With nearly 1,900 skilled nursing beds spread across three of New York City’s five boroughs, NYC Health+Hospitals serves patients whose needs can vary greatly depending on their community or the specialty care they seek.
That could make maintaining consistent quality standards a major challenge. Instead, quality has become a hallmark of the organization, which this summer celebrated five-star quality ratings at all five of its nursing homes. Four of its centers are also rated five stars for overall performance by the Centers for Medicare & Medicaid Services.
“It’s not all about numbers and data crunching. That’s just part of the story. There’s a person behind these numbers. These are the patients. These are the staff,” Khoi Luong, DO, NYC Health+Hospitals senior vice president of post-acute care, told McKnight’s Long-Term Care News last week.
Luong said an approach that layers quality responsibilities on frontline staff, middle managers, and board governance creates a powerful structure that ensures daily efforts go beyond lip service.
“In other organizations I’ve worked with previously, there were only select champions that have been anointed to do quality and so they’re very versed,” he added. “But we’ve taken a lot of care and time teaching the principles and understanding definitions of how quality works [across multiple levels]. That structure has allowed us to then go into the realm of looking at quality assurance on things that we’re supposed to do — the marks we have to hit because that’s what the government says so. Then there’s the part that is most exciting for our staff: the quality improvement. This is where the creativity comes from.”
The larger system’s investments in technology and the creation of a division for data collection and analysis frees staff from tracking problems to instead be able to offer ways to tackle them, Luong explained.
Then, instituting measurable goals and adjusting them to current observations and needs helps keep the needle moving forward. The process begins each quarter with each facility holding a quality meeting to identify areas that need renewed focus or new intervention.
The board of NYC Health+Hospitals — which also includes other post-acute services, outpatient, primary and specialty care centers, a health plan and 11 hospitals — then reviews the goals and decides which need to an “acute” focus across the system.
“There are strategic pillars that can help channel where that creativity comes in or the ideas that should be prioritized,” he said. “There’s governance over the work that is done. Everyone is not just doing what they want. There’s alignment.”
Challenges to five stars
It’s not all easy work, Luong concedes. Among the five skilled nursing facilities, Coler Rehabilitation and Nursing Care Center is an outlier. Both its location and its increasingly younger, behaviorally oriented population have made it the hardest facility to bring up to the five-star overall level.
It’s currently ranked at two stars, thanks to a score of one on health inspections, in which resident compliance issues surface as a repeat theme.
“Sometimes the ratings system that’s put out by the federal government doesn’t reflect the nuanced care that an individual will get. What makes Coler unique is that their behavioral health program has organically evolved over time, and it’s highly valued by the system and by the city,” Luong said. “It serves a greater purpose because these are the individuals that other for-profit nursing homes will not take. The evaluation of accepting these patients, meeting their needs and maintaining their dignity, it’s very difficult.”
Even with its challenges, Coler still maintains five stars on staffing and quality measures.
And across its skilled footprint, NYC Health+Hospitals averages five hours of daily nursing care per patient, far exceeding coming federal standards.
In addition to staffing based on changing acuity, Luong said NYC Health+Hospitals has also invested in helping them navigate the evolving regulatory landscape, especially as surveys have fallen out of their traditional cadence.
Those include governance touch points, where staff know they need to understand outcomes and be accountable for them. The organization has also hired a consultant to conduct mock SNF surveys that can last a week, drilling into macro and micro issues and helping spot problems and collaborating on solutions before government inspectors visit.
“The lag has made us self-conscious about it, so we try to find other ways to simulate the survey experience,” Luong explained. “Keeping our readiness, our level of attention to compliance and regulations, that’s been instrumental.”
In addition to Coler, NYC Health+Hospitals operates the New Gouverneur Hospital SNF in lower Manhattan; the Henry J Carter Skilled Nursing Facility in Harlem; the Dr Susan Smith McKinney Nursing and Rehab Center in Brooklyn; and Sea View Hospital Rehabilitation Center and Home on Staten Island.
