H. Olsan, Ph.D., M.P.A., R.N., associate professor at the School of Nursing, is working cooperatively with several local organizations to provide QI training at selected nursing homes. Her efforts are supported by a recently received three-year $513,000 training grant from the Health Resources and Services Administration (HRSA), which builds upon a 2001 Institute of Medicine report linking staff involvement in QI with ensuring that more older adults have access to safe and high-quality care.

“Our project uniquely focuses on building the infrastructures and collaborative relationships fundamental to achieving excellence in resident care,” said Olsan, whose grant enabled the creation of the Greater Rochester Nursing Home Quality Consortium (GRNHQC), a forum that brings leaders and staff from nursing homes outside of Monroe County together to exchange ideas and collaborate on implementing best practices in resident care.

While rural nursing homes have been communicating with each other, the Consortium enhances these efforts with newer QI methods and resources to support staff training and coaching on-site in nursing homes.

“This presents a tremendous opportunity for us to learn more and share with each other on topics that are germane to long-term care,” said Eileen Gage, M.A., R.N., vice president of nursing at Finger Lakes Health, which operates three homes participating in the Consortium.

Six member homes in the first year of the grant will work with Olsan’s project team on QI topics they specifically want to address through the lens of Lean Six Sigma (LSS) methodologies, which use data and statistical tools to measure and improve processes, finance and clinical quality. These include prevention of falls and skin breakdown, transition of residents from hospitals to nursing homes, prevention of medication errors, pain control and improved care for residents with dementia. 

Locally, LSS has been used by businesses and health systems to foster excellence in products and services. Transitioning the process to nursing homes is a logical step, said Reginald Stewart, an LSS certified master black belt who works with the Greater Rochester Quality Council (GRQC), an affiliate of the Rochester Business Alliance. “LSS will work in any business or organization because it is about improving work processes. All nursing homes utilize similar processes to conduct their business,” he said.

In addition to the GRQC, Olsan’s other co-collaborators include the University of Rochester Medical Center’s Division of Geriatrics and Aging and the HRSA-funded Finger Lakes Geriatric Education Center of Upstate New York (FLGEC-UNY).

“The idea of going into individual facilities and teaching a self-sustaining process is the beauty of this project,” said Paul R. Katz, M.D., community medical liaison for the Consortium and director of the FLGEC-UNY. “Other interventions to improve quality have been tried, but most are fairly limited in their potential. Here, the tools are given so that facilities can continue to improve long after the project ends.”

The project calls for the first six nursing homes to complete their training and identified projects within 12 months. An additional six homes will be recruited and go through the same process each of the next two years. Nursing homes that complete their training will remain members of the Consortium, continuing their work and mentoring new participants.

With a total of 51 nursing homes serving older adults in greater Rochester’s underserved and rural counties, there is an ample pool from which to pull project participants.

“To create a successful network, we selected homes that already have an unfailing commitment to putting quality of resident care at the center of all they do,” said Olsan. “Leaders must be highly visible champions of quality improvement and remove barriers to change. Employee teams have access to data and coaching to clearly define and analyze problems.”

The facilities taking part the first year range in size from 60 to 190 beds.

 “The training in QI and leadership skills provided to teams of nursing home staff through the Consortium will transform how we approach improvements in long-term care,” said Suzanne Gillespie, M.D., R.D., assistant professor of medicine at the University of Rochester Medical Center and education director for the project.