Course HCA 621: Nursing Home Administration

As the administrator for a nursing facility you are expected to be knowledgeable in a wide range of areas which assists you in attempting to try to predict the ever-changing landscape of the healthcare field. It has been clear for a long time that administrators who are successful are those that can manage change. Inherent in this concept is that the administrator can be open to change themselves! This may seem like an obvious statement but my experience, all too often, shows that administrators are many times very resistant to change on a personal basis and therefore interferes with the professional need to be the leader in change within their organizations.

Change is not a new concept within organizations, but the accelerated rate of change in organizations is, and the "culprit" we need to manage. The rapid improvement in our abilities to exchange information and knowledge using new technologies forces us to be constantly reevaluating the way we conduct our business. This is true of the educational field, who would have thought that we would be offering college credit courses via the internet, as well as health care where with the use of telemedicine, the physician is again making "house" visits. To survive in this dramatic, laser fast change environment, the administrator will need to look at issues in innovative ways, understanding that yesterday's or today's solutions may not work in tomorrow's world. Just as our residents have changed over the years (i.e., we just had our first Elvis impersonator visit the facility, per the residents request) our healthcare business is changing and administrators must change or be left behind.

To successfully prepare for the future administrators must be able to anticipate the rapid changes that are going to occur and then make the adjustments to the current systems in anticipation of the change. In this manner, you remain in control and manage the change instead of reacting to it when it occurs. The trends in the healthcare business need to be analyzed by the administrator and your forecasting will be based on this analysis. Thinking about how a nursing home administrator must consider how change effects everyone involved with the facility, read Case Study 2 - Change in Administrators at Field Nursing Facility and answer the questions at the end of it in a 1 - 2 page paper.

Case Study: Change in Administrators at Field Nursing Facilty

Ms. Denicola had been the administrator at field nursing facility for 30 years. She was retiring and leaving behind many departmental managers that had worked with her for many years. Ms. Denicola was well respected, if not liked, by all that worked at Field Nursing Facility. She was seen as a tough but fair leader who always had the resident needs as paramount in her decision making.

Some of the deparmental managers saw Ms. Denicola departure as an opportunity change some of the things "wrong" with the facility policies that would make things "better" for all those at Field. The new administrator, Mr. Lewis, much younger in years and experience that Ms. Denicola, wanted to get off on the right foot with the administrative staff. He called a meeting and told the departmental managers he respected their experience.Mr. Lewis stated he was dictatorial and trusted the departments could work out their issues out democratically among themselves. This would give him time to work on the financial issues and put together a 3 year plan for the facility.

It did not take long when some of the "democratically" determined decisions made by the departmental managers began to effect resident care. The director of Nursing, with a much more aggressive personality, talked the Housekeeping Director into agreeing that nursing would not be cleaning up any spills when they occurred. it would be housekeeping's total responsibility. After all, the nurses and CNA time was better spent on direct care to residents. The activities Director got a reluctant Buliding Services Director to agree to breakdown and set up multi-service rooms before and after every activity. Previously this was done by the activities staff. The Director of Therapy stated her therapists were to busy to attend morning report and would get the information about from nursing "as needed".

The administrator was now getting complaints that spills on the floor were going unattended until someone could find a housekeeper. This was dangerous situation for everyone. Activities were being delayed and residents and families were complaining. Maintenance issues throughout the facility became backed up with leaky sinks, lamps not working and wandering systems not being attended to in a timely manner. therapies were late in doing evaluations on potential rehabilitation admissions and this was causing problems with being complaint with the MDS timelines.

1. What is wrong, if anything, with the new administrator's "leaderships"?

2. How should policy issues be handled when they are between different departments?