I hate surprises, don’t you? Especially bad ones. So when we received some very disheartening results a few weeks ago from a surprise survey of our skilled nursing facilities from Operation Guardians (OG), a team at the California Department of Justice focused on potential violations of federal, state, and local laws and regulations, I was none too happy. In fact, I was downright shocked. I thought we were better, much better, than how we were depicted in the OG reports. In fact, I was confident we were.
So I read the OG reports a second and third time and began to separate what I would call objective clinical findings from sweeping generalizations and emotionally charged language choices. I could see where the OG surveyors had some valid issues, and how they could be a “wake-up call” for MPTF to improve. But I could also see as clearly how the reports were wrapped in an overall negative bias, and that’s when I started getting a little angry.
Why? Well, there’s a long list of reasons but at the top of the list were the sweeping generalizations, all negative, made by the OG surveyors about our clinical staff, particularly our Medical Director and Nurse Practitioner. Dr. Humayun is a board certified geriatrician with additional training in palliative care. He has 20 years of Medical Director experience in Transitional and Long Term Care, and is a teaching faculty member at Northridge Hospital where he was previously Chair of the Primary Care Committee and Department of Medicine. Linda Healy, NP, is a nationally certified geriatric nurse practitioner who is additionally certified in palliative care: NBCHPN Certification as Advanced Practice Hospice and Palliative Nurse; ANCC Certification as Family Nurse Practitioner; ANCC Certification as Gerontological Nurse Practitioner. She is also a recurrent lecturer on Geriatric Nursing at Los Angeles City College. Both Dr. Humayun and Linda keep current with standards and innovations through continuing education and association membership which are supported by MPTF. In other words, they’re well trained, have tons of experience in the field of geriatrics, are beloved by their patients and patient families, and have provided fabulous care for our skilled nursing residents for many years as well as for industry members in the community. And they certainly didn’t deserve to be disrespected in the Operation Guardians reports.
Health care is HIGHLY REGULATED, and it should be because the work we do, the physical facility we manage, all are critically interwoven very often into matters of life and death. Like all regulation, understanding the logic and practically complying can be challenging at times and terribly frustrating at other times. It requires a lot of patience, attention to detail, subject matter knowledge, tight teamwork, and great communication. When you’re good at all of this, which MPTF is most of the time, your quality of service is high and your residents/patients/customers and their families are happy and well taken care of. Time and time again, we are a 5-star (highest) rated skilled nursing facility in the reports from CMS (Medicare and Medicaid) When you slip, and it happens, and it gets caught in a survey like the kind that Operation Guardians conducted or that the California Department of Public Health frequently conducts, it is upsetting because we are operated by a group of professionals, from Dr. Humayun and Linda Healy to our LVNs and CNAs and housekeeping and food service workers, who take their work very seriously and very personally.
Rather than wallowing in our upset or anger, we took a different and more productive approach. Let’s not dismiss the OG report just because it says bad things about Dr. Humayun and Linda Healy, we concluded. First, let’s look at it point-by-point and understand where we agree or disagree and let’s respond to the OG in a detailed, thoughtful manner. Then let’s look at the areas where the report points out weaknesses in our practices and policies, let’s re-examine them internally and go even further and bring in an outside evaluation team, and let’s get better. Let’s use this as an occasion to check in with ourselves on whether we are doing the absolutely best job that we can do for our industry members and their families, let’s be brutally honest about it all, let’s open the records to the outside team for scrutiny and questioning, and then let’s learn from it, implement change, and safeguard ourselves from ever getting this kind of criticism leveled at us again.
And so that’s what we’re doing. An internal team led by Dr Humayun is pulling apart everything we do and questioning whether we are doing it right or we can do it better. An external team of evaluators led by a group of really excellent UCLA Health System specialists in geriatric psychiatry, geriatric medicine, and geriatric psychology, and a clinical nurse specialist, are measuring our processes and practices against the highest industry standards and where we are coming up short, they are providing us with a roadmap to improvement.
I’m sure that this is the right way of doing things and equally confident that 6 months from now we will be incredibly proud of how we have taken our quality of care to a new and exciting level. Our residents will benefit, our staff will benefit, and MPTF as a whole will benefit – and so will all of you.