The relationship between nursing homes and regulatory agencies has varied since the start of the pandemic — surveyors were initially very helpful, but as the pandemic went on, clinical leaders started to see a shift in that relationship with mounting directives around citing outbreaks.
In recent months, that relationship has shifted again to be more positive and supportive, a change some clinical leaders hope will usher in a more progressive regulatory and accountability system in nursing home care.
The pandemic has shown the industry that how we set accountability needs to change altogether, and according to Dr. Arif Nazir, chief medical officer for Signature HealthCARE, “that cannot be done by carrot and stick systems only.”
“Our healthcare system has grown beyond a carrot and a stick system. There’s so much science out there through behavioral economics, how to nudge positive behavior, and it’s not through money and punishment, I can tell you that,” Nazir said during Skilled Nursing News’ Clinical Executive Summit on Tuesday.
Nazir was joined by Tony Costa, chief nursing officer at Sava Senior Care.
The science is “absolutely clear,” Nazir said, that regulatory accountability should lean into autonomy and mastery of purpose in order to engage and motivate the industry’s workforce.
Agencies would better serve the industry and residents in its care by supporting the mission and vision of frontline staff, and adopting a “coaching demeanor,” Nazir added; he considers this the core strategy for a new accountability regulatory system moving forward at this point in the pandemic.
Instead of going back to a reactionary mode, nursing homes and survey agencies should take the pandemic as an opportunity to forge a different kind of relationship, Nazir said.
“Over the years, we’ve really become so focused on regulatory compliance,” explained Costa. “So much of the practice that’s happened in our buildings pre-pandemic was driven by surveys … and yet, there’s everything we learned, whether it was in nursing school or medical school or therapy school, this vast knowledge, and I think at times pre-pandemic that was sometimes put to the side in order to be in regulatory compliance.”
Regulatory guidelines that align with the latest science, instead of basing changes off of surveyor notes, will help clinicians deliver better care to residents, Costa added.
“I think one of the things that pandemic showed us was the importance of going back to our roots as clinicians and following the guidance and the science that was coming out from those organizations,” noted Costa.
Assessing root causes that may have led to a survey outcome, Costa said, rather than just addressing the problem arising from the survey through an intervention, is the path forward.
“When we have a survey outcome, oftentimes the next question is, well, what are we going to do about it? Minor corrections are put in place and we implement the plan of correction, but we rarely ask the question, why did it happen, what were the root causes that led to that outcome?” said Costa.
Outside of the state survey process, Costa said relationships with local health departments has strengthened considerably. Pre-pandemic, health departments and nursing homes stayed in their silos and didn’t interact much.
“Many of our centers weren’t even sure who their local health department was, nevermind who their contact was at the local health department prior to the pandemic,” explained Costa, adding that the stronger relationship will help navigate future infectious disease spread in local markets.
“For me, that’s been the biggest and most successful change,” Costa added.
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