The Promise of the Baldrige Framework for Nursing Home Excellence

I’ve spent a significant amount of time as an adult visiting people in nursing homes (also known as long-term and post-acute care facilities, or nursing care centers). The practice started when I was in college and joined a student-run volunteer program. I was first paired with a blind, wheelchair-bound resident of a nursing care center. At 96, she was still an avid reader, so I mainly spent our visits reading poetry aloud to her and facilitating her use of audio books. Over the following decade in other cities and counties, I continued to provide occasional company for lonely, usually elderly residents in similar facilities as a community volunteer. Eventually, my dog became my more-popular partner for many of those visits.

After a hiatus in such volunteer work for a few years while I juggled the demands of growing children and my career, I resumed visiting senior citizens in nursing care centers about five years ago. By then, the residents I came to see were my own mother-in-law, followed by my father. At that time, I appreciated from personal experience the favorable impact of the Baldrige Excellence Framework (which includes the Health Care Criteria for Performance Excellence) in promoting excellence in U.S. nursing care centers.

These days, I have another elderly family member to visit in such a place. She’s an aunt of mine who doesn’t have children but has always had me. She first entered a “rehabilitation and health” center to recover from surgery after an injurious fall. Her condition continues to require a level of care beyond what we can provide in her previous home. Although I visit her regularly to support her needs—including that of knowing she has a family advocate no matter where she lives or whether her health further declines—I have reason to believe she would receive good care regardless of my monitoring. Besides other quality indicators I’ve observed first-hand or checked online in publicly reported data, her facility has earned recognition in the Baldrige-based, continuous-improvement program of the American Health Care Association (AHCA)/National Center for Assisted Living (NCAL).
    

The AHCA/NCAL award program belongs to the nonprofit Alliance for Performance Excellence—a nationwide network of state, regional, and sector-specific Baldrige-based award programs and a key partner of the federal Baldrige Performance Excellence Program. Using the Baldrige Health Criteria for Performance Excellence as the basis for organizational assessments, the AHCA/NCAL program offers three tiers of recognition annually for participating organizations that provide long-term and post-acute care services in the United States. Those progressive award levels are Bronze (“Commitment to Quality”), Silver (“Achievement in Quality”), and Gold (“Excellence in Quality”).  

Since 2004, 38 organizations throughout the United States have earned the third level of recognition in the AHCA/NCAL award program. They include four 2018 Gold Award recipients that were announced in early August. Each is now eligible for five years to apply for the Baldrige Award—the nation’s highest and only Presidential honor for organizational excellence in U.S. business, nonprofit, health care, and education sectors alike.

Two years ago, Kindred Nursing and Rehabilitation–Mountain Valley (now Mountain Valley of Cascadia) became the first Gold Award recipient in AHCA/NCAL’s National Quality Award program to proceed to earn a Baldrige Award. To reach that high performance level, the 68-bed, skilled-nursing facility in Kellogg, Idaho, used Baldrige Health Care Criteria-related feedback from the AHCA/NCAL and Baldrige Award programs to help it determine key strengths to leverage and prioritize opportunities to improve.

As highlighted in a previous blog, the 2016 Baldrige Award recipient’s strengths as a national role model include creating and maintaining an organizational culture of safety, empowerment, innovation, excellence, and “no fear.” With that culture in place, the organization has been able to better address industry-wide challenges such as high staff turnover and a shortage of candidates for registered nurse (RN) and licensed practical nurse (LPN) jobs. (It meets the hiring challenge in part through a “grow-your-own” strategy that supports training for LPNs to become RNs, for nursing aides to become LPNs, and even for some housekeeping staff members to become nursing aides.)

Given our nation’s growing population of senior citizens, a greater number of Americans than ever before are likely to become residents of skilled-nursing facilities in coming years and decades. They can rest assured that those organizations already must meet many regulatory requirements promoting the health and safety of their short-term (post-acute-care/rehabilitation) and longer-term (nursing care) patients and other residents. But for the greater well-being and satisfaction of such customers—and the employees who serve them, too—who would not want organizations that provide nursing care and homes for incapacitated people to meet criteria that go beyond regulatory compliance to demonstrate excellence across all care-giving and operational processes?

I have personally spent enough time as a regular visitor in such organizations (10 different facilities in two states!) to understand how a focus on achieving comprehensive, customer-focused excellence at these sites could make a positive difference in the lives of people who live, work, and otherwise see themselves as stakeholders in them. As someone in the latter group, I salute the four new 2018 Gold Award recipients of the AHCA/NCAL award program—and wish them well as they continue their journeys of excellence. 

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