Category Archives: Leadership Insights


Pathway Perspectives: Competency-Based Training


Designing a Competency-Based Training Program


The complexity of the health care environment requires staff to participate in educational programs that ensure they have the knowledge, skills and abilities to provide individualized care.

Recently, we connected with Lisa Thomson and Sue LaGrange to discuss the importance of competency-based training to support clinical outcomes. Below is a highlight from our conversation:

Q: Lisa, what is competency-based training?
A: Training that is focused on specific competencies for a single key skill. Multiple skills are combined into modules. This type of training may also be called outcome-based learning/training or skills-based learning/training. This structured approach to training and assessment is directed toward achieving specific outcomes. With competency-based training, the learner knows exactly what is expected and trainers know the precise training and learning that is required to achieve the expected level of competency.

Q: Sue, why is competency-based training important for LTC leaders?
A: As we all know, there are competencies required by federal and state regulations and other governing organizations for health care employees. There are also other entities or organizations that may impact our decision as leaders when determining the competency needs for your team. These other organizations may include, Occupational Health and Safety Administration (OHSA), Medicare and Medicaid integrity programs, state and federal labor laws and building codes, and practice rules for licensed, certified and registered professionals. Simply put, competency-based training is essential in order to maintain regulatory compliance and meet facility and individual licensing requirements.

Q: Lisa, where is the best place to start when developing a competency-based program?
A: Start with a comprehensive organizational assessment. It is important to gather all of the facts and gain a further understanding of the education and competency needs of your organization before developing a plan. This begins by identifying the core elements or determining factors that impact staff competency needs and what is needed to include in your training program.

Q: Lisa, from a market positioning view, what are a few of the core elements?
A: The first element includes strategic initiatives and priorities, which encompasses the overall strategic initiatives or priorities for your organization. This may include priorities such as, implementing a respiratory recovery care program taking COVID-19 patients, providing services for higher acuity individuals, specialty programs such as cardiac rehabilitation, or memory or dementia care that require additional clinical stabilization prior to going home with their loved ones. Another core element is marketplace trends and initiatives. This focuses on the expectations of the local marketplace or impactful market shifts, such as partnerships, new networks, payment models. As leaders, it is imperative to understand what is happening outside of our organization’s “walls,” not only for sustainability, but also for determining the skill level expectations of staff in order to achieve those outcomes.

Q: Sue, what are a few of the important core elements from a clinical perspective?
A: It is important to understand all of the regulatory requirements. There are a number of F-Tags related to competency expectations including:
F725 – Sufficient Nursing Staff
F726 – Competent Nursing Staff
F727 – RN 8hrs, 7 days/week, Full-Time DON
F728 – Facility Hiring & Use of Nurse Aide
F729 – Nurse Aide Registry Verification, Retraining
F730 – Nurse Aide Performance Review – 12 hours/year In-service
It is vital to have a pulse on how your team is meeting the regulatory requirements.

Speaking of team, workforce trends are also key. When designing a competency-based training program, it is important to assess the skill level requirements and needs of the current staff along with how skills align with their job descriptions or specific responsibilities. Another part of this equation is identifying future needs based upon the marketplace needs as well as the types of care and services your organization provides today and in the near future. It is important to look beyond what has always been done in as it relates to who does the training, what training is conducted and how to engage more people to conduct training and complete competency verification for the team. Facility-specific training program objectives play a foundational role. It is important to identify any other specific training program objectives that need to be considered for your overall master plan.

Five Strategies for Creating Meaningful and Competency-Based Training
Both Lisa and Sue mentioned that once the education and competency needs assessment is complete, leaders should map their organizations’s overall education journey by addressing five key steps.


Step 1: Understand the overall needs and requirements which includes your resident population which means identifying your overall population demographics and needs.

Step 2: Identify the knowledge, skills and abilities (KSAs) that your team members need in order to care for your residents/patients.

Step 3: Prioritize the specific competencies that are needed and determine how to verify that your staff can move their knowledge into action.

Step 4: Develop your overall training plan. Step 5: Evaluate the outcomes of the journey.

The overall process for the determination of competencies and training needs cannot rely on one individual within an organization. Utilizing a team approach to evaluate and determine the competency and training needs will engage team members in the process and will provide additional insight for successful outcomes.

Contact us to discuss how Pathway Health can support your staff competency training needs.




The Critical Role of the MDS Coordinator for the Success of Your Facility

Over the years, the Minimum Data Set (MDS) has evolved beyond a clinical assessment tool. It is no longer “paperwork” that any nurse can fill in. Successful completion of the MDS requires complex expertise, exposure to the nursing home environment, knowledge of the MDS coding rules, awareness of the federal nursing home regulations, deep understanding of the Medicare and Medicaid payment systems and skill in assigning and managing ICD-10-CM diagnosis codes.

As you know, the MDS is the data collection tool for resident information abstracted from the medical record and shared with the federal and state governments, researchers and the public. The information is used for regulatory compliance reviews, state and federal care reimbursement, quality data collection and public reporting, and the development of a person-centered care plan.

It may not be a surprise that the job website Indeed has over 1,000 MDS Coordinator job postings and LinkedIn has 75,000 MDS Coordinator job listings or that the job website Zippia states that there are over “3,700 open MDS Coordinator job” vacancies in the U.S. and that the position is expected to “grow 12% by 2028.”

At this time, CMS shows no signs of replacing the job function of the MDS Coordinator, even if they follow through with replacing the MDS with another data collection tool. So, how will we fill these critical positions?

To support the ongoing success of the MDS Coordinator, It is important to ensure the following basic competencies:

  • Detailed knowledge of correct coding rules for the MDS and Care Area Assessments
  • Robust understanding of the Medicare PDPM payment classification system
  • Thorough familiarity with the Official Coding Guidelines for ICD-10-CM diagnosis coding
  • Command of the data used for Quality measures, the SNF Quality Reporting Program and Value-Based Purchasing
  • Exposure to the nursing home regulations and survey process
  • Comprehensive skill in the use of the organization’s electronic health record
Leadership Perspectives
  1. There is a tremendous need for MDS Coordinators throughout the U.S., which will continue to grow.
  2. In-depth clinical, coding and regulatory knowledge is a must in order to be a successful MDS Coordinator.
  3. Ongoing mentorship, training and support are vital to not only the MDS Coordinator but also the provider’s overall success.
As leaders, we have to offer nurses a clear path to the knowledge and skills they need. This can be accomplished by providing mentorship, ongoing training and support.
Pathway Health’s team of experts is available to support your organization. Contact us to learn more.

Karolee Withers, RN, RACT-CT
Director of Reimbursement and Clinical Consulting


Leadership Considerations: F689-Free from Accidents and Hazards

This CMS regulation is number four on the most frequently cited deficiencies in 2021. In an effort to avoid a citation, we may take a routine approach to assess and plan for fall reduction. Can we really prevent residents from falling? The accurate answer is “No.” However, we have many tools in our toolbox to minimize the number of falls and injuries from falls.

Perspective: Fall risk screening or assessment only predicts the likelihood of a fall; it does not prevent falls.

As clinical leaders, we are familiar with the myriad of fall risk screening and assessment tools available to the nursing and therapy profession to assess fall risks in the elderly, the Berg Balance Scale, the Hendrich IITimed Up and GoTinneti Balance Scale, Morse Fall Risk Scale and more. Each has its strengths and weaknesses. Each has a slightly different focus. There is no single fall risk assessment tool that includes all fall risk factors. Therefore, we need to apply critical thinking to the data we collect about each person’s fall risks in order to prioritize them and understand the risks in the context of the individual person. The use of a fall-risk score alone will not help with the development of an effective care plan.

Often an individual resident will have multiple risk factors. Analyze risk data to determine which factors are reversible or modifiable. Address the easily modified factors and develop a plan to address the more complex or challenging factors as soon as possible. For example, you can lower the bed and leave a night light on in the bathroom without assistance from others, but a medication review will need to include the pharmacist and access to the medical record.

Include the individual’s preferences, self-assessment of their abilities, knowledge of their conditions and willingness to accept assistance in your overall assessment of fall risks. These factors can be underlying causes of the failure of our best fall prevention care plan. By acknowledging these personal characteristics, we can approach fall prevention with a realistic and personalized plan. Educate the resident and engage them in a plan to regain those abilities most important to them.

Finally, try to avoid focusing the entire fall prevention plan on restrictions. Include interventions that bolster the person’s strengths. People who are inactive and those who are very active are at the highest risks for accidents. A review of research on fall prevention conducted by Gillespie et al. identified a 17% reduction in falls for those involved in a multiple-component group exercise program. This approach facilitates the resident’s abilities by building strength, stamina, and balance to minimize fall risks. Ask your team, “What can we do to make it safe for the resident to do what they are trying to do?”

In addition to the usual approaches, such as eliminating trip hazards and improving lighting, an Hourly Staff Rounding Policy has a major positive impact on fall reduction in hospitals and nursing homes. Use an interdisciplinary approach to ensure the schedule is met. Hourly rounding includes a staff member checking in with the resident every hour. The schedule can be modified, depending on the resident’s needs. The staff member goes into the resident’s room, asks if they need anything and meets that need. Some organizations focus rounding on the “Four P’s” (pain, potty, positioning and personal items (in reach)). By maintaining a consistent schedule, the resident is reassured that someone will be in to visit them and make sure they get assistance as needed. A positive effect of hourly rounding is the decrease in the call lights.

Key Take-Aways

  1. By using a person-centered approach to fall risk assessment and care planning, clinicians can develop a more effective plan of care to minimize the risk of falling.
  2. When we focus on the resident’s strengths, we improve their function and minimize fall risks rather than restricting their movement, which may increase the risk for falls.
  3. Providing reassurance that the resident’s needs will be met helps decrease anxiety and minimize spontaneous high-risk behaviors.

Pathway Health’s team of experts is available to support your organization. Contact us to learn more.


Analyzing the problem of falls among older people. Yannis Dionyssiotis. Int J Gen Med. 2012; 5: 805–813. Published online 2012 Sep 28. doi: 10.2147/IJGM.S32651.PMCID: PMC3468115

Development and evaluation of evidence-based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies, D. Oliver, M. Britton, P. Seed, F. C. Martin, A. H. Hopper. BMJ. 1997 Oct 25; 315(7115): 1049–1053. doi: 10.1136/bmj.315.7115.1049. PMCID: PMC2127684

Interventions for preventing falls in older people living in the community. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007146. doi: 10.1002/14651858.CD007146.pub2. Update in: Cochrane Database Syst Rev. 2012;9:CD007146. PMID: 19370674.

Karolee Withers, RN, RACT-CT
Director of Reimbursement and Clinical Consulting


INTERACT® QIP – Raising the Bar With SBAR

Since early 2020, we have been faced with a pandemic that has challenged health care more than anything else in our lifetime. Therefore, it is important to focus on strategies to effectively evaluate and communicate acute changes of condition and how to provide prompt and complete follow-up for quality and positive outcomes.

With a COVID-19 infection, acute changes in condition can happen very rapidly in residents of LTC facilities. Being prepared with a good response plan is essential. In order for the clinician to make an informed decision regarding orders, transfer, care needs or new medications, it is crucial for the nurse to have all of the resident’s information ready to communicate when calling or discussing the change of condition with the practitioner.

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient’s condition. INTERACT® (Interventions to Reduce Acute Care Transfers) is a quality improvement program that focuses on the management of acute change in resident condition and includes clinical and educational tools and strategies for use in everyday practice.

View INTERACT® tools and resources>

The INTERACT® SBAR provides an exceptional guide for nurses to gather all pertinent information prior to calling the clinician. It also improves communication, provides a consistent language for the entire care team, provides the nurse with standardized criteria for resident evaluation, and has clear guidelines.

Leadership Considerations

Implementation of the INTERACT® SBAR communication tool within your organization is a key strategy in a thorough evaluation and assessment of a resident with an acute change of condition in order to provide the clinician with informed decision-making. It is important to have good systems to identify:

  • Who should fill this out in your organization
  • Steps to implement it into your organization
  • Communicating with physicians
  • Discussion points for consideration – obstacles, competency needs, performance improvement needs
  • Policy and Procedure discussion
  • Paper vs. electronic considerations

As providers continue to move forward, INTERACT® QIP strategies can help support the following:

  1. Prevent conditions from becoming severe enough to require hospitalization through early identification and evaluation of changes in resident condition
  2. Manage some conditions without transfer when this is feasible and safe
  3. Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents
  4. Improve communication and documentation within LTC facilities and programs and between LTC and acute care
  5. Integrate into ongoing QI initiatives (e.g., QAPI)
  6. Embed in Health Information Technology across care settings

Fostering consistent communication by using the INTERACT® SBAR will help to keep your quality “bar” raised for ensuring a quality mindset throughout your organization.

Lisa A. Thomson, BA, LNHA, CIMT – Chief Strategy and Marketing Officer

Susan LaGrange, RN, BSN, NHA, CDONA™, FACDONA, CIMT, IP-BC™ – Chief Nursing Officer



Celebrating Nurse Leaders

From the desk of Lisa Thomson, Chief Strategy and MarketingOfficer, Pathway Health
Recently, I had the opportunity to connect with Pathway Health’s Chief Operating Officer, Donna Webb, to gain her perspective on nurse leadership as we celebrate Nurses Day and the start of Nurses Week. ~Lisa

Especially today, I would like to recognize all of the Nurse leaders, consultants and team members who have been working tirelessly to support those we served over the last year. The COVID-19 pandemic created numerous barriers to the delivery of care, causing us all to quickly adapt to care for those we serve.
Throughout it all, nurses in all roles have shown incredible courage and dedication to provide the best care possible. Nurse leadership has remained consistent and it is and always will be the heart of health care.

As a clinical and operational leader, my role was to set the operational and strategic direction of the organization while working side by side with our nurse leaders. The success of the organization could not be attained without their support, as these professionals lead their dedicated teams.
In post-acute care and across most health care settings, the nursing leader focuses on setting standards, policy, dealing with compliance, overseeing quality measures and clinical outcomes while spearheading innovation and transformation with their teams and within the organization. Since the beginning of the pandemic, never has this been more self-evident.
As I reflect on my career as a nurse leader, the key roles that I consistently have observed of dynamic and successful nurses are the following:
  • Visionary – Overseeing care delivery, customer and staff satisfaction, clinical processes, financial outcomes and compliance are just a few of the oversight responsibilities that a nursing leader possesses. Nurse leaders provide vision and direction for their department while holding staff accountable.
  • Educator – Nurse leaders continue to expand their knowledge and understanding of the changes impacting health care and those we provide competent care to. Staying on top of the changes that affect organizations is challenging and causes some level of stress for nurse leaders. As an operational leader, it is important that nurse leaders continue accessing education, tools and outside resources. These resources will help guide them to provide a level of support for their department and organization’s priorities, as well as expected outcomes. Translating the information and knowledge obtained, aligning with organizational goals, while including other team leaders in the process, will take some of the pressure off of the nurse leader today. This will allow the leader to focus on targeted high-level priorities and clinical processes for successful outcomes.
  • Mentor – Nurse leaders continue to work with their team at all levels. They identify the knowledge, skills and abilities of their team, align those talents with the clinical and organization priorities, which allows them to mentor and develop future leaders. Successful nurse leaders build their role upon the strengths of their teams. Team building is the cornerstone of their leadership style, which is essential to leading a diverse group of people with distinct personalities and skills. Continuing to foster an environment of collaboration and professional growth is a key strategy for success for nurse leaders in today’s organizations.
  • Motivator – Given all of the changes faced by nurse leaders, their unique ability to motivate staff during challenging times is first and foremost. They know when to talk and when to listen. They are often confident and optimistic while inspiring enthusiasm in those around them. Today’s nurse leaders also spark and support innovation, knowing that the way we did business before needs to change in order to be successful in the new health care environment.
Being a nurse leader is an amazing journey, and it continues to provide opportunities for innovation, as well as personal and professional growth. Working next to the dynamic nurse leaders in post-acute care is an honor and a privilege.
Know that you are one of the shining examples of what makes this field so valuable in this world we live in.
Often people will say, “how you treat your elders is the true measure of a culture.” Thank you for being the center of our organizations and for being the heart of health care.

Insights from Donna L. Webb, R.N. – Chief Operating Officer, Pathway Health


Celebrating the Leadership Heroes of Long-Term Care

The weather is an analogy that fits well the current environment of senior care. We are living through a storm called the COVID-19 pandemic, and it has been extremely challenging. I have seen colleagues work harder than they ever have to protect their residents and staff, and, at times, that was not enough.

Real leadership rises to the occasion during difficult times and provides hope to those around them. The energy this has taken has been monumental and, at the same time, awe-inspiring to those of us deeply invested in this profession.

Well, we can probably now say that although it is not over and “still raining hard” in each of our corners of the world, that ray of hope is growing stronger. For many of us, our communities and the public understand a bit better how important our efforts are to serve the deserving frail seniors entrusted to our care.

In many of my conversations with people outside of our usual circle of senior care colleagues, there is a deeper appreciation of the heroic work efforts and energy we have had to draw upon to battle through this unprecedented time. For many of us, we are starting to experience a few “cloudy only” days that offer a bit of a reprieve that helps us recharge a bit.

The senior care field has also been forced into the limelight and required to share both our struggles transparently, and yes, our successes as well.

Caring, Always.
A couple of new epiphanies that we can draw strength from is that people better understand that we care a great deal about what we do. They have seen management teams pull together and work as a force to do whatever needs to be done for both residents and staff. It has also been crystal clear that the public understands that we are invested in the business of relationships. We have people throughout our organizations that deeply care about what they do for the people we serve.

This is Long Term Care Administrators Week and a great time to let the sun come out and shine a bit on you and each other. You are leading organizations that value both the dignity and relationships with seniors and others that need us. Many of you are also developing some of the future leadership heroes that will lead organizations, and thus, are helping pass on the baton of senior care leadership.

Your extraordinary efforts this past year are appreciated and respected.

Thank you for your herculean service in this noble profession. Know that you are one of the shining examples of what makes this field so valuable in this world we live in.

Often people will say, how you treat your elders is the true measure of a culture. You are special people called to do special things every day. Thank you for your shining example of service to our country.

Douglas Olson, Ph.D., MBA, NHA, FACHCA
Senior Advisor


Celebrating Your Team – Reflection and Appreciation

Reflecting upon this past year and the unprecedented levels of disruption impacting our team members at home, in their community and at work, employee appreciation continues to be a top priority for all leaders. We can add up all of the days, weeks and months in 2020. However, for most of us, the time has felt much longer than a year.

We have hit the one-year anniversary of the COVID-19 pandemic, and leaders have at least a year’s worth of achievements and milestones to celebrate. Despite all the challenges and adversities, employees at every level in all departments rose to the occasion, persevering through difficult times while providing insight, creative ideas and dedication to keep things moving forward. Our team rose to the challenge!

COVID-19 may have changed how we work, so how do we provide that “sustenance for another day” at work for our employees? It is by showing ongoing appreciation. Many organizations have instituted recognition programs, pictures and stories of inspiration and hope throughout this past year to celebrate our true heroes.

Often, we forget about the little things such as how our words and our actions as a leader can empower our team, positively impacting the whole organization. Employee appreciation is your leadership “secret weapon.” It’s finding a way to balance one of the most basic human needs, appreciation, in a way that supports getting the work accomplished. It’s important because feeling genuinely appreciated lifts people up. At the most basic level, it makes us feel safe, which is what frees us to do our best work. It’s also energizing.1

Leadership Considerations

Appreciation does not have to cost anything. Being present and planful in your words and actions will go a long way. Below are a few appreciation reminders for leaders.

Say “Thank You.” Although we do this daily, remember to take a moment to pull someone aside, look them in the eye and say thank you – it can have a profound effect on someone’s spirit! Employees appreciate sincere recognition from their managers, supervisors, coworkers and leaders. It lets them know that their work is having an impact and it makes them feel good.

Connect for a few moments. Spending a few moments to talk with employees (different departments and shifts), asking them how they are doing, how their family is doing and what you can do to help them – goes a long way.

Send a note. In today’s digital world, often forgotten is sending a short written note, acknowledging an employee’s efforts and saying thank you for a job well done. It allows leaders the opportunity to reflect and acknowledge all that has been accomplished this past year and to craft a message to each of your team members, recognizing them for a job well done.

Engage your team in decision-making. Organize “what’s your thought or opinion” meetings, regular open forums for your staff to ask questions, share their thoughts and ideas to specific challenges, new business lines, regulation updates, etc. You cannot do it alone as a leader. Your staff has wonderful ideas and suggestions to move beyond the challenges that your organization is facing. Harness the collective brainpower within. Engaged staff feels trusted, needed and treated as insiders in their organization.2

Even in the best of times, employee appreciation is an important element in engagement and organizational culture. So, during tough times like this, it’s even more important for employee appreciation to stay a top priority for all leaders. The show of appreciation they get from you can be the spark that inspires them to press on.

1 – Why Appreciation Matters So Much. Harvard Business Review
2 – 5 Strategies to Support Your Employees Through a Crisis. Harvard Business Review


Lisa A. Thomson, BA, LNHA, CIMT – Chief Strategy and Marketing Officer


Ready to ‘LEAPS’ Forward

These truly are crazy times for all of us as leaders in healthcare. COVID-19 has upended our daily operations, how we do business, how we provide care for our residents and how we are positioned in the marketplace. It has disrupted our already ever-changing world in long term care and all of its challenges prior to the pandemic. COVID-19 has challenged our leadership abilities, forcing agility and creativity in our new world! How do we move forward? Lead. Inspire. Action.

Re-igniting your passion and leading transformation and innovation requires new mindsets and behaviors, for leaders themselves and for the organization. I ask you first to take a step back, breathe deeply and look within yourself.

Today’s leadership style is different and can be fun! Being a coach (a leader) starts with understanding and acknowledging what is happening, what I can control and how I can engage, mentor and lead my team through change.

Leaders don’t change how people behave; they change how people think—and they do it without ever telling them what to think. Leaders change the way people think about the future, change, and opportunity, in essence, the way they think about the fundamental concepts that inform their worldviews, plans, ethics, and life strategies.

The ability to lead is directly tied to our ability to inspire confidence. And to earn the confidence of your team in a world of transformational change, we as leaders need to learn how to identify the driving forces that are shaping the future.

Gaining further insight and knowledge of your organization is key to setting the stage for innovation and inspiration. To begin the process of reimagining, or redesigning, and re-igniting our passion, we as leaders need to look within ourselves, our organizations, engage our team and design a plan.

LEAPS, developed by author Soren Kaplan, is a model I have used for many years to help leaders engage their team and determine a plan of action for innovation for your organization. This model includes five key strategies to address the inherent uncertainty of disruptive change and innovation:

Listen – Start with yourself, not the market. As leaders, we need to understand the marketplace, our customers, new technology, the landscape of healthcare and perceived constraints. Use your organization data and outcomes, however, think beyond. Leading through disruption (like the COVID -19 pandemic) involves determining what one values and where we want to make a difference, both in what we do and how we do it. Using what we have done really well, building upon it as well as looking at what might be different or unique—positioning the organization in a different way in the “new normal” healthcare world.

Disruptive innovations come from people and organizations who “innovate for themselves” because they want to make a difference for others, not wait for the regulators or marketplace to tell them differently. What does this mean to you as a post-acute care leader? Listen to your organization and your team and you will find that the answers are there if you ask. Your team has the answers and ideas for the future. Engage them in the process. If your team believes that they can help the greater good, not only will it help you with your strategic vision and your position in the marketplace in the new norm, it will also help with your retention of great talent. Remember, you cannot do this alone. You need your team and they need a way to think, plan and move beyond the COVID-19 pandemic.

Explore – Go outside to stretch the inside. Leading through disruption requires an agile mindset that appreciates ambiguity. While our industry is highly regulated and under-appreciated by some, now is the time to “go outside to stretch the inside of your organization.” Transformational leaders and organizations who embrace disruption know that uncertainty contains as much opportunity as it does risk. However, to make this mindset practical, it is essential to re-ignite yourself personally, your team, and your partners. Re-engaging with your partners is a key step to LEAPS forward in order to visualize new opportunities, leverage what you have learned through this pandemic and to meet the needs of consumers as they re-enter our market space. Our partners are redesigning how they do business in 2021 and beyond, and now is the time to be at the table. Having the conversations, engaging your team and observing and visualizing will help you see the possibilities, seeing connections and patterns that most others don’t see and find the most creative opportunities.

Act – Take small simple steps again, and again, and again! Leading with disruptive innovation involves simultaneously focusing on your own intentions and motivations to make a difference, while at the same time gathering as much external input as possible from employees, partners and others. I like to say that disruptive leadership involves putting a flexible stake in the ground around a specific opportunity, and then taking a series of actions to intentionally challenge assumptions and rapidly change direction as many times as necessary. Leading change does not have to be big steps. It requires a mindset of continuous agility and adaptation, small steps, to get to your goal. Prioritizing and determining which small steps will have the greatest impact.

Persist – Take the surprise out of failure. While few leaders want failure when creating and implementing strategic direction, positioning or innovation, they realize that setbacks are a natural part of the process. These setbacks can lead to great opportunities. Engage a cross-functional team in the process. Their keen insight will turn obstacles into opportunities.

I am reminded of when my team and I wanted to open up a new unit that served a specific disease state, similar to what many of you have done for COVID-19. I thought I had a great plan—worked with a cross-functional and cross-department team of employees and gave them what I thought was great insight into the need and the challenges. I thought we were truly prepared, down to creating SME nurses as well as direct care staff. When we started to promote the new unit and our services, it didn’t go as planned. Admissions were slow, and we couldn’t get our heads around as to why. We found that we had a glitch in our messaging and our communication to decision-makers. The team went back to the drawing board and reinvented a very innovative messaging and brand campaign. My team was not defeated as they knew failure was a possibility, but they took it as an opportunity to change and innovate.

Seize – Make the journey part of the (surprising) destination. As leaders, we need to recognize the potential power of surprise when we receive unexpected changes or challenges to our strategies, plans and assumption. Often times some of the “surprises” in our plans became the best course of direction for our organization. COVID-19 has made all of us look within ourselves and our organizations and ask “why.” It has caused us to execute many series of pivots as facts, operations, support, outcomes and operational context shifts. It is during those pivots, we can identify surprises that can help our team and organization prepare for the new normal (e.g., emerging leaders, creativity, communication, clinical competency, collaboration and more!).

Re-Ignite your Enthusiasm and Passion for LTC

Now is the time to look at your organization through a different lens. As you re-ignite your enthusiasm, think how your organization will look in 3 months, 6 months or a year, and what type of services you need to look at providing, what the community needs in this new norm, how to engage staff at all levels to redesign our organization, and what partners need from my organization in 2021.

You cannot inspire unless you’re inspired yourself. Every inspiring leader is abundantly passionate—not about the product itself, but what the product means to its customers.

Passion is contagious. When leaders display emotion, others will follow. Igniting passion starts with defining your personal and company purpose: your beliefs, values, passions, principles and connection to the company’s mission. Purpose isn’t what a group does, but why it performs. Defining your purpose is just the first step. Leaders must activate people’s emotions and desires.

When you begin to let your passion shine through, your team will follow. Every inspiring LTC leader is abundantly passionate and that passion is contagious. When you begin to let your passion shine through, your team will follow. They need a leader to set a course, increase their knowledge and understanding of the who, what, where and why and how it impacts the residents, the organization and themselves. They will watch you and emulate your passion and actions, moving your organization by LEAPS and bounds into 2021!

Lisa Thomson, BA, LNHA, CIMT – Chief Strategy and Marketing Officer




Leadership Insights: Leading through Adversity with Appreciation


With the beginning of the holiday season, I pause to reflect on all that I am grateful for, including my health, family, friends, the important work of our clients and all whom we serve.

As a leader, I am also thankful for the opportunity to positively influence change by using Appreciative Leadership principles. This focus helps facilitate positive change even through times of adversity.

Appreciative leaders recognize another person’s potential and turn it into positive power. They trust each person has the capacity to make a meaningful contribution. As we continue to lead through unprecedented times, now more than ever, we could use more positive power to fuel resilience and foster teamwork.

The principles of Appreciative Leadership support high performance by ensuring that your team knows they have a mission, feel valued for their contributions and understand the organization’s overall purpose. Individuals know that excellence is expected and that they are contributing to the greater good.

Consider the following key principles:

  • Inquiry lets people know that you value them and their contributions. When you ask people to share their thoughts and feelings— their stories of success or ideas for the future—and you sincerely listen to what they have to say, you are telling them, “I value you and your thinking.”
  • Illumination helps people understand how they can best contribute. Through the practices of illumination, you can help people learn about their strengths and the strengths of others. You can give them confidence and encouragement to express themselves, take risks, and support others in working from their strengths.
  • Inclusion gives people a sense of belonging. When you practice inclusion, you open the door for collaboration and co-creation. This, in turn, creates an environment in which people feel they are a part of something. When people feel part of something, they care for it.
  • Inspiration provides people with a sense of direction. By forging a vision and path forward, you give people hope and unleash their potential. These are the foundations for transformation, innovation and sustainable high performance.
  • Integrity lets people know that they are expected to give their best for the greater good and that they can trust others to do the same. When you lead with integrity, people know they can depend on you to connect them to the whole. Your example sets a standard for others to follow.

As an Appreciative Leader, it is important to cultivate positive emotions within your team’s current circumstances. Even though we will continue to face many obstacles, focus your team on their strength and resilience to move forward in difficult situations. Express appreciation, love and gratitude for individual accomplishments and support compassionate acts toward those in your care.

Thank you for making a difference each day. I am grateful for your leadership.

With Gratitude,

Lisa Thomson, BA, LNHA, HSE, CIMT
Chief Strategy and Marketing Office


The Center for Appreciative Inquiry


Leadership Perspectives: Answering the FAQs for PPE

As the COVID-19 health crisis continues, reducing the spread of respiratory illnesses, like flu, this fall and winter is more important than ever. Personal Protective Equipment (PPE) remains a hot topic. Below you will find answers to frequently asked questions regarding PPE and how to keep staff on the right course.

Q: What foundational area should leaders consider in regards to PPE?

A: Follow a best practice approach and provide focused policy and procedures. It remains essential for providers to ensure their PPE policies and procedures remain consistent with state, CMS and CDC guidance. Keeping up-to-date with any new guidance is essential—as we know that guidance continues to change rapidly.

Q: What are a few PPE best practice approaches to reinforce with staff?

A: It is important to stress with staff that the proper use of PPE is not only for mitigating the spread of COVID-19, but to also limit transmission of any infectious agent. As you know, standard precautions are based on the principle that all blood, body fluids, secretions, excretions except sweat, regardless of whether they contain visible blood, non-intact skin, and mucous membranes may contain transmissible infectious agents. Reinforce the following:

  • With Transmission-Based Precautions, it is essential that staff understand actions (precautions) that need to be implemented, in addition to standard precautions that are based upon the mode of transmission in order to prevent or control infections.
  • Understanding and proper demonstration of PPE use is essential for all staff who care for residents, entering a unit that has COVID-19 positive or quarantined residents, and for employees who clean and disinfect the residents’ rooms.
  • Re-emphasizing the primary mode of transmission of COVID-19 and other infectious agents, which of course is from person-to-person, will lead us to identifying PPE necessary for protection—for employees and for residents.

Q: What areas are important to especially emphasize to ensure quality and compliance?

A: All staff in all departments play a crucial role. Reinforce universal source control (e.g., face masks for all staff and masks for residents when tolerated, visitors and vendors) throughout your facility and staff even when there are no cases in the facility and a low community prevalence.

Q: What are a few considerations to support ongoing staff knowledge?

A: It is important to provide multiple opportunities to reinforce the importance and proper use of PPE. Unfortunately, the misuse or lack of use can be one of the factors that can contribute to the spread of COVID-19. Therefore, today more than ever, it is crucial for all staff to understand WHAT to use, HOW to Don and Doff using proper sequencing, if PPE can be reused, and if so, how to follow the policy for extended use and the importance of hand hygiene. Emphasize the following key areas with staff:

  • How to select, use, and Don and Doff PPE in a proper sequence.
  • It is important to stay up to date with the most recent CDC and CMS guidance for PPE.
  • Use full PPE, including gloves, gowns, face protection, mask or N95 and eye protection) for the care and interaction with any resident with known or suspected COVID-19.

Leadership Considerations

Consider the following when designing strategies and developing practical approaches to PPE use, optimization and practice:

  1. Update policies and procedures, in accordance to state, CMS and CDC guidelines, and keep up-to-date with any new guidance.
  2. Emphasize a PPE best practice approach to help mitigate the spread of COVID-19, and limit transmission of any infectious agent.
  3. Creating a supportive culture for all team members and providing ongoing support will be essential to foster adherence to PPE standards and expectations.
  4. Ongoing PPE education and training is important for all staff, and should include best practices, state and Federal guidance and your facility policies and procedures.
  5. View COVID-10 resources and tools from Pathway Health >>



CMS: Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes, October 2020

CDC: Optimizing Personal Protective Equipment (PPE) Supplies

CMS: Frequently Asked Questions (FAQs) on Nursing Home Visitation

Director of Education

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