American Health Care Association

AMERICAN HEALTH CARE ASSOCIATION QUALITY IMPROVEMENT COMMITTEE Wednesday, February 16, 2011 8:30 am - 3:30 pm San Antonio Marriott Rivercenter – Texas

Members Attending:

1. Mark Anderson 13. Bob Lane 2. James Avery -- Chair 14. Regina Louis-Figueroa 3. Judy Bagby 15. Nancy Leveille 4. Chris Boldt 16. Jeff Mukamal 5. Christi Card 17. Lucy Rogers 6. Bob Chur – Vice Chair 18. Karen Schindler 7. Dangerfield 19. Chick Stepahin 8. Mike Dodge 20. William Thompson 9. Eleanor Fritz 21. Rita Vann 10. Marianna Grachek 22. John White 11. Eric Kivisto 23. Barbara Yody 12. David LaLumia

Guests: Brigetta Nethery and Donna Magnuson, from Grace Healthcare, represented Debbie Combs.

Staff – Chris Condeelis

1. Welcome and Introductions - Jim and Bob welcomed the group and everyone introduced themselves. The antitrust statement was reviewed and the minutes were approved. Jim asked that everyone on the committee strive to make PAC contributions. AHCA has set a goal that 100% of all committee members contribute to the PAC. Contributions of any amount count toward our goal. Four members of the committee contributed the day of the meeting. Jim then reviewed the meeting agenda which includes 2011 goals and subcommittee formation, lunch with NCAL’s Quality Committee, and a joint meeting with the Survey Regulatory Committee.

2. 2010 Team Accomplishments  Team 1 – Chris Boldt (2010 Annual Quality Report) – Chris reported that the audience for the report are policy makers. The team felt that it was important that the 2010 report “put a face on what we do,” and this was accomplished.  Team 2 – Mike Dodge (Leadership Paradigm) - Mike reported on the completion of several resources which now reside on the AHCA quality improvement website. The resources include one-pagers that

1 correspond to the levels of the Quality Award program -- Commitment to Quality, Achievement in Quality, and Excellence in Quality. For each section there are lists of books, articles, tools, and direction to the Quality Award website. In addition, a power point was created to emphasize the leadership role and goals that are essential to shifting the culture from a regulatory focus to a focus on quality improvement. Mike showed members how the resources are accessed on the website. Mike, Lucy, and Barbara are doing a session at the symposium that presents the work that their teams accomplished.

 Team 3 – Barbara Yody (Success Stories) – Barbara reported that the submission form for Success Stories had been piloted with staff from Grace Healthcare – special thanks to Debbie Jones for making this possible. The results of the pilot showed that the questions on the submission form need to be more specific to get the type of information that is needed. Barbara also reported on having met with Tanika, AHCA’s web manager, to identify the best option for having the Success Stories posted and searchable.

 Team 4 – Lucy Rogers (Quality Initiatives) – Lucy reported on the results of the Advancing Excellence recruiting strategies that were put into place in November and December. These strategies included double-checking with larger organizations that did not have all their facilities signed-up, and also a letter from Bruce Yarwood that went to the CEOs of member organizations that had 15 or more facilities that were not participating. These strategies increased the number of AHCA members participating in the Campaign by more than 250. At the end of 2010, 67% of those participating in the Campaign were AHCA members. Our stretch goal for participation was 75%.

3. Updates  Quality Awards - Chick Stepahin – Chick reported on behalf of the Quality Award Board of Overseers (BOO). Below are the key points he shared.  Record numbers filed Intent to Apply applications for the 2011 awards program. There was huge growth in the numbers of Silver (618 as compared to 271 in 2010), and for the Gold (70 as compared with 26 in 2010). We expect that some of these will not end up applying but the number of applicants will still be much more that we predicted.  The BOO is employing several strategies to effectively manage the application review process. These include reaching out to state Baldrige programs for more examiners, enhancing the examiner training to expedite the evaluation process, extending

2 the timeline for examiner review from 8 to 14 weeks, and using a pre-screening protocol to decrease examiner workload. Chick also presented the 2011 strategies which focus on the goal of assessing and re-engineering the program to improve and sustain performance, credibility, and participation.

 AHCA Update -- Chris Condeelis – Chris provided several updates which included:  Advancing Excellence Highlights: Advancing Excellence has become incorporated and has developed a strategic plan. In addition, the Critical Access Nursing Home Project is doing well especially in Macon and in Chicago, and there are 22 performance projects underway in 15 states.  Educational Programming – the following members helped to design educational programs for the 2011 Symposium and the 2011 Convention. These members include: Jana Clement, Nancy Leveille, Gail Rader, Lonnie Bisbano, Mariana Grachek, Bob Lane, Bernie Dana, Dorothy Ray, Rita Vann, Chris Boldt, Christi Card, and William Thompson  Policy Memos – the Policy Memos for Health Care Reform sections 2701, 3011-3015, and 3501 are done and posted on the Health Care Reform section of AHCA’s website.

 CAHPS- Bob Chur - Bob reported that he, Jim Avery, and Lonnie Bisbano had met with Mark Parkinson to brief him about the CAHPS for LTC. Mark will be meeting with staff from CMS on March 1st to find out the status of the CAHPS.

4. 2011 Mission and Goals – The committee reviewed and discussed the goals, and the use of subcommittees and ad hoc committees. It was clarified that the goal for the Quality Awards program is the responsibility of its Board of Overseers. Judy Bagby volunteered to chair the subcommittee on the Advancing Excellence Collaborative joining Bob Chur and Bill Kubat (co chairs for the Quality Dashboard) and Barbara Yody (chair of the Communications and Education subcommittee). It was noted that we should keep our mission and vision close at hand so that we remain focused. There was discussion of the importance of the language that we use. Much of our language reinforces the view that LTC is an industry and does not focus on the person – e.g., resident versus Mrs. Jones. Some refer to LTC as a profession but this is not an accurate use of the term. Members divided up into their respective subcommittees to work on their strategies.

5. Subcommittees Report Back – Each of the three subcommittees provided a summary of their strategies. There was discussion about the staffing that would be required to support the work of each of the

3 subcommittees. It was suggested that the subcommittee chairs meet to determine what staff support is needed. Chris will set up a conference call for the chairs.

6. Improvements for the Committee -- Chick Stepahin –Chick gave everyone a copy of his book on personal values. He then led a discussion about improvements that we can make for future meetings. Members liked the following about today’s meeting: meeting new people and networking (strive to have the committee meet in conjunction with other AHCA committees), the value of expertise and multiple perspectives, the great interaction and exchange of ideas, the fact that 2010 goals transitioned into 2011 goals, having Jim visit each of the subcommittees, the ice breaker, and the tortilla soup served at lunch. Ideas to make the meeting even better included, shortening the length of the meeting, being sure that staff supporting a subcommittee are present, being sure that the meeting room has good acoustics if multiple groups are meeting, put in place a mechanism so that members can access documents that need to be shared, and ensure that subcommittee work is not duplicative.

7. Future Meeting Schedule – Conference calls for 2011 are, April 6, June 22, October 12, and December 13 (if needed). There was discussion about when to schedule the next in-person meeting. Chris will send out options for the committee to vote on.

The meeting was adjourned at 2:30 pm.

From 3:00 to 4:30 pm the Quality Improvement Committee met with the AHCA Survey Regulatory Committee. The purpose of the joint meeting was to identify synergies and to discuss QAPI (Quality Assessment and Performance Improvement). Members of the Survey Regulatory Committee provided a briefing on the Health Care Reform legislation that is the impetus for QAPI. The larger group divided into three subgroups to dialog about customer satisfaction, tiered survey process, and culture change. The chairs of both committees made the commitment to work closely on QAPI in the months to come.

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