6 Things Top LTPAC Management Teams Do to Manage Adverse Events

There are top performers in every industry and every sport, and they have remarkable similarities. Sure, they have talent, but they also approach their work in the same ways and with the same tools.

I was just watching the U.S. Olympic Trials, which was dramatic and exciting. For most of the athletes, it was their best chance to go to the Olympic Games, to be an Olympian. No matter if they were a high jumper, a sprinter, a wrestler or a gymnast, after their event—when the microphone was placed in front of them, every one of them said the same thing: “I worked so hard to get here.”

The same is true for the best teams in LTPAC. You all work hard, but as we learned from the legend of John Henry, you can only get so far with a hammer. There is an upper bound to the benefits of hard work.

What separates the Olympian and a great team from the competition is working hard and working smart. Training often evolves to cover even the most esoteric details, and sometimes to such levels that it's hard to believe that everything matters. Everything might “matter”—it's just that some things matter more and they're easy to understand.

The six things that the top LTPAC management teams consistently do to manage adverse events matter more and are easy to understand.

Most Important Practices of Top LTPAC Management

1) Their EHR Systems Don’t Manage Adverse Events for Them

Former GE CEO Jack Welch’s number one principle was that you need to see the world as it is, not as you wish it were. So Jack fails the hyper-optimist feel-good test, but he makes an important point. We're all subject to great biases, but we have to try to strip them away if we are going to plot a sound course of action—especially for a large organization.

EHR systems are resident-centric. When you're managing a community or group of communities across floors, wings, shifts, and days of the week, you aren’t relying solely on your EHR system. Top performers rely on a separate incident management system that provides them with a 10,000-foot view to gain management-level insight into adverse event trends.

2) Their Separate System Is Automated

Creating paper incident forms is one thing, but handling that paper over and over is another. Putting the data into a spreadsheet is a positive start, but it's expensive (and error-prone). Your resident spreadsheet guru might know how to input data, but they probably don’t know pivot tables (pivot tables, what?). That's alright. That's not why you pay her or him.

You can spend up to .25 of a full-time equivalent (FTE) nurse just managing incident forms and data. That can be as much as 500 hours per year, at how much an hour? The crazy thing is that because it might involve multiple people, you might not see it.

There's an IT adage that goes like this: you are what you don’t automate. You never want to automate care. You do want to try to automate things that aren’t resident-, family-, or team-facing. The best teams automate incident data.

3) Their Data Is Consistent Across All Communities

If you've managed to gather incident data from multiple communities, hats off to you. If the data isn't captured with some discipline, it might offer some value, but it could also lead you astray.

The best teams capture data the same way within and across communities. You might not want to stage a competition between communities for adverse event management, but you may well want to answer questions. Why is one community having an uptick in events? Why are they having fewer than the others? Why is one shift doing better than the rest?

Top teams have consistent data so that they aren’t talking about data. Top teams work hard to solve problems and improve care.

4) Top Performers Get Independent Assistance

What percentage of Olympians have coaches? 99%. Why? Because coaches make athletes better. The top performing teams in LTPAC get assistance as well.

One thing we all struggle with as families and teams is getting too mesmerized by our own perspective. We have a principle that says, "don’t believe everything you think." The reason for that is a phenomenon called WYSIATI—What You See Is All There Is. Nobody knows everything and that's just fine. We just have to be able to find the people who are experts in the areas we're lacking—or, as I like to say, you don’t have to be the guy or girl, you just have to be able to find them.

Top performing LTPAC managers get outside risk managers to review significant adverse events in their communities for two reasons. The first reason is to gain an informed, but independent perspective. The second is because adverse events are a really big deal.

5) Adverse Events Have Real Costs

Top performers are laser focused on having a professional approach to managing adverse events because adverse events are very, very expensive. Adverse events can affect your rating, your referrals, your surveys, employee morale, family confidence, and, above all, the health and wellbeing of those in your care. Think of the recovery time from an adverse event. It can be years, a lifetime, or never.

The top teams prioritize well and then work hard.

6) Caregiving Has a Financial Context

Top performing teams face the reality that providing care comes with a financial context, and they make sure to place the emphasis on care first. Anything that detracts from care gets weeded out. Anything that conserves resources and contributes to quality care remains.

That means that if you consider projects, new equipment or software, it needs to clearly contribute to the mission and have a clear and quick return on investment. Who is going to champion an expensive, speculative project? Nobody with a real career future in the organization. Top performing teams get behind initiatives that pay off and pay off quickly.

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