Goal Realized...

As I sit here; my feet, legs and back are screaming in agony...But it is a good agony. Yours truly finished her first half marathon(13.1 miles!) today at the age of 39.11 months...Yes it is a goal realized.

No I did not run it, I walked it with the encouragement/companionship of a peer/coworker who has completed several of these as a walker. When I say walk, do not picture a leisurely stroll..No it is a timed event, and we averaged a 16.38 mile. It does not seem like much, but to me, it is a goal that I never thought would be met..

As I reflect on the past 10 years of change and growth in my life, exercise and getting healthy were not high on the list until the past two/three years. As I have lost weight, and started exercising, the thought about doing something like this was in the back of my mind, but it took someone to be persistently annoying and encouraging to first adopt it as a goal, and then to continue encouraging me to seek and desire it for myself.

Now I have not only pain, but I also have the medal proving "I did it" and knowledge that I completed an idea from start to finish and can cross this goal off my list of things to get done in my lifetime. The other interesting thought that comes from this; is that I don't think it will be my last...I think the experience is something I will seek out/train for harder next time. The other irony of goals realized..."So I did this now how can I do it better?"

I think these personal principles apply so aptly to what I am desiring as a leader for my staff, peers and elders. It is time for some personal pain, sweat and tears to get the goals we have, achieved.

Another analogy to use as a talking point for my managers and staff. What goals do they have, personal/professional that they would like me or someone to be persistently annoying and encouraging about for them? Personal goals will remain a secret personal goal until you share it with others..The cool thing about sharing is that now you are held to level of accountability to see your goal come to fruition. The downside is that you are now held to a level of accountability to see your goal come to fruition. There is a risk in the sharing...the paradox of sharing as I call it.

Is it worth the risk to share? Yes, it makes us human, and it makes us stronger achievers...If I had just listened to this specific peer talk about her walking, instead of saying, "you know,I think I would like to try that" one time; my Sunday would have been spent not in pain! But isn't the emotional pain of having goals and ideas that you don't share, more difficult then the physical pain of seeing your goal/idea realized?

Think about that..I am now off to pack for a week of training in Texas. Another goal that I have wanted for two years...I am sure it will make great discussion for my next blog.

The Gift of Potential.. A Thank You on Bosses Day..!

As a leader, I think the best gift I have ever been given is having someone who leads me; recognize my potential. Not only was the potential recognized, it was developed through opportunities, education, and some well deserved kicks in the seat of my pants when needed. Now, as I reflect on my relationship with my own "boss" whom I view as a mentor and role model, I find myself thinking about what she could possibly have recognized in me close to 8 years ago when I was first given the opportunity to become a leader.

It is an interesting self retrospective; I have undergone dramatic personal growth during the past 8 years; most who know me view the change as occurring in the past 18 months. The reality is that once I understood that it was okay to have ideas; and then to try implementing those ideas, I found confidence in both the success and the failures. A recognition of self potential was the gift she gave me and I now recognize this for what a true gift it is.

So on bosses day, I give a sincere thank you to my boss, mentor and leader; for recognizing my potential and then giving me the tools and opportunity to recognize it for myself to develop new skills and confidence.

I only hope that as I develop my own leadership style and see ideas come to fruition; that I too can help develop the potential of those I lead. There is no greater gift to be given; or perhaps receive as a leader....

Vigilante Regulators...

Wow...Who wants to duck and run from long term care in Michigan today after yesterdays frightening "joint provider" training?

For those of you who are not fortunate enough to work in long term care, let me share with you that yesterday we (providers from all over Michigan) and our survey agency staff, affectionately called the "state" by providers sat thru the most vigilante/out to get you with a vengeance seminar/training that I have ever experienced. "The underlying theme I felt was that we, (providers) cause harm, have the potential to cause harm, and that we are going to be "caught" irregardless of what we do for our elders.. When I define caught, I am referring to the use of the surveyors new weapon against nursing facilities; the Immediate Jeopardy tag that strikes fear in the heart of every Nursing Home Owner, Administrator and staff care giver.... Read on for the highlights of yesterdays events.

The original purpose of these training seminars was to bring providers and the oversight agency from the State of Michigan together for training on best practices, new regulations and to create an environment that focused on collaborative visionary care thinking... Well the training continues but what originally was started as a collaborative "good will" event has quickly become a "here are the new rules and best practices as we see them; and by the way; tough about what you think is really important/priority for your elders"... Common sense and practical thinking about what elders really need and want be damned....

Maybe I am biased, maybe I am way off base, but when I sat and listened to the surveyors from the CMS regional office share "great stories" about facilities that have been closed, or suffered from an IJ tag with such relished enthusiasm I felt an illness in my stomach. Where is the elder in their enthusiasm? Where is the resident opinion and right in the citations that they quoted so joyously? As an advocate for elders I fear that our regulators are jumping to judgement without considering the resident point of view and their rights are being forgotten..

Let me share the story that made me the most ill and frightened for my elders..During a presentation about how an immediate jeopardy citation can be cited for the potential to cause harm, the CMS regulator spoke with great enthusiasm about a small facility in rural Wisconsin that had received four perfect, zero citation surveys during the past four years; only to get an IJ on the last day of survey for delivering a resident a birthday cupcake with a lit candle on it. The surveyor even described the scene, "the dining room was full of staff, families and residents; all there to celebrate this residents birthday and they were singing to her and it was her special day".

The problem? the resident had a nasal cannula in her nose with oxygen to it. NO she did not blow up, no fire, no injury no harm. Yet, they(the surveyors) ruin the excitement for this elder/staff and give them(the facility) an immediate jeopardy for the potential for a fire due to oxygen in her nose, and the small lit birthday candle....Could she have been hurt, possibly. Should they have known better, probably. Did the facility deserve to be fined, nearly closed, lose it's ability to admit residents, get placed on a "bad facility listing" and lose it's nurse aide training because of it? Not to mention the "label" and Internet label of poor performer; hardly.

As an Administrator this type of story is not only infuriating it is devastating. This facility has to be one of the best facilities you could encounter. Knowing the type of care/resident and staff interactions that must exist for a perfect survey to occur; I know that this facility has to have real person centered care relationships and outcomes in existence. I would bet this facility has great family, community, resident and staff support and enthusiasm. How do I know this? I use my own facility as a gauge and my peers who also have had the great fortune of a "perfect survey". To attain this you have to have reached beyond the regulations to create the remarkable person center nirvana that is the pinnacle of the elder care experience.
I can only imagine how crushed/damaged the dietary aide who delivered the cupcake would be. I think of my own enthusiastic, caring young people who work in my kitchen. I see them deliver the snacks in the hallway, in fact as I type this I am hearing them singing to one of my elders a rap song...there is laughter and a real relationship occurring spontaneously.

I think of the emotional damage to the elder. In our building, the elders are outspoken about their needs and wants. This is good! To me that says, "hey, I trust you to fix this, and I know it is o.k. to say what I think because I trust you, you will not harm me, you love me and want what is best for me when you care for me." They demand real relationships and the unconditional love that is given and received in a person centered care model.

I think about some of my elders and how devastated they would be if they knew that their special day and the love from the staff resulted in devastation for the very same caregivers who love and care for them. They would feel such guilt and be emotionally harmed by the knowledge that their event caused this. (No, my staff would not share, but trust me they would know, we exist as a community and family; that is why our great buildings remain great...)

So where was the elder in this citation? Yes, I agree we must protect our elders from actual harm. But to try and prevent every "possible harm outcome" is ludicrous. Every environment, every person has the ability to be a victim of potential harm. I think about when I fill up at a gas station, and see the person next to me smoking a cigarette or filling a gas can in the back of their pick up. I think about my own bad behavior of using my cell phone while driving. I think of the countless times I have spilled hot coffee on myself in my car; or while wearing ridiculously high heels I have tripped or stumbled.

I think of my parenting and how I raised my son. If you were to look at my environment when he was young, using this model of "potential for harm" you should have taken him from me early on...He broke his collar bone three times before he was 12 years old. I was present at only one of the fracturing events. Yet, he had actual harm from his own volition, and my apparent lack of keeping him from harm. Using the surveyor model, I should have been eliminated from the mother model.

Apparently, because "we" accept money to care for elders, "we" are now held to the light that we must eliminate every "potential for harm" that could exist for the person/elder we are being reimbursed to care for. Resident choice be damned; if your care is being funded by the government I am obligated to give you lukewarm coffee, and wrap you in bubble wrap...Your right to the dignity of making poor choices such as falling from trying to ambulate as long as possible,or smoking a cigarette with poor reflexes, or eating sugar while diabetic could get me an immediate jeopardy, and can no longer be tolerated if I am to exist as a provider of care.

I wonder how many great caregivers went home yesterday and pulled out the resume...This quest for culture change and person centered care is definitely not for the faint of heart.

Defining Culture...

Ok, I have been called on the carpet this week for speaking to "culture change" but not defining what culture it is we want to change in long term care. This came to me from a new reader via email.

So after receiving said email; I sat back and observed, thought and experienced my communities culture full throttle this week. If you have never done so; the next time you find yourself in a public setting that involves members of your community, I encourage you to sit back and observe the people and what they are doing, saying and the interactive behaviors that occur. Trust me this can be a fun yet frightening experience.

I spent Friday night in full bologna queen regalia, (crown, sash, fancy dress and heels) to be part of the high school homecoming parade in Yale. Needless to say, this cultural event was wrought with great observation about the culture of our town, its people and the rituals that have existed for many years...My next opportunity came today as I went with my parents to a small town dinner fundraiser at a local township hall for the fire department. Picture a simple wooden building where indoor plumbing was an after thought; situated 25 miles from any main city/town with services. The food is always phenomenal at these small town events; always served family style on mismatched donated dishes with home made pie for dessert..The culture of middle small town America at it's finest. In comparison to last week where I attended a black tie social event for a main religious community of metro Detroit. Different cultures, different rituals, different norms.

For those of you not raised in, or having never lived in a small tight knit community the culture may appear/act/feel very different from what the culture you were socialized or live in. To use a tool that my boss uses, (thanks for always having a Webster's handy...) I took the time to research the common definition of culture. Per Wikipedia; "Culture has been called "the way of life for an entire society." As such, it includes codes of manners, dress, language, religion, rituals, norms of behavior such as law and morality, and systems of belief".

As providers of health care, I think we often refer to the culture as the norms that we have come to know inside of our own care communities and provider associations. The culture of care that I seek change for is the pervasive culture of what nursing homes are in America; and the societal norms that people perceive to be true about aging and long term care facilities. How we as providers define our culture of care is vastly different from what society feels our cultural norms are. As the provider we are obligated to create a change for how society and we ourselves view our culture of care. We must not accept the current norms to be continued if we seek to exist in a positive light for society. Care is evolving, and our cultural norms; rituals, and beliefs about what we do must evolve and change with the needs of society.

Further, depending on where your facility is located, what community you draw from will greatly impact the culture of your building and we need to be ever aware of the impact this has on us as providers. Using a one shoe fits all model; does not work for care providers. We must mesh our culture to impact the overall community culture in a positive win/win situation. Nothing is worse then having cultural conflict between a provider and the community it serves. It will not bode well for your reputation or opportunity to become the provider of choice.

So this little lesson on how I perceive culture is brought to you via an email question. I hope this helps you to understand what it is I speak of when I refer to culture and why change is needed.

QualityCan Not Be Legislated, It Must Be Lead By Innovation

I have had a full 24 hours of great education this week, and my head is spinning with new thoughts and ideas..

Last night, I had my first organizational leadership class; and I remembered why I loved organizational psychology and sociology so well as an undergrad! The class had a great discussion on leaders within organizations and their defining moments; IE; leading during the non-traditional events that occur within an organization. It got me thinking about the market disruptor's and changes that are looming in health care and the prospect of where the great leaders will emerge from to get us thru the changes as they occur. As health care organizations,we need to start spending significant time on teaching and mentoring innovative leadership. We need to think about how we reward and grow those individuals who have the ability to see the big picture, absorb it and make the critical decisions that will be necessary to stay competitive in a world market of care decisions.

The other part of my education occurred today at a Detroit Economic Club lunch where the president of one of the largest health care companies in America spoke about the future of health care in America. His thoughts put into words what many of us need to hear about our health care choices. I am still thinking about one item that he said and I am going to make it my new mantra for what I do within my organization, and for my leadership model to my staff. To paraphrase the thought: Quality will drive health care in the future. Further, quality can not be legislated, compliance can be legislated. Quality must be lead by innovation. Compliance does not create quality....

As providers, too often we find ourselves seeking "quality" to be defined by meeting the criteria set up by the government regulations. The reality is that quality is driven by creating market disruptive innovation that customers desire and demand. Without creating remarkable quality services and outcomes, we will fail in the future. By allowing the government and other regulatory entities define quality for us; we are missing the critical element; customers. Customer based definition of quality should be our one and only focus. In a true market based economy the customer should drive the success of a health care provider. Subsequently, as health care providers we need to fight for this vision. We need to demand that we are allowed to have the latitude to create customer driven quality care environments where consumers are able to define the quality they want. If the regulators really want to "thin" the poor performers, this system would work quicker, and fiscally more affordable for tax payers.

As an example of a market disruptive innovation, I think of the remarkable one of a kind wellness center that our company just opened at a sister facility. This is a living breathing example that will set the bar on remarkable quality for customers and families. This center will redefine what rehabilitative short term care should look, feel and act like. Kudos to the innovators who designed this, and thank goodness I work for a future sighted company!

As providers it is time to let go of the regulated quality/compliance outcomes that we feel comfortable with. We must allow our customers and market demand define what "quality" should be. It is in this innovative thinking that we can finally break thru the regulatory bureaucracy and achieve a competitive market based organization where the services we offer are worth the price to the consumer.

As a future leader, the times are both frightening but wrought with possibilities...I cannot think of a more exciting time and career to be in for the next 25 years!

The Character of a Community

On Sunday evening I had the pleasure to attend a very touching and inspiring event. This event, celebrated a 100 year anniversary, and the retirement/service of a dedicated individual who has dedicated a great portion of her life to providing care to the elderly of her community.

During this gala, one of the speakers made a simple statement that touched me in a profound manner. The statement? "You can judge the strength and character of a community by how they treat their elders."

As I sat there pondering his words and the rest of the evenings events; the strength and prophetic wisdom of this thought kept reverberating in my head. Several questions came to mind... How does my community treat it's elders? How have I role modeled the expectation of treatment to elders? Would my community members who are not part of my "care giving" environment agree with this statement?

I had never thought of a communities character in this manner. The speaker was referring to a religious based community; however his concept and thought can be applied to several sets of societal communities. Where do my "communities" measure up in comparison to the role model that I observed last night? (picture near 700 people who paid a large sum of money to attend this fundraising/retirement gala, all of whom were supporters of this specific religious community via religious or business affiliation.) Tough assessment and evaluation for myself.

Where have I been as a role model for care in my community sharing the expectation of how elders should be respected and treated? Am I a true advocate in every sense of the word? I would like to think yes; however I find myself thinking I/we could do better, and should do better. As a prospective elder, I would hope someone would advocate for me when I can no longer do so for myself.

As fellow caregivers; I ask you where is your community in the realm of respect and honor toward it's elders? Is it where you would like it to be when you are aged? If not, do we really have a community of value or character that we can be proud of?

Interesting thought, and one that I will share with my management staff...Great discussion topic for our next meeting.