Don’t be afraid to demand accountability

Jaime Todd, LNHA, MBA

One would assume that an industry, which is intrinsically involved with life-and-death issues, would demand top performances from its employees-along with a strict code of accountability and some manner of redress. However, in today’s America, accountability is not high on the agenda of many businesses. Those in charge of business have been cowed over the years by threats of lawsuits, pressure from unions, fear of being perceived as not employee-friendly, laziness, greed, and employee lack of concern and work ethics. Daily, some businesses increasingly fail us, businesses with whom we entrust that which is most valuable and precious to us: our banking, our investments, our government, our children’s educations, our family’s healthcare and, at the very end of their lives, our vulnerable frail elderly.

Those who run long-term care facilities know the alarming number of obstacles that might be lobbed at them during the course of a month: industry surveys, complaint investigations, lawsuits, justifiable (or not) family complaints, staff attitudes and lack of judgment at times, and so on. The business health and sustainability of a facility depends on how it responds to whether staff can appropriately react to perceived and real failings and immediately institute the appropriate fixes-or suffer damaging consequences.

Because of the change in attitude and ethos in much of the American workforce, many employees and facility owners forget that they are there for those in their care, as well as for the company that has invited the aged into their community. Accountability should be the number one priority-from the CEO all the way down to the part-time, substitute, or temporary worker. Today, too many employees believe they are a gift to the job and the company; they put their own interests above the demands of the job and the long-term success of the organization for which they work.

The CoreStat Process

CoreStat is a process combining core competencies and statistics. This management tool is unique because it can be implemented by any company, costs are negligible, and it improves organizational effectiveness. It’s that simple. A panel, sitting at one end of a table, is designated to ask questions, while the department head being evaluated sits at the opposite end. The Information Technology department sets up a computer to project statistics/performance measures directly above the department head. The panel then proceeds to conduct a review of the projected statistics.


CoreStat is a simple process which allows any company or business to address problems within that workplace while helping all employees define the problem, trace its origin, and assign praise or blame where appropriate, and then move forward to take remedial action. Accountability at all levels of an organization is the only way to ensure success. In addition to accountability, CoreStat enhances staff effectiveness, and acts as a visual aid and teaching tool that can be extremely valuable in improving overall performance.

Any company can implement this procedure; it is a statistical evaluation of core competencies (performance measurements) that add value to the organization.

  1. Identify which value-added performance measurements will be addressed. Resist the impulse to measure everything; focus on what adds value to the residents, employees, and the company.

  2. Once a division, department, or business unit identifies what they must measure, statistics will subsequently be tracked. CoreStat meetings can be quarterly, or more frequently as needed, resuling in an ongoing improvement policy for a facility; don’t just use it when there are difficulties. Increased use will familiarize workers with the process and lessen the negative impacts that might register with staff.

  3. CoreStat meetings can be held at headquarters or in the facilities.


Let’s consider a divisional vice president who is responsible for 10 skilled nursing facilities. One of the performance measures identified is revenue. The statistics indicate that last quarter’s payment sources for rent-roll, Medicare A, Medicare B, and HMO reimbursements were all significantly higher than the present quarter. The panel will want to know the following information:

  • Why the change?

  • What are current trends in the local market?

  • What is the effectiveness of the current marketing plan?

  • Can we determine reason for decline-move-ins, Medicare A, Medicare B, HMOs?

  • What corrective action is required and how will we implement it?

In another scenario, examine the facility history with a nursing home administrator. One of the performance measures identified is regulatory compliance. Consider that in the prior quarter there were three complaint visits and two deficiencies cited as a result of those visits. However, in this quarter there are nine complaint visits and six deficiencies cited. In this situation the panel will ask questions that delve into the overall safety and care of the residents:

  • What types of deficiencies?

  • What is the scope and severity?

  • What corrective actions were/should be taken?

  • What is the procedure for identifying other residents potentially affected?

  • What systemic changes need to be implemented to prevent recurrence?

  • Is there quality assurance monitoring?

Finally, let’s postulate the case of the director of nursing of a skilled nursing facility. One of the performance measures was selected from the facility quality measure/indicator report under the category of Accidents, particularly falls. In the prior quarter the Observed Percent of falls was 12%. However, in the current quarter the percentage increased to 22%. The panel should ask for the following information:

  • Reason for increase

  • Time and day of falls

  • Observed trends

  • Toileting schedule

  • Medication issues

  • Rates of infection

  • Mobility assessments

  • Corrective actions

The executive, department head, or manager should be able to explain these issues to the panel’s satisfaction. If he/she cannot, then he/she is part of the problem. This process will identify who doesn’t belong in a given position, who is adequate in a position and can (and should be) be developed, and who excels.

Caring for America’s aging population in our long-term care facilities is an honor and privilege. Demanding accountability, positive outcomes, and effective problem solving is what our residents deserve.


The salutary effects of such internal reviews is that there are no secrets about any issue and no secret agendas on the part of management; also, employees’ personal issues with coworkers cannot intrude on the process-here are the facts, here’s what happened, here’s the weak link (if there is one), and here’s what we need to do to protect our residents. If someone must go, the CoreStat process should give solid evidence of wrongdoing, with no allowance for excuses. Those individuals who excel should be considered for “Drop Down” teams to go into the field when a department or facility is alleged to be in a crisis. The Drop Down teams continue examination of entities throughout the system, where needed, identifying the system’s strengths and weaknesses, and implement corrective actions.

The most compelling reason for using the CoreStat process is that everyone becomes aware of what needs to be fixed in a facility, department, organization, etc. If the employees are made cognizant of how inefficiencies, mistakes, slacking, and lack of appropriate follow-through cost money and negatively impact care, they will be more inclined to improve their on-the-job performances.

The CoreStat process is uncomplicated and entails little or no extra cost; if conducted properly, it eliminates the “he said/she said” defenses that impede progress in any business or facility.

Caring for America’s aging population in our long-term care facilities is an honor and privilege. Demanding accountability, positive outcomes, and effective problem solving is what our residents deserve. Let’s make long-term care one of the most accountable and respected business sectors in all of business by demanding CoreStat throughout the industry.

Face reality and address on-site problems; acknowledge those on the staff who consistently do a good job. Do not fear an employee who jeopardizes the welfare of the residents and the facility: Get rid of such employees. You can do all of that and more by implementing CoreStat into the management system of your organization. LTL

Jaime Todd, LNHA, MBA, is a Governor’s Appointee with the California Department of Veteran Affairs as a hospital administrator. He is currently working on the design and construction of a 300-bed Veterans Home in Fresno, California. For more information, e-mail Long-Term Living 2011 February;60(2):48-49

Topics: Articles