HCA375: Continuous Quality Monitoring & Accreditation-Joint Commission Standards and Processes

Filling the Ranks Home Care Organization Innovates to Improve Staffing and Scheduling A ll health care organizations need the right number and mix of staff to be able to provide safe, high-quality care for their patients. According to Joint Commission Human Resources (HR) Standard HR.01.01.01, a home care organization must have the necessary staff to support the care, treatment, and services it provides. This can be a challenge for any health care organization, but the nature of home health care intensifies those challenges. In different regions throughout the country, LHC Group has an innovative system of staffing and scheduling practices—specific to each region—to ensure that sufficient numbers of staff are available to provide care, treatment, or services to their patients. (continued on page 14) Sufficient staffing levels are essential to proving safe, high- quality care.

Page 1 Copyright 2017 The Joint Commission The Source, February, Volume 15, Issue 2 About LHC Group LHC Group is a national provider of post-acute care services. It provides high-quality, cost-effective health care to patients within the comfort and privacy of their home or place of residence. The organization offers a comprehensive array of services through home health, hospice, and community-based services locations, as well as long-term acute care hospitals in its facility-based division. More than 60 hospitals and health systems across the country have partnered with LHC Group to deliver patient-centered care in the home. LHC Group is headquartered in Lafayette, Louisiana, and employs more than 11,000 people at more than 350 locations in 26 states.

Flexibility Is Key LHC Group’s large size requires the organization to be f lexible in order to meet diverse needs, yet still maintain consistently high standards for all its employees and locations. “We don’t have a one-size-fits-all solution to staffing and scheduling,” says Angie Begnaud, RN, executive vice president and chief clinical officer for LHC Group. “Staffing policies in each region are adjusted to meet the needs of that region, while still adhering to our high standards.” This f lexibility is the key to LHC Group’s staffing and scheduling successes, according to Brecken Anderson, RN, regional operations director for LHC Group’s Coastal Division. “The great thing about LHC Group is they allow us to keep health care local,” says Anderson. “What works in Atlanta, Georgia, doesn’t necessarily work in Jackson, Mississippi.” Meeting Everyone’s Needs Anderson explains that in the Coastal Division, which covers Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, and South Carolina, many of LHC Group’s branches in metropolitan areas have begun scheduling nontraditional shifts. For example, in addition to the standard 8 a.m. to 4:30 p. m . shift, they also offer shifts starting at 10 a.m. or 11:00 a.m. and ending at 8 p. m . or 9:00 p. m .. Others have instituted weekend shifts. These changes, made possible by LHC Group’s encouragement of local f lexibility, allow the organization to meet the needs of everyone involved in its provision of care. First, these new shifts meet the needs of its employees.

Anderson says that metro-area branches in her region were trying to attract younger recruits whom they could hire, train, and hopefully retain for a long time. But this created an unexpected challenge.

“Our recruiters in larger branches were having difficulty finding enough RNs who wanted the traditional 8:00 – 4:30 shift,” Anderson explains. They found that many of these potential employees wanted to start work later in the day. In some cases, the recruits have young children to get to school in the morning; in others, their lifestyle involves late nights. Flexible scheduling allows LHC Group branches to accommodate these needs, which both widens the pool of potential employees and provides a more satisfying work experience for those who are hired. Second, the new shifts meet the needs of LHC Group’s referring partners. Shifting patient populations and demand for home care was affecting patient f low from referrals.

Anderson gives the example of a patient who is discharged with an IV from the referring hospital at 5:30 p. m . Traditionally, the referral source would call the home care organization and get the answering service, then go through the process of waiting on a return call from the on-call nurse. With the new, later hours made possible by LHC Group’s scheduling f lexibility, a nurse would be dispatched right away. “The process f lows the same at 6:30 p. m . as it does at 10 : 0 0 a.m.,” Anderson says. Similarly, for branches that are able to offer weekend hours, the process would f low the same on Sunday as it would on Tuesday. Finally, and most importantly, the new shifts meet the needs of patients. Extended hours mean that patients have greater access to home health care at times that work for them, without dealing with an answering service. “Answering services are a great resource,” Anderson emphasizes. “But we have found that speaking immediately to a ‘live’ person results in better patient engagement. This leads to better patient care and satisfaction.” Seizing Opportunities LHC Group’s leadership team has been extremely supportive of its branches’ new scheduling patterns. From senior Filling the Ranks (continued from page 1) We don’t have a one-size-fits- all solution to staffing and scheduling. Staffing policies in each region are adjusted to meet the needs of that region, while still adhering to our high standards. Angie Begnaud, RN Executive vice president and chief clinical officer, LHC Group “ ” Page 14 Copyright 2017 The Joint Commission The Source, February, Volume 15, Issue 2 management to the state level to the branch level—all understand how LHC Group’s commitment to patients and meeting their needs requires f lexibility at the local level. According to Anderson, “Leadership has been on board with whatever needed to happen to meet the needs of patients, referral partners, and the organization itself.” Leaders have been very responsive to feedback coming from the field and has given branches the autonomy needed to respond to the needs in their particular areas. “In rural areas, it is often harder to find someone who wants to work a later shift,” Anderson explains. “However, the need for services is not there.” Larger metropolitan areas, though, frequently have both greater employee resources and greater demand for services. LHC Group’s approach is to embrace opportunities as they present themselves. “If a location has staff willing to work a weekend shift, it’s an opportunity to offer a service that others cannot,” Anderson says. “At LHC Group, if we see that opportunity, we can just do it.” Challenges Since instituting new staffing and scheduling processes in June 2016, Anderson has noticed one major challenge among branches in her region: Making sure that quality is not sacrificed for the sake of f lexibility. “Flexibility with hours does not mean f lexibility with expectations,” she says.

LHC Group branches that expanded their hours had to ensure that employee expectations were clearly defined and enforced. It was not enough to fill a time slot—the branch needed to be sure the individual filling that time slot was qualified and met the organization’s standards. The quality of care should be consistent, whether it is morning or evening, weekday or weekend. Another challenge LHC Group branches faced was being prepared. Branches that expanded their hours needed to have a plan in place for unexpected situations.

Without a plan, commitments may be broken and patient care compromised. As Anderson says, “If you’re open seven days a week because you have an employee who wants to work weekends, make sure you know what will happen if that employee calls in sick.” Evaluating the Impact The new staffing and scheduling policies have not been in place long enough to provide useful information on their impact on patient care, employee retention, or other relevant metrics. However, Anderson notes that employee turnover in the Coastal Division has been trending downward. She attributes this to greater employee engagement as a result of local branches’ ability to function outside the traditional scheduling box. LHC Group continues to monitor the needs of its patients, staff, recruits, and referral partners. “Global perspective on the organization as a whole is necessary, but it misses the detail at the local level,” Anderson says. LHC Group’s f lexibility lets the local branches respond to input from people in the field, which Anderson says has been critical to the organization’s staffing success. T S Page 15 Copyright 2017 The Joint Commission The Source, February, Volume 15, Issue 2