Dear Diary

Tuesday, August 11..........Dear Diary:

7:30 a.m. I'm back at work following a wonderful week vacation. I didn't leave town, but had a blast spending time on the boat, taking kayak trips, going to a concert, taking in a baseball game, knocking off household projects and working on the writing of my novel. Weather was great and I had a relaxing week. Having a hard time getting used to wearing shoes and a tie again.

8:30 a.m. A lot of people stopped by to welcome me back. My desk and work load isn't to bad. The nice thing about not going away on vacation is that I was able to check my e-mail and voice mail daily. I found by spending a little time each day managing my office data it kept things from piling up upon my return. Kirkhaven Administrator, Amanda Brown, stopped in to say hi and get me caught up on things. Quiet week while I was gone. Poor Amanda, she has been trying to schedule a vacation of her own, but is afraid the Health Department will show up for their annual surprise inspection while she is gone. Now that I'm back, she has finally decided she is starting her vacation tomorrow.

9:00 a.m. What's all the commotion outside my office? Uh oh, I think we have visitors. Like wild fire, the word spreads throughout the nursing home. "The Department of Health surveyors are here!" A team of nurses, sanitarian, dietitian, social worker have arrived armed with lap tops, manuals and paperwork. Amanda has postponed her vacation plans. Let me see, at this time yesterday I was kayaking out on the Genessee River. Welcome back to work Jim.

Noon It's hard to explain the atmosphere during a survey. We go about our business as usual, but it is like someone just pushed the "fast-forward" button on your life but you're running in knee deep sand. Everything we do is under the microscope and magnified. The surveyors observe, ask questions, talk to residents & families, review charts, dig deeper, ask more questions, watch your every move as you try to go about your "normal" day. I guess you could say it's a little intimidating and nerve wracking for our staff.

5:00 p.m. End of the first day. According to Amanda, all is good so far. Staff is okay and nothing major appears to have surfaced. Time to go home, this working for a living is tiring.

Wednesday, August 12........Dear Diary:

9:00 a.m. I can't believe I'm stuck in this meeting across town. Didn't the rest of the world get the memo about the surveyors being at Kirkhaven? Doesn't our regular work go away when the annual State survey is underway? This is a pretty important meeting in its own right, so I need to focus. I know Amanda and her team have things under control at Kirkhaven.

11:00 a.m. Finally, this meeting is over. We accomplished a lot. I'm helping to lead a potential shut-down of our self-insured Workers Comp Trust, which we participate in along with several other health care organizations. A significant initiative with critical implications. I wonder how the survey is going today.

1:00 p.m. "Houston we have a problem!" Seems the coffee temperature is too hot according to the surveyors. Could cause serious injury to our residents. But our residents like hot coffee and often complain it's too cold? According to the surveyors, this could put us at an "immediate jeopardy" deficiency level. That's not good! Immediate Jeopardy (IJ) means no new admissions and potential fines until the problem is adequately resolved.

4:30 p.m. Still a lot of commotion going on about coffee temperatures. Surveyors taking coffee temperatures throughout the house. We pulled the plug on the coffee dispensers on each floor and started serving coffee from urns. The coffee vendor has been called. Amanda copies me in on an e-mail from our Medical Director entitled, "Coffee, Tea or IJ". You have to have a sense of humor to get through this stuff. I wonder what tomorrow will bring.

Thursday, August 13.......... Dear Diary:

8:00 a.m. Amanda and I met with our Medical team Director. Our new physician team is awesome and all is well, but we need to work on some coordination issues to ensure the staff and physicians are working as efficiently and effectively as possible. We identified some good ideas and a process to begin working on this. I wonder how the survey is going today?

10:00 a.m. I had to attend an important meeting with the County Department of Human Services. I'm working with other industry representatives on a unique initiative to help expedite the vast backlog of Medicaid Assistance applications that cause critical cash flow issues for nursing homes. The meeting is very productive and we agree in principle on a process to move forward with.

noon I met with Amanda to get an update on the survey. The coffee debacle seems to be resolved for now. A few other issues are cropping up. Nothing devastating, but the normal little things that eventually happen when under the microscope. There are so many resident interactions within a day, so many clinical treatments, so many opportunities to both do well and slip up, that eventually the surveyors will find something to write you up about. That's just how the system works. The surveyors are just doing their job, no different than us.

2:00 p.m. I went to participate in the Valley Manor Newcomers Welcoming party. What a nice respite from the rest of my week. We have had a lot of new residents move in over the past several months. All have such interesting backgrounds. All the residents come to meet and greet everyone. It is a lovely event and enjoyed by all. The renovated Valley Manor courtyard is finishing up and looks great! I wonder how the survey is going?

Friday, August 14.............Dear Diary:

7:00 a.m. Early start today. I'm finishing up two big projects. The first is the completion of our annual IRS filings for our 4 corporations. These are usually done by our auditors, but there are significant changes in the forms this year and there's no way a third party can complete them without us providing them the information anyway. The filing has gone from approximately a 10 page form to a 25 page form. I can't ask the finance office to take on yet another project. Sometimes I find that the best way for a CEO to stay in touch with the organization is to immerse yourself in the operation. It's a fine line between micro-managing and staying informed, but I like to walk it. The second project is the compilation of the Assisted Living licensure application data to submit to the State. Staff have been working hard on this and we appear to be getting to the end of the long process.

10:00 a.m. Spoke with Amanda for an update. She seems a little ragged. It's been a long week. She shared some incidents that the surveyors and staff have shared with her. Seems like some potential for deficiencies are adding up, but still nothing real major. Then again , maybe we're just paranoid at this stage of the game.

Noon Had lunch with board member, John Billone, a local developer. We had good conversation about the Kirkhaven Replacement Project and the current property opportunity we are evaluating with Buckingham Properties for the old Armory site on Culver Road. Some good ideas, input and support from John who is very knowledgeable about the property and development projects in general. The survey exit conference is scheduled for 2 p.m. today.

2:00 p.m. The survey team leader sits down with our entire leadership team in the conference room. We open up the Exit Conference to the entire team. We work as a team and we take the good and the bad as a team. The survey team leader begins with her scripted disclaimers and instructions. She then begins to identify the survey team findings which represent the "potential" for any deficiencies. She indicates there are no deficiencies that represent substandard care. Nice, we're off to a good start!

She then proceeds to identify 3 circumstances whereby they witnessed a failure of staff to properly wash their hands, which is an infection control issue. I struggle to keep up with my notes as she rattles off the details. Then she begins to thank us for our cooperation during the survey and do we have any questions. "Uh.........is that it?" I wonder to myself. Could I have dozed off for 20 minutes and just woke up in time for the concluding remarks? The room is stunningly quiet as Amanda escorts the survey team out and sees them to the front door.

I never noticed before how long it takes for the conference door to close itself. When it finally clicked closed, everyone looked at everyone else and burst into a collective sigh and then laughter. "What just happened?" everyone asked. "Well," I said, "It appears we just aced our survey with the potential for only one little deficiency of minimal scope and severity."

When Amanda returned she had the biggest smile on her face that any of us have ever seen. "Amazing job everyone," she said. "we did it!" The key word being "we". It has been a long and tiring week for all, but because of the work of all, we aced our survey. Now I still believe that the State survey is only one measure of our quality, and arguably not even a great measure. But it is a measure and a critical component of our regulatory compliance requirement and public relations. We take it seriously and thus are overjoyed with our awesome results!

3:00 p.m. "Great job everyone. Take the rest of the week off," I said to an exhausted yet elated leadership team.

p.s. Thank you Amanda for your incredible leadership and enjoy your well-deserved vacation. Thanks for visiting my Blog. Talk to you all again next week.