Page 54 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
dichotomy of survey process is one that most all providers and surveys have faced, often with frustration, as well intended professionals, working toward a common objective of quality resident care from sometimes differing perspectives. The need for survey process reform, to distinguish “very good from the poor or merely acceptable performers”, as the IOM 1986 report referenced, is still present and strong.
Supporting Culture Change: Working Toward Smarter State Nursing Home Regulation, a Commonwealth Fund Issue Brief by Stone et al., suggests that the states and federal government must strike a balance on the deterrence-compliance continuum, recommending a “responsive” or “smart” regulation that would “seek to encourage cooperation, information-sharing, and negotiated agreement between regulators and providers while retaining the powerful incentives and sanctions of deterrence regulation.” The authors further state, “A growing number of advocates, providers and regulatory officials have recognized the need to shift the regulatory paradigm toward a more collaborative and cooperative model.” The issue brief is provided in Appendix F. (Stone, 2009)
OBRA ‘87 SUPPORTS CULTURE CHANGE – LACK OF CLARITY ON BEST PRACTICE OFTEN IMPEDES IT
Pioneers in culture change have moved forward, doing what they believed to be the right thing to do as gleaned from the experiences of others in related care giving fields and from their own personal experiences, but without a strong base of empirical research to support specific approaches.
Rahman and Schnelle propose that research address five key questions in moving forward:
What are potential outcomes?
What care processes are related to these outcomes?
What factors limit staff ability to implement the intervention?
What are the staffing costs of implementing the intervention?
Do all residents, including those with cognitive impairments, benefit from the intervention? (Rahman and Schnelle, 2008)
The hope is that the answers to these and related questions can quickly be learned, in time to guide the work of future adopters of culture change toward the most successful practices as the movement evolves. Additional research can also strengthen the ongoing work of the pioneers and “early adopters” who continue to explore new opportunities for honoring resident rights and self-determination. While lack of research has not been a formidable barrier to these early pioneers and early adopters, it will likely be more so to the 45% of nursing homes in the country who still consider themselves “traditional” as they ponder advancing to “striver” status and beyond.
Recommend all stakeholders should work aggressively to support survey process reform
supportive of “smart” regulation as advocated by Stone et al.
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