Silvercrest Center for Nursing and Rehabilitation has an open door policy for those in need. Unlike many extended care facilities, we accept all patients qualifying for short or long term care, regardless of the complexity of their medical profiles. This requires that we maintain particularly sophisticated care programs on site, and means that we must regularly expect to welcome patients who arrive with significant established illness and related complicating conditions.
The Silvercrest Board of Trustees is completely committed to the provision of quality care. This is in no way better demonstrated than by the direct participation of Trustees in the Performance Improvement process.
Two members of the Board directly contribute as members of the Performance Improvement Steering Committee. Trustee and Board Secretary, Kathleen M. Burke, Esq., brings legal and regulatory expertise to the committee, while clinical acumen and experience come from the participation of Trustee Ann Alexis Cote Taylor, former VP of Nursing at New York Presbyterian Hospital.
As Ms. Burke relates, their job is to bring better focus upon the "bigger picture," providing administration and staff with a broader view. Mrs. Taylor underscores the entire Board's concern for safety, declaring that all issues are "considered through the prism of quality and safety. This emphasis informs the whole philosophy of the institution."
Silvercrest's staff, administration and Board are all committed to a comprehensive program of Performance Improvement and Safety. This plan seeks to provide a coordinated, organization-wide roadmap by which to measure and improve important systems and services. In order for this to be achieved, performance improvement must be considered the responsibility of all Silvercrest employees, at every level, and at all times.
Among the key goals of Silvercrest's Performance Improvement plan are:
- To promote a sustained, institution-wide commitment to quality and safety with a system involving the top leadership
- To sustain quality of care through objective, systematic assessments of processes and services, with identification of those changes that will enhance performance
- To ensure the delivery of care in the safest manner possible, thereby preventing adverse outcomes
- To facilitate the most appropriate allocation of resources
- To comply with accreditation standards and legislative regulations
- To respond proactively to consumer and payer queries concerning the quality of care rendered
- To participate in industry-wide quality improvement activities
The Performance Improvement Program is implemented using the Joint Commission "Cycle for Improving Organizational Performance" and the Shewart PDCA Cycle. The Board of Trustees delegates authority for performance improvement and safety to the Performance Improvement Steering Committee, from whom they receive reports, and direct the actions necessary to achieve the goals of the program.
The Performance Improvement Steering Committee provides oversight for the coordination of facility-wide performance improvement and safety activities. It allocates resources and establishes the monitoring schedules that will be used to improve care and outcomes.
This committee also provides oversight to the Performance Improvement Committee, which ensures the implementation, monitoring and effectiveness of the overall plan. This is accomplished by, among other things, seeing to the dissemination of all needed information at the departmental, committee, workgroup, and individual levels.
Another mechanism of performance improvement is voluntary participation in the S.T.A.R. Initiative, ("Setting Target Achieving Results). This program was developed under the direction of the Centers for Medicare & Medicaid Services (CMS) to provide the tools and information institutions need to improve the quality of their services.
Measures used to compare resident experience of illness between institutions can at times prove confusing.
At the outset, it is important to understand the difference between the "prevalence" of a condition, and its "incidence." Using pressure sores as an example, we could say that the prevalence of sores in a particular population during a particular period of time, (say, the month of June), is the number of individuals who had sores during that period, divided by the total population, (those with sores plus those without). This group, (some percentage of the population) would include all who had sores in June, whether the sores developed in June or not, and whether the sores healed in June or not.
This "prevalence" is to be contrasted to the "incidence" of sores in the same period, which is calculated by taking the number of people actually developing sores during that time, and dividing by the population size. The incidence of sores in June will be less than the prevalence, since it will not include those who developed sores before June and simply continued to have them. (This difference between prevalence and incidence obtains for any condition that can be "on-going," but not for problems that are, in fact, discreet events, such as falls. The monthly prevalence and incidence of falls for a population would be the same.)
Comparative prevalence and incidence rates can be misleading because of their inability to characterize all other relevant aspects of the patient populations being contrasted. For example, if one facility has a higher prevalence of sores within its population than does another, this may, of course, reflect something wanting in the facility's care of those at risk for pressure sore. However, it might equally reveal something important about the facility's population itself, i.e. that the residents of the facility are generally sicker and more frail on average than those seen in other institutions, and are therefore more likely to suffer from sores. Such differences in population types could, for similar reasons, also effect the comparative prevalence and incidence of "events" such as falls.
Finally, prevalence and incidence are calculated for blocks of time, but do not always take into account "where" events occurred. For example, if Facility A (with 100 residents) admitted three patients on June 15 who happened to have fallen on June 12, its prevalence of "falls" for June would be higher than that of Facility B (also with 100 residents) where two patients fell during the same period while in the facility. Hence, the institution with no falls would have a higher prevalence of falls than the facility where two falls took place. This reveals the importance of so-called "internal data" when trying to fully analyze the meanings of broad prevalence comparisons. Internal data for Facility B above would show a 2% incidence of falls, while that of Facility A would show a rate of 0%.
The issue of population mix is particularly important at Silvercrest, where we care for a group of people with very much higher intensity of illness than seen at most institutions. As the sophistication of our abilities has grown, so has the medical complexity of our population.
While there is no way to take this complexity precisely into account when comparing outcomes with institutional averages, there can be little question that it makes Silvercrest's many accomplishments all the more laudable. Internal data confirm that where Silvercrest outcomes lag behind state or national averages, those data are driven largely by the subsets of our resident population with extreme acuity of illness. Over and again, Silvercrest staff have taken up the challenge of generating new and more effective protocols in order to better serve those within these most challenging resident groups. In so doing, they have succeeded in obtaining overall quality data that surpass those found in many facilities with simpler callings.
There are a variety of common measures used to compare the effectiveness of different medical care facilities. Long term care and rehabilitative institutions are often scrutinized with respect to their performance in the areas linked below. We present for your review the raw data, together with some information that will help to make more clear the way that Silvercrest is succeeding in "Giving Quality to Life."