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AHRQ Survey of Nursing Homes -- Reporting Mistakes An Issue

The Agency for Healthcare Quality and Research, or AHRQ, recently released the "2016 Nursing Home Survey on Patient Safety Culture."

Lots of interesting data in this report, including the not-so surprising fact that administrators/leaders in most nursing homes have a higher opinion of the safety, quality, and excellence of their facilities versus their front-line staff! The question about would you put your loved one in this facility received a much lower score from CNAs, nurses, and physicians versus leadership! There was also a stark difference between leaders and front-line staff concerning the "Communication Openness" of their nursing homes, with 77% percent of leaders responding positively while only 47 percent of staff doing the same.

The survey was completed by 209 nursing homes and over 12,000 long-term care professionals. For readers of this space, the most interesting data in the report was that while 85 percent of respondents felt good about how their facilities discuss safety, only about half felt responses to mistakes was non-punitive. Indeed, how can we expect staff to disclose adverse events if they believe their heads will be chopped off?!? The AHRQ report listed non-punitive responses to mistakes as one of the "areas for potential with improvement for most nursing homes." Unfortunately, there were no direct questions in the survey about disclosure and post-event communication strategies....this was a missed opportunity.

Sorry Works! has had the pleasure of working with many assisted living and long-term care facilities across the United States. The vast majority of folks who work in long-term care organizations are angels who have a passion for caring for our elderly, and they truly try to do their best every day. Unfortunately, many facilities are understaffed (another improvement area noted in the AHRQ report), most staff have not been trained how to communicate with angry residents and families, and too often staff are blamed, suspended, or even fired when something goes wrong. There's a lot of work to do. Moreover, nursing homes are being targeted more and more with lawsuits, so there is a good business case for addressing these issues now.

Let's start from the rear and work forward.

Over the years I have had several conversations with HR managers/directors in nursing homes concerning how staff are often punished when something goes wrong. My "favorite" response is, "Well, we suspend them with pay!" Look, I can understand that we want to remove an emotionally traumatized caregiver from the floor, but we need to support that person emotionally. They are 2nd victims, and they need compassion and support, especially if the event was their fault. Don't send people home...don't put the "X" on them with a suspension ....instead, temporarily re-assign 2nd victims to the administrator's office to do paperwork (or some other task that does put them in contact with residents). Nobody wanted to hurt grandma, but mistakes do happen, and if we are going to learn from those events and provide closure for all sides, we need staff to believe they will be supported post-event. Sure, if the event happened because of immoral or unethical behavior, or if a staff person repeatedly makes mistakes, then termination is certainly warranted, but if an honest, hardworking CNA or nurse is involved in an adverse event, they need support. Bottom line is you have to change or update your HR policies...and this is true for our friends in acute care as well!

Second, front-line staff in nursing need to be taught how to empathize and stay connected post-event with residents and families. With high staff turnover, this can be a challenge in nursing homes, but Sorry Works! has developed content to fill the need. Indeed, the orientation process for every newly hired CNA and nurse in a long-term care facility should include education on empathy and how to stay connected post-event.

Finally, I am glad AHRQ is focusing on nursing homes and medical errors, but I am still puzzled why AHRQ's recently released Candor Disclosure Tool Kit has zero mention of nursing homes. Their Tool Kit is all about acute care. We at Sorry Works! have written about this significant oversight, but have not received any response from AHRQ or the Candor team. My e-mail is or you can call 618-559-8168. Moreover, I hope AHRQ will include direct questions about disclosure and post-event communication in future surveys. Questions such as "Have you (or your staff) been trained how to empathize and stay connected with residents and families post-event?" could be very informative.

Here is the link for the AHRQ nursing home survey, and here is a link for a news article on the survey.

Have a great weekend!

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