Interview with Jan Lowell

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an Lowell is the Executive Director of Roger Williams Home Care, a department of Roger Williams Medical Center. Located in Providence, Rhode Island, Roger Williams Home Care has 140 employees, predominantly field staff, including 54 registered nurses. Field staff consists of registered nurses, physical therapists, occupational therapists, speech therapists, social workers, and certified nursing assistants. Roger Williams Home Care serves home-bound patients who need skilled nursing. In addition, there are also employees in the office, including support staff and managers. Following, Jan answers some of our questions about her agency.

Jan Lowell, Executive Director of Roger Williams Home Care in Providence, Rhode Island

       Tell us about your role and responsibilities at your agency.
       Jan: I have been employed by Roger Williams Hospital for five years and have worked as the executive director of Roger Williams Home Care for five years. We are a department of the hospital and have been in existence for 15 years. I am responsible for the day-to-day home care operations and oversee the management team, which consists of five individuals. I also serve as liaison between the hospital and home care. We rely on the hospital for public relations, human resources, maintenance, etc. I serve on several hospital-based committees, including strategic planning and hospital-wide recruitment and retention. My goal is integrating quality of care and seamless communication.

       How is your agency managed and by whom?
       Jan: Our agency is managed by a multidisciplinary team including rehabilitation, finance, regulatory, marketing, and public relations.

       Does your agency have a wound care team and/or a skin care team?
       Jan: We do not have a designated wound or skin care team, but all nursing staff provide wound care under the supervision of a qualified staff educator. Many of our nurses are certified in using the VAC (Vacuum Assisted Closure, Kinetic Concepts, Inc., San Antonio, Texas). In addition, we hold wound care inservices, and the hospital has a skin clinic consisting of physicians with whom we consult as needed.

Roger Williams Home Care management team, from left to right: Rose Lamoureux, Health Information Supervisor; Jeanne Bolduc; Bob Picard, RN, Clinical Nurse Manager; Kathy Shatraw, Home Care Liaison (seated); Ann DeQuattro, Regulatory Manager; Jan Lowell, Executive Director; and Karen Oswain, Business Office Manager (not pictured)

       What are some of the new equipment, devices, and products introduced at your agency lately?
       Jan: We recently piloted a telemedicine program and are exploring computerized field documentation.

       Who handles your procedure scheduling? Do you use a particular software?
       Jan: We use a software product called Novius, which is a scheduling package, from Siemens Medical Solutions USA. We also have custom scheduling through a consultant. Scheduling is one the toughest jobs in home care. We use a combination of both electronic and manual.

       How is inventory managed in your agency? Who handles the purchasing of equipment and supplies?
       Jan: We buy supplies through the hospital's central supply, and we have contracts with a couple of medical supply companies. Decisions are based on what the companies have available, cost, and turnaround time.

       Has your agency recently expanded in size and patient volume? Will it be expanding in the near future?
       Jan: Last fiscal year, we made 75,000 visits to the state of Rhode Island and the bordering towns in Massachusetts. Our visit growth has stabilized in the last couple of years, which is not uncommon, particularly in Medicare. We are paid by episode, not by visit, and are encouraged to think of other ways to help people in fewer visits. We take a look at community resources and try to come up with ways to reduce the number of visits.

       What measures has your agency implemented in order to cut or contain costs and improve efficiency?
       Jan: Our staff flexibility and reliability have enabled us to contain costs and improve efficiency. We have developed a work culture, which depends on a lot of cross training--from line staff to managers--so we can keep our business going.

       Does your facility have an outpatient program?
       Jan: We have out-patient flu clinics and blood pressure clinics.

Janice Muehlberg, RN, staff educator, administering the flu vaccine to Jane Delaney as Jane's husband, Joe, looks on.

       How are new employees oriented and trained at your agency?
       Jan: Employees are trained on two levels--first, they are oriented at the hospital. Each new employee spends a full day at the hospital. A lot of attention is paid to each department and how it functions.
       Each home care employee completes a full checklist of orientation appointments to explain how the organization works operationally, financially, and clinically. We are accredited by Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and received a high score on our last survey, of which we are very proud.

       What are your strategies for retaining and motivating staff?
       Jan: The hospital has a recruitment and retention task force who has worked very diligently over the past year. This year, we have had 2 1/2 percent less turnover than the previous year. We also have a program of reward and recognition, examples of which include entertainment coupons, thank-you notes, and employee-of-the-year programs. The hospital offers longevity bonuses and strives to stay competitive in wages and benefits.

       What continuing education opportunities are provided to staff members?
       Jan: We provide education through the hospital's continuing education program. We have an affiliation with Bryant College and have conducted leadership seminars, business writing workshops, and medical terminology workshops.
       Employees are encouraged to apply for registration for conferences and seminars. We have funds set aside for CEUs for staff. We also have monthly area visitations during which vendors will demonstrate equipment or provide education. We are currently working on certifying nurses in wound care and ensuring that all nurses are proficient in working with the VAC.

       How is staff competency evaluated?
       Jan: For our field staff, we develop a general competency each year. Most recently, our staff was trained in cultural diversity. All staff were asked to attend the seminar and take a pre-test and a post-test. When we do evaluations, the staff advisor will check staff for competency. In areas where the employee was deficient, we educate and counsel around those areas.

Robin Sloane, OT, with Claire McManus, a patient

       Does your agency utilize any alternative therapies?
       Jan: No, we do not currently utilize any alternative therapies, but it is something we are looking into. The hospital is exploring alternative medicine.

       What quality control/quality assurance measures are practiced in your agency?
       Jan: We have a very extensive performance improvement program. We follow state and federal regulations for benchmarking and JCAHO regulations. We are keen on making sure complaints are responded to within 24 hours, and we learn from the experience. In addition, we conduct patient satisfaction surveys. Last year, 98 percent of our clients told us that overall they were satisfied. In these surveys, a high percentage of individuals write a narrative about clinicians. These narratives reinforce the effectiveness of the clinician's work. What we've tried to do is give a copy to the respective staff member along with a thank-you letter as a way of showing our appreciation.

       What trends do you see emerging?
       Jan: Reimbursement continues to be a challenge. Medicare reimbursement has gone through three models in last three years. First was cost per visit; from there it went to interim; and from there to the Prospective Payment System (PPS), which mirrors the diagnosis-related groups (DRGs) that hospitals have encountered. A home health-related group (HHRG) is like a DRG. In the current structure, a nurse performs an assessment and completes the Outcome and Assessment Information Set (OASIS), which represents the patient functionally and medically and the utilization of service. From that admission/OASIS completion, it is determined how much a home care agency will receive in a 60-day period. The results are essentially in the hands of the admission nurse and the accuracy in documenting. The challenge lies in keeping nurses educated in how to complete the documentation and how to make sure it's accurate. Managed care rates in the state of Rhode Island do not always meet the cost of doing business. Most home care agencies around the country probably struggle with this in one way or another.
       Positive trends are found more in technology. We are exploring telemedicine with video, telephone, and a machine that checks vital signs placed in the home and linked to a screen at the office. We can check the patients' vital signs without making a visit. We're currently testing this technology.
       Also, computer technology needs to be state of the art to really be able to conduct business with the highest efficiency. We are looking into acquiring hand-held systems for our nurses when they make patient visits.

Karen Giordano, PT, with Madeline Carrigan, a patient

       What makes your agency unique?
       Jan: Our work culture makes our agency unique--our employees enjoy working here. The atmosphere is supportive and caring, and we try to maintain a sense of humor in dealing with difficult situations. Our managers lead the quality of care for the patients. From the secretary that answers the phone to intake staff who are kind and passionate people who want to get all the information they can so nurses can give the best care possible--our goal is personalized service. We focus on teamwork on a day-to-day basis. Also, the disciplines work well together. We have a positive work culture. I hold a yearly strategic planning meeting for managers but incorporate line staff. We have a complete group effort and we look at the "big picture" to determine the areas on which we need to work. We identify our goals and objectives and feel good about being able to achieve them.
       We hold staff meetings quarterly so staff can ask questions. I bring them up to date on what's going on in the hospital and what's going on in home care. It's important to pull people together and give them the opportunity to speak. All of our managers have an open door policy. We also have an anonymous suggestion box, and we respond through a newsletter or memo. We keep the lines of communication wide open. Answers to business problems come through people who are doing the work. That's how we've tried to run it.

ECPN will spotlight an administrator or director of nursing from a long-term care facility, acute care facility, or home care agency in every issue. Please contact Renee Olszewski by phone at (800) 237-7285, extension 209, or by e-mail at rolszewski@hmpcommunications.com for a questionnaire.