Unpredictable, biased, and time consuming. Or maybe disruptive, stressful, and intimidating. Do any of those words describe your experience with state surveys in your nursing care center? Going through the survey process is demanding on all staff members, but have you ever gotten a surveyor’s perspective on the situation? Perspectives had the opportunity to catch up with two individuals who work for Nursing Home Quality, the organization that is responsible for training surveyors around the nation on Quality Indicator Survey (QIS), to discover what trainers and surveyors are saying about QIS.
Robin Harper, RN, has been training surveyors on the new process over the past year. A former surveyor herself, she was presented with the opportunity to train individuals from different states on how to understand the new process and how to conduct accurate and successful surveys. She has found that survey teams in general are “very receptive to the process” with about “95% of the surveyors wrapping their arms around it and loving the change.”
A challenge the trainers found while conducting QIS training is some surveyors who have been surveying for a very long time are a little reluctant accept the changes that come with the new survey process. But after much encouragement from the trainers to “let the process work,” they soon realize what a great process QIS can be.
Despite people coming from different backgrounds and experiences, all must complete an intensive training program for the new QIS process. During the training program, each surveyor must complete a week of classroom training, be shadowed by a Master Trainer during a mock survey and achieve two successful compliance assessments during surveys of record. All of these activities are monitored closely by trainers who provide direction and assistance when needed. After completion of the two consecutive compliance surveys, the teams are required to conduct four more weeks of surveys of record on their own to fulfill their training requirements. In total, the stringent training process takes over four weeks to complete. Currently, there are eight states (Florida, Connecticut, Ohio, Minnesota, North Carolina, Kansas, Louisiana and New Mexico) that have gone through the training process and have a portion of their surveyors actively using QIS.
What does all this mean for you? It means more consistency in the survey process. With surveyors being trained by a consistent group of individuals, in addition to having a structured group of questions that are administered during the actual survey, providers can rest easy knowing that they are receiving the same treatment as a competing nursing care center.
Another difference in the process, according to the trainers, concerns what takes place offsite before the survey. Prior to the new QIS process, surveyors could walk into your residence with preconceived notions about your quality of care. Or maybe they were present during a former survey and remember a specific individual who they spoke with before. With QIS, a random sample of current residents is chosen, so surveyors aren’t “targeting” individuals to review prior to entering the nursing centers. With the randomized process, it puts everyone on equal footing, which is seen as a benefit to both the providers and the surveyors.
Cindy Mason, VP of Provider Services, Nursing Home Quality, also added that the new process is challenging individuals to rethink how they prepare for a survey. This doesn’t just refer to DON’s or Administrators, but surveyors as well. Everyone involved has to change his or her perspective on what is acceptable in a care environment and what is not. Harper used the example of one of the scripted questions that a surveyor asks a resident. The question is, “do you get the choice as to what time you get up in the morning?” If the resident answers “no,” then there is a follow up question that asks the resident if this is acceptable to them. If the resident says no to the second question then there would be a potential Stage II investigation in the care area of Choices. During the Stage II investigation the surveyor would interview the staff that provides the direct care to the resident in regards to what time they get the resident up in the morning. They would also re-interview the resident and possibly come in the care center during the early morning hours to make observations. In addition, any care area that triggers a Stage II investigation, surveyors have the chance to speak with all team members, from the aides to the therapists, in order to get an accurate picture of the care that the resident is receiving.
Overall, surveyors and trainers are finding that QIS is going to become a much easier and less stressful process for care providers. Administrators have access to all forms that the surveyors have, which reduces the uncertainty and intimidation of the survey process. The process provides a more balanced view for both the residents and the providers – after all, we are all working towards the common goal – quality of care and life.
A special thanks to Robin Harper and Cindy Mason from Nursing Home Quality who helped make this article possible.