‘Game Changers’
The 7 Secrets of Highly Effective Home Health Agencies
A focused, visionary, ideological
culture drives effective organizations. The licensed Home Health Agency (HHA) is not simply
an organization with an owner, some skilled nurses, an administrator, a
corporate charter from the state and a Medicare license. The employees, nurses,
billers, and owners/management, are members of the particular HHA “tribe”, and are
members which function within the agency team. Since prehistoric times, the
basic human organic structure is tribal**. An HHA which operates as a tribe is
a well led organism which exudes confidence, competence and proficiency in its
behavior. Highly effective HHA’s have these cultural components present in
order to thrive in technical nursing, point of care skill and professionalism, administrative
competence, and in communication of a shared vision. Many of the same or similar characteristics of
tribes are inherent in what is known as “a learning organization”. These
concepts, when strategically applied can yield highly effective practices that
result in successful, effective home health agency operations. The
characteristics of learning organizations in this essay are presented first,
but not in order of priority. The
Learning Organization framework gives meaning to all aspects of effective
HHA’s.
The 7 secrets:
1. Effective Home Health Agencies are Learning
Organizations*
Agencies which teach and encourage shared vision and
corporate learning, over time become true “learning
organizations”. The learning organization concept was introduced by Dr.
Peter Senge, of M.I.T.’s Center for Organizational Learning in Cambridge, MA,
and author of “The Fifth Discipline, The Art and Practice of the Learning
Organization”. Dr. Senge identified that
a learning organization exhibits five main characteristics: Systems Thinking, Personal Mastery,
understanding Mental Models, a Shared Vision, and Team Learning.
- The idea of the learning organization developed from a body of work called Systems Thinking. This is a conceptual framework that allows people to study businesses (home health agencies are businesses) as bounded objects, like cellular organisms. Learning organizations use this method of thinking when assessing their company and have information systems that measure the performance of the organization as a whole and of its various components (metrics). Systems thinking involves all the characteristics that must be appear in an organization for it to be a learning organization. If some of these characteristics are missing, then the organization will fall short of its goal of being fully effective.
- An individual’s commitment to the process of learning and professional proficiency is known as Personal Mastery. There is a competitive advantage for a Home Health Agency organization whose workforce learns and implements quicker than the workforce of other organizations. Individual learning is acquired through staff training and development, and credentialed formal education. However eventual learning cannot be forced upon an individual who is not receptive to learning. Effective agencies know the importance of the development of a culture where personal mastery is encouraged and practiced in each member’s daily work-life. The effective HHA must employ agreed upon mechanisms to encourage individual learning to be transferred into organizational learning.
- The assumptions held by individuals and organizations are called Mental Models. To become an effective agency which is growing as a learning organization, these models must be challenged. Individuals tend to espouse theories, which are what they intend to follow, and theories-in-use, which are what they actually do. Similarly, organizations tend to have ‘memories’ which preserve certain behaviors, norms and values. In creating a learning environment for the effective Home Health Agency, it is important to replace confrontational attitudes with an open culture that promotes inquiry and trust. Unwanted assumptions, norms and misaligned values need to be discarded in a process called ‘unlearning’. It is the responsibility of each agency to identify the flawed mental models of its members. These should be dealt with discretion and in a considerate, humble manner.
- The development of a Shared Vision is important in motivating the HHA staff to understand the shared vision of excellent, quality patient care as being the overriding cultural value can energize the tribe. In some agencies the agreed upon shared vision is often to succeed against a competitor; however, these are transitory goals. The shared vision should reflect a long term goal that is intrinsic within the company, such as the vision of excellent patient care.
- The benefit of Team Learning is that staff members grow more quickly and the problem solving capacity and agility of the organization is improved through better access to knowledge and expertise. Team learning requires individuals to engage in dialogue and discussion; therefore team members must develop open communication, shared meaning, and shared understanding. (Tribunals aid in developing this capacity.)
·
*For more
in-depth information on the theory and practice of Learning Organizations,
please refer to the work of Dr. Peter Senge and the Society for Organizational
Learning www.solonline.org
**Many of
the ideas that are contained in this essay have their root in Tribes, a book by
Seth Godin, published in 2003.
2. Effective agencies
know the “why” behind their agency—an authentic desire to care for their
patients, and their members
In the effective HHA, patient care
must be the top priority. If all other characteristics are present, yet the
agency is not patient focused, the agency will be less than highly effective.
Care for patients is the “why” behind everything that is done. The effective
agency’s “lifeblood” is quality patient care, and in that highly effective
agencies share a common cultural ideology. Together HHA staff members believe
that care for patients is something we are called to do.
Helping others should come naturally
to us as individuals, and together we aspire to this cultural norm as a living
company, an organism, a tribe. No members of our agency staff are to be hired
unless they can agree and agree to learn to espouse the agency’s shared
cultural operational vision. Owners and managers who are unable and unwilling
to be open and to submit to this shared vision/teamwork oriented concept and agree
to grow towards operating in this way are acknowledging that they will accept
something less than becoming highly effective as an agency. Leaders are very
aware that they must constantly praise and encourage the members of the tribe
to continue learning, initiating and growing in personal mastery. The agency
without a focus primarily on quality patient and member care, empowering its
employees/members to act as “care agents” in the field, are not able to achieve
anything similar to the effectiveness of those HHA’s that do.
3. Effective agencies
are proficient in skilled nursing and therapeutic care
Skilled Nursing Proficiency is also
a non-negotiable cultural norm of the effective HHA. Highly effective agencies
know that skilled staff members working in the areas of patient admissions,
charting, case management, therapy deployment, regulatory/billing & compliance,
and RN accreditation are necessary in order to become more and more effective
in operation. The highest professional standards for skilled nursing care,
nursing licensing, and knowledgeable, well-designed workflows and well-trained
administrative staff are high return targets for each HHA. Decisions regarding
software platforms and operating systems for the agency should include
methodologies for tracking and maintaining the necessary ongoing training
necessary for always current professional nursing licensing. Effective tribal agency leaders have a
constant eye on the professional standards maintained by the nursing staff.
4. Effective agencies
achieve a growing competence in Regulatory Compliance
The most important reason for choosing a software
platform is to provide a methodology for maintenance of regulatory compliance
in skilled care of patients, and billing & reporting those patient episodes.
In the current environment the home health industry is regulated by our primary
payment source, the Center for Medicare Services. The effectiveness of the
agency in billing and overall compliance is directly attributable to the accuracy
achieved in preparation of the Outcome and Assessment Set documentation (the
OASIS). Also the 485 summary report to be signed by the Physician in charge of
the patients care must be accurate and in compliance. The technologically
superior and constantly improving updated software platform* is the driver for
this accuracy and completeness in the effective HHA. Because of the sophistication of operational
platforms maintaining the home health agency on paper forms, while still possible,
is now impractical and counterproductive. The time required in generating paper
charts and billing submission documents in order to maintain regulatory
standards for OASIS and 485 submissions is clearly cost prohibitive.
If you still utilize paper docs to run your agency. Your results will not be as effective.
*Note: Axxess’
Agencycore® is the leading state-of-the-art Point-of-Care and Operations
based software platform in the US. A rapidly growing number of prominent and
effective Home Health Agencies utilize Agencycore® to enhance their ability to achieve highly effective and
productive operations. To the writer’s knowledge, no other platform available
in the marketplace today can compare to Axxess in the enablement of highly
effective agency operations.
5. Effective agencies act with wisdom regarding expenditures
Are the agency’s costs and expenditures aligned with the agency’s shared
vision of excellent patient care?
Generosity with patients and with
staff brings about the joy of working, of having fun with one’s co-workers and
the patients in the field. Cost containment managed wisely means being generous
with patients and the pay scale for agency staff, because these factors drive
greater returns, more referral generation and more expansive revenues. Cost
containment is non-negotiable; however, the effective HHA is wise in
strategically deciding on how costs are linked to productivity. Additionally,
effective agencies utilize productivity and performance metrics as motivational
drivers towards greater productivity. Personal productivity and team
productivity can effectively be managed in an open facilitative manner,
appropriate to the adaptive, learning organization based tribal culture.
6. Effective agencies are Ideological and Visionary in Nature
Tribes are a prehistoric way of
organic alignment of like-minded people working together collaboratively for a
common goal or shared vision. An authentic desire to provide quality patient
care is an excellent example of a shared vision. The effective agency is a
living organism, a tribe, whose culture must be guided and disciplined by its
shared vision and its collaboration. Each member is expected to seek Personal
Mastery of his or her role in the tribal organism. This recognizes the skilled
nurse, the aide, the social worker, the billing and administration personnel,
the ownership and management, as being highly proficient and ever-learning,
ever-growing-in-knowledge and proficient in their assigned duties. The age old
“guild” interrelationship between the master and the apprentice is a guiding
principle in an effective home health agency. Knowledge is not hoarded for
personal advantage. Teaching and learning is encouraged between team members
and between care givers and patients.
7. The effective tribal/organic agency is protective of its
collaborative culture
Tribes have strong, visionary,
focused and competent leadership. Effective “Tribal HHA’s” are focused on ‘the
why’ behind what they do, so that every member acts in accomplishment of the
shared vision of the tribe. For effective
HHA’s it has to do with excellence in patient care. Tribal organisms are quick
to identify the mental models (or flawed assumptions) that are not aligned with
the agency’s vision. Left unattended, flawed mental models can harm an agency’s
shared culture, and can in turn do harm to its ongoing business success. The effective HHA acts and initiates based on
its best knowledge and shared learning. The
effective agency is always creating, initiating, evolving. This creative action
and initiation has the effect of causing others in the market to react. Most
HHA’s are not aware of tribal organic operational culture, so tribal cultures
can move stealthily within their local markets, to quietly and forthrightly accomplish
their goals and objectives, and move closer to their shared vision. In doing
so, they are lethal competitors.
Because effective agencies are
learning organizations, and every member is encouraged to act in accordance
with a shared vision, creative solutions and methods are constantly being tried
and implemented. Like a tribe in the wilderness, it constantly adapts and is
agile as a team.
An effective HHA recognizes its
organic nature, in that tribal culture is the fundamental unit of human
activity. Everyone knows and understands his or her role and is expected to do
his or her job because each member is committed to achieving an ever growing
sense of personal mastery and is fulfilled in his or her role. He or she is
being encouraged to grow in their role, and is praised when they achieve new
attributes. This mastery and the encouragement of leaders can assist each
member in making their assigned work become “fun”.
Let’s have fun! “Having fun” and achieving positive feedback at work
creates a work environment in which members enjoy participating. Once organic
concepts and learning organization cultural standards are implemented in the
HHA, more effective workflows in operations result, because the team members
are enjoying their work and working together towards a common goal. Why not try
these concepts? You might become more effective! Not only that, you
might begin to have fun at work.
