Home Care Education in 2019: Growing Clinical Knowledge And Technical Skill Is The Secret Sauce To Outcomes And Success In The Face Of Challenge!
Kenyon HomeCare Consulting • March 16, 2021
Home Health is preparing for another big challenge with payment reform moving into PDGM in 2020. As home care has always worked out a way to do more with less, the thing that always seems to take a back seat is education. Clinical knowledge and technical skill has always been key to properly manage the patient at home. But, as cuts continue to come and costs of doing business increase, it is often the first thing to be cut. It shouldn’t be. If you wouldn’t cut the trunk of the tree out and still expect it to stand, why do it in a clinically-based practice? Let’s look at why it needs to be front and center as you move forward.
What We Face Today:
As predicted many years ago, the industry struggles to have the clinical staff available to care for the volume of patients today. The baby boom generation needs us now in a big way. This leads agencies to often hire nurses and aides quickly just to have the number of people needed to provide service. This doesn’t mean we don’t hire good people that can’t be great long-term staff, but the point is to make sure each one has knowledge and training to be successful. Shortages of nurses and aide staff leave agencies with staff burn-out and holes in quality patient care. Nurses can’t make 10 visits a day and do it well. In a PDGM world, the visit must be comprehensive and follow the care plan or it is waste time and money.
How Do We Best Get Staff The Clinical Knowledge They Need:
Years ago, as an agency, we looked at what made clinical staff leave. The numbers of those staff leaving due to the orientation process was alarming. Staff felt unprepared to take call and handle issues faced in the field by themselves. This came even from those with a previous home health background. Let’s face it, times have changed. Documentation, Oasis, Emergency Preparedness, Care Coordination and Managed Care are just some of the items involved in the evolution of the home care visit. All of that comes on top of making sure the staff have properly cared for the patient. It is a lot for any staff member.
Enter education and training. It is time to re-vamp clinical training and learn to properly assess clinical knowledge. If you expect staff to be successful in the field, then you have to provide the right clinical knowledge to set them up for a win. This means looking at your whole system to determine if it has what it takes. Maybe you train well at orientation, but that is where it ends. Maybe you are the agency that pushes staff out of the nest to see who learns to fly. Agencies can’t take the exact same approach to teach every staff member. It takes finding a formula for clinical knowledge that sticks. It begins with having a comprehensive ongoing program for chronic disease management. Chronic disease isn’t going away, so agencies must find solutions to manage the patients at home.
Let Kenyon Homecare Consulting Be Your Clinical Knowledge HQ:
At Kenyon Homecare Consulting, we work with agencies to develop and maintain clinical education programs that set them up for ongoing success. Whether you need a do-over for your training program or want someone on-site to train senior clinical staff, we can help. Call us today at 206-721-5091 or contact us online and let us help your operations and education/ training. Now is the time!
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Today, this article will look at little different than out typical articles. We all know the costs of losing employees and trying to hire and train new ones. It is exhausting and expensive. So, we think about our wages and benefit packages all the time. What can we do differently that makes people stay? We can’t change the job and we don’t want to keep people that don’t like the work itself. So, how do we acknowledge employees in a way that is valuable to them and that our businesses can afford to do? 5 Things To Consider About Employee Recognition At Your Christmas Party: 1. Years of Service: These can be based on milestone work anniversaries (5, 10, 15 yrs, etc.). If a person has been at your agency 11 years, you pull them up and acknowledge them in the group of employees who have been there at least 10 years up until the time they hit the 15 years landmark. This way longevity is recognized yearly. 2. Special Employee awards: Now, this may be difficult if your staff is very small, but acknowledge the employee who has gone the extra mile in the job they do. Tell the story. The employee needs to know when the employer is proud of the work that has been done. Consider a plaque or certificate. Don’t minimize the value of the employee having them to display. 3. Acknowledge all employees in the mix: Because we are a clinical industry, the administrative staff is often overlooked on day-to-day operations. Ultimately, don’t miss the chance to acknowledge the employee who was able to catch billing errors or collect on a large account. Staff doesn’t like to hear about money, but those types of collections keep Christmas bonuses in place! So, make sure the other staff knows the accomplishments of the finance department or the office manager that every caller loves to speak to. Don't ever forget the IT staff that is on call more than any clinical person in your agency! 4. Letters from the administration: Add a personal note to your staff either collectively or individually depending on the size of your agency. If you are larger, there are employees you don’t often see or get to talk to on a regular basis, so take the time so send a note with that Christmas bonus. 5. Consider the Christmas bonus: Listen, some of you can afford to do substantial monetary bonuses and that is fantastic. However, if you are not in that position, consider something in its place. Maybe small gas cards go with the letter from administration. With the cost of groceries, consider something that helps with the costs of daily living for employees. Big box gift cards in your area will always be used. You may do a lot of these things on a yearly basis to employees. All this being said, it doesn’t mean there aren’t reasons for acknowledgement throughout the year. However, your annual Christmas party is a good way to do it collectively. Between your annual party, write the individual cards to employees when you hear a patient interaction worthy of praise. Or, maybe you buy a gas card for the employee who has picked up extra shifts and always shows up on time. Ultimately, employees will feel valued. You will not regret the time, effort, and energy put into these efforts. Merry Christmas! If you want help with recruitment and retention strategies for your agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online today.
When you think in practical terms, what does your ICD 10 coding mean to the clinicians in your agency? It probably isn't as important as you would like. Realistically, your nursing staff cares about hands on patient care. If you want the code itself to be more meaningful, then you need to attach the concepts of patient care to the ICD coding. You may think the code itself goes hand-in-hand with the care, but this is not always true. As a clinician, there are concepts within the nursing care plan that are automatic and some that are instinctual based upon the body system causing the need for care. It's a given that medication, diet, and disease process teaching are going to be in the care plan (or should be). When you get to disease process, our experience shows the clinician doesn't always run deep into the specifics of the disease when it could lead to valuable interventions being included in care. For example, when clinicians do a care plan related to cardiac disease, are the interventions very broad to include all things related to any type of cardiac disease? If you have a patient with right sided heart failure versus left sided heart failure, how many nurses would assess the patient differently? Would your nurses change the frame of mind to look for distended neck veins or anorexia and nausea if the patient had right sided failure? Would they be in the head space of considering whether the patient's appetite changes are more about just having been in the hospital than about potential venous stasis in the abdomen? The point is that although there are certain interventions that would be the same regardless the type of heart failure, picking up on different symptoms and critically thinking through the cause is often missing in the hustle and bustle of the day-to-day. This is not a judgment on the capabilities of the nurses but more about how our nurses are trained to consider care planning and assessment. We have people for ICD 10 coding now. Most nurses are not in the ICD coding manual looking up their own codes anymore because of the specificity that wasn't the same 25 years ago. So, the nurses go out with an H&P from the hospital or doctors office and develop a care plan. It isn't necessarily with the coding in mind. So, we need to get back to basics when it comes to coding and clinical care. We need to train out staff to look harder at the coding. Our coding departments need to have open communication with clinicians and understand the concepts of care planning to understand if things are missing in the care plans. What about your clinical manager's role? Are these things considered when reviewing care plans? What about your record review process? Are your ICD 10 coders nurses that understand care planning and is it part of the coding process to review the care plan? These are things to consider when you look at your clinical practice as well as your coding solution. At Kenyon Homecare Consulting , we have a comprehensive ICD 10 coding department that can provide education to clinicians, accurate ICD 10 coding, care plan and Oasis review. Call us at 206-721-5091 or contact us online to see if we can help you merge the code with the clinical practice in a way to improve your outcomes and your bottom line. We will offer 5 free recodes to any agency that would like us to check the efficacy of their current coding system or talk about becoming your coding solution.