November 7, 2016
By Mountain-Pacific
Using quality improvement methods, the Weston County Health Services of Wyoming reduced employee injury rates and turnover, which resulted in improved care for its residents.
JoAnn Farnsworth, nursing home administrator for the Weston County Manor in northeastern Wyoming, learned firsthand that a stable staff is important to ensure quality care for its residents.
“If you take good care of your staff, they take good care of the residents,” Farnsworth said. “Having stable staff is vitally important and valuable to families and residents.”
This lesson was an expensive one. In 2011 and 2012, Weston saw a high rate of worker compensation claims, with injury costs of more than $670,000. Worker turnover at the 54-bed, long-term care facility was high. Employee satisfaction was low. Repeatedly bringing in new staff put residents at greater risk for falls, incontinence and isolation and forced residents to work with new caregivers and rebuild relationships and trust.
Forming a committee and using quality improvement tools
Something needed to be done—for both staff and residents. To find a solution, the facility created a safety committee. Members included a wide range of staff, from the chief executive officer to human resources to maintenance.
An Occupational Safety and Health Administration (OSHA) assessment uncovered opportunities for improvement and provided possible solutions. The OSHA assessment would point out what areas needed to be improved and also introduced some other ideas to remedy the problems.
The committee applied Quality Assurance Performance Improvement (QAPI) methods, learned from Mountain-Pacific years ago, and other quality improvement tools such as root-cause analysis, small tests of change and SMART (Specific, Measureable, Action oriented, Realistic and Time bound) goals. The committee also used data whenever possible to establish benchmarks and, hand-in-hand with QAPI methods, to evaluate, measure and document issues and solutions.
Solutions included:
- Updating OSHA programs
- Identifying a way to report safety concerns
- Providing education and outreach
- Requiring drug screening
- Including safety tips in the monthly newsletter
- Holding annual department trainings
- Sending frequent safety emails
- Conducting new hiring training
- Providing training on proper lifting
To improve safety, the committee bought traction cleats for employees’ shoes and placed heated mats in walkways during winter.
A common cause of staff injury was lifting fallen residents. The committee provided education about how to properly transfer residents. A new lift policy required injured staff to go to the emergency room for a post-injury drug test to ensure employees were not under the influence of drugs or alcohol. Thanks to a grant from OSHA, the facility also got a new mechanical lift.
“I have lifted people off the floor, and it is not an easy thing to do,” Farnsworth said. “The lift is more comfortable and not as scary for the residents and safer for everyone.”
The new lift policy required staff to use the lift to avoid injury. Not following the policy results in disciplinary action.
Change accomplished
After more than two years of monthly meetings and hard work, the committee has achieved measurable change:
- In 2015, the turnover rate was less than 20%—the lowest in recent history.
- Worker compensation injury rates dropped from 37 in 2012 to just 10 in 2015.
- Staff satisfaction increased by more than 35% from 2012 to 2014.
Farnsworth recommends facilities struggling with high injury rates and staff turnover contact OSHA for an evaluation. “It is free of charge and well worth the time and effort,” said Farnsworth.
Mountain-Pacific, a valued partner
Mountain-Pacific’s Wyoming Director Pat Fritz has been there for Weston and its staff for the past seven years. Her ongoing support has included providing QAPI techniques, tools, conferences and other learning opportunities.
“We were introduced to QAPI several years ago, and I remember Pat bringing us a whole binder of information. We still refer to that,” Farnsworth said. “If we need some help, we are always comfortable contacting her, and she is the best with answering our questions. She is our go-to person!”
About Mountain-Pacific—Mountain-Pacific is a 501(c)(3) nonprofit corporation and holds federal and state contracts that allow them to oversee the quality of care for Medicare and Medicaid members. Mountain-Pacific works within its region (Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands) to help improve the delivery of health care and the systems that provide it. Mountain-Pacific’s goal is to increase access to high-quality health care that is affordable, safe and of value to the patients they serve. www.mpqhf.org