Key Factors in Achieving Quality

Neil Kurtz, M.D.President and CEO

Presentation Overview

•What quality means to our company– How we define it– How we measure it– How we maintain and improve it

•Challenges we face

•Quality initiatives to address the challenges

•Results

What is Quality?

•We define quality as:– “Skilled Compassionate Care”

•We look at quality in three basic ways– Process-based measures: these

represent the actions of providers– Outcome-based measures: these

represent the results of care processes– Best practices: these explain and define

the nuances of best possible care

•Clinical, rehab outcomes

•Quality Indicators

•Survey performance,5-Star results

•Rehospitalizations

•Medication management

•Customer satisfaction, quality of life

•Employee engagement/retention

Measuring Quality

Communicating Quality

•Discussion of quality results and outcomes starts every leadership meeting

•Publications focusing on quality– Quality Highlights

• Internal and external– Partners in Quality

• ED, DNS, physicians– First Monday

• For Medical Directorsand attending physicians

– Safety Caps• Medication safety for nurses

•Daily Clinical Start-Up

•Clinical Scoreboard

•Facility PerformanceAssessment

•“Stop and Watch”

•SBAR nurse/physician communication tool– Situation, Background, Assessment, Response

•Quality Assessment and Assurance process

Quality Management Tools

Challenges

•More medically complex patients

•Shorter-term stays

•Varying approaches at multiple facilities

•Shortage of qualified staff

•Acceptance of change

•Funding

Addressing the Challenges

•Standardize care across multiple facilities– Ensure uniformity in approach

•Enhance measuring and monitoring tools

•Get better at managing transitions of care

•Reduce rehospitalizations

•Adjust staffing mix, scheduling approaches

•Modify and improve training

• Improve physician alignment

Key Initiatives

•Quality Improvement System utilizing Baldrige criteria

•Enhanced technology– Amalga for Daily Clinical Start-Up

• Increased Medical Director involvement

•Building a network of healthcare services

• Improving medication management– Golden Clinical Rx Solutions

• Improving the patient experience

Improved Survey Performance

• Average number of deficiencies 5.95 5.48

• Deficiency-free surveys 17 30

• Surveys resulting in sub-standard2.8% 1.8%

• Surveys resulting in IJ 2.5% 1.4%

• LivingCenters with 3 or less tags 33% 41%

• Overall HDI .97 .92

2009

2010

Industry-Leading 5-Star Quality Results

All Facilitie

s

Natl. Not For Profit

Natl. For

Profit

Perce

nt o

f Fa

cilities

January 2011

5-Star Quality Improvement

3.20

3.25

3.30

3.35

3.40

3.45

3.50

3.55

3.60

3.65

3.70

3.75

Q1-09 Q2-09 Q3-09 Q4-09 Q1-10 Q2-10 Q3-10 Q4-10

Golden LivingAverage 5-Star Quality Rating by

Quarter

5-Star Recognition

NURSING HOMES

52 Golden LivingCenters named to the 2011 U.S. News & World Report

List of America’s Best Nursing Homes

Golden

Living