Page 53 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
do a better job. Similarly, the rules from one state to another vary greatly in what foods can be served, their requirements for documentation of who ate food from an unapproved source, the education of the preparer and the availability of the preparer for interview.
Recommendation: CMS mandate joint provider and surveyor training shared nationally
through a web-cast format.
Recommendation: State coalitions and state advisory groups work aggressively to decrease the variability between state and federal standards, and to universally promote
residents' constituional rights to self-determination.
Recommendation: CMS workgroup research available technology to facilitate communication of interpretations and other guidance to surveyors and providers in a high tech format that would make all relevant current guidance and clarifications available in
real time.
Survey Process Can Be A Barrier
Historically, the Institute of Medicine Committee on Nursing Home Regulation report in 1986, Improving the Quality of Care in Nursing Homes, identified the need for survey process reform to “reliably distinguish the very good from the poor or merely acceptable performers.” Consider this excerpt:
Modern management theory holds that excellent results are more likely to be achieved when the members of an organization are motivated not by fear of sanctions for inadequate performance, but by pride, accountability, cooperation and loyalty. The HCFA (now CMS) and state governments can apply this concept in their dealings with nursing homes. The current federal regulatory system is structured only to punish poor behavior. Good behavior goes unrecognized. Only a few states have developed systems for rewarding good or outstanding facilities. In part, it is attributable to the crudeness of the survey instruments. After the HCFA has implemented the new survey process recommended in Chapter 4, and after some statistically derived outcomes standards are developed, it should be possible to reliably distinguish the very good from the poor or merely acceptable performers. It will then be possible to reward facilities for excellent performance and thus to encourage continued excellent performance.
Twenty-three years later, the industry still waits for this reform. Shields and Norton state it simply: “As CMS and state regulatory agencies begin requiring changes, they are obligated to consider these same changes within their own systems. The regulatory system they ultimately establish, while it should have the teeth to deal strongly with providers who do not routinely comply, should also focus on educating, coaching and assisting providers during and between surveys as a primary methodology for ensuring quality. Such a system would be effective while creating a partnership in mission and purpose.” (Shields and Norton, 2006, p 23)
Miller and Mor, in Out of the Shadows, raise the issue of survey process as they explore the question of the role of surveyors as “Cops vs. Consultants.” (Miller and Mor, 2006 p 71) This
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