Kindred Healthcare Hospital Division Annual Nursing Report

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1 2009 Kindred Healthcare Hospital Division Annual Nursing Report Dedicated to Hope, Healing and Recovery

2 CONTENTS About Kindred Healthcare...4 Interdisciplinary Care Coordination...6 Kindred s Patient-Centered Perspective and Care Philosophy...8 Our Commitment to Quality Care...10 Investing in Nurse Leadership...12 Wound Care Symposium...14 Patient and Employee Safety...16 Clinical Councils...18 Kindred Nurses By the Numbers...19 Directory

3 WELCOME Welcome, In this inaugural 2009 Kindred Healthcare Hospital Division Annual Nursing Report, it gives me great pleasure to highlight our ongoing commitment to our greatest resource our caregivers. At Kindred, we are proud of the high quality care delivered daily in our 83 long-term acute care hospitals. In order to facilitate the continued trend of performance excellence and improved value for the patients and residents we serve, we remain committed to providing the best environment in which to work, and opportunities for professional and leadership development. Investing in our nurses and caregivers is investing in Kindred s future, which is why we have put key leadership development initiatives in place. These programs build upon one of our most important Key Success Factors, which is to take care of our people. It is our goal to enhance the environment in which we all work, live and provide life-sustaining care. As you will see in this report, efforts and initiatives geared toward realizing this goal are having tremendous positive impact. This is evident through improved clinical outcomes for our patients, consistently improved retention rates and high levels of customer satisfaction. Personally, I want to thank our nurses for the work you do every day to care for our patients and families. Your role is key and you are truly our greatest asset. The intent of this report is to highlight the excellent work of our nurses, to detail our programs dedicated to professional and leadership development, and to illustrate Kindred s continued efforts to make our hospitals and care centers the best places to work. Anthony Disser, Senior Vice President of Clinical Operations, Hospital Division 3

4 s are 15,200 dedicated employees taking care of over 3,800 patients every day in 83 long-term acute care hospitals in 24 states. 4

5 OUR MISSION OUR MANAGEMENT PHILOSOPHY Kindred Healthcare s mission is to promote healing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employee and shareholder we serve. Kindred Healthcare s Management Philosophy is to focus on our people, on quality and customer service, and our business results will follow. WHAT IS AN LTAC HOSPITAL? Kindred s long-term acute care (LTAC) hospitals provide aggressive, specialized interdisciplinary care to medically complex patients who require intense services and extended recovery periods. These extremely ill patients often with several serious medical conditions requiring specialized care come to Kindred because of their unique care requirements and prolonged recovery times that many traditional short-term acute care hospitals are not able to provide. In order to best meet our patient needs, Kindred LTAC hospitals feature a coordinated, specialized approach through our Interdisciplinary Care Coordination. Care levels in Kindred LTAC hospitals range from ICU to general medical care, and most hospitals feature either operating rooms or treatment rooms for invasive and minor surgical procedures including G-tube placement and debridement. 5

6 OUR Interdisciplinary Care Coordination The patients in Kindred s LTAC hospitals have three to six concurrent active diagnoses and have suffered an acute episode on top of several chronic illnesses. We utilize our Interdisciplinary Care Coordination to best treat the patient by planning for the patient s unique clinical needs, focusing on any barriers to discharging the individual to the next level of care through a truly coordinated, multidisciplinary team approach. The expertise of every team member is critical in the collaborative process in order to achieve Kindred s standard of quality patient care. The organization embraces a continuous quality improvement philosophy as outlined in our Strategic Quality Plan in which interdisciplinary cross-functional teams are chartered for the purpose of performance improvement. Interdisciplinary relations are maintained to ensure continuity of patient care services through open communication. Each patient is unique and their specific needs determine their care delivery. This approach to individualized care is age-specific and appropriate to the patient s needs and severity of disease, condition, impairment or disability. Patient care goals are identified, prioritized and directed toward discharge and are discussed at regular team meetings. The following disciplines play key roles in determining patient care and services: Nursing Physicians Case Management & Care Management Rehabilitation Services Respiratory Care Food & Nutrition Services Pharmacy Chief Clinical Officers & Quality Managers Wound Care Specialists 6

7 Many disciplines work together to promote patient healing in Kindred LTAC hospitals, which calls upon the wide variety of patient care services to help. Provision of Care, Treatment and Services It is our goal to provide patient care in an integrated system of settings, services, health care practitioners, and care levels. We will match the patient s ongoing needs to the appropriate level and type of care before admission, during admission, while in the hospital, before discharge, and at discharge. Our goal is to maximize coordination of care along this continuum. It is our goal to determine care needs through assessment of each patient s needs. It is our goal to provide individualized, planned and appropriate care in settings that support the patient s care, treatment, and rehabilitation goals. It is our goal to educate patients and the people who play a significant role in the patient s life, on improving patient health outcomes by promoting recovery, a speedy return to optimal level of function, healthy behavior, and the appropriate involvement of the patient and or family in his or her care. Having many disciplines involved shows how much Kindred values a teamwork approach not just to wound healing but as a valued asset in all care. Carol-Sue Goodby, MS, RD, Regional Director, Nutritional Services, Kindred Healthcare 7

8 A Patient- Centered Perspective It is the goal of Kindred and all of our care professionals to recognize and respect each patient in the provision of care, treatment and services in accordance with fundamental human, civil, constitutional, and statutory rights to improve patient outcomes. We believe the staff must function as patient advocates and participate in problem identification and resolution to ensure a high level of quality care. All business relationships with patients and the public are conducted in an ethical manner. Kindred s Patient Care Philosophy It is the philosophy of s to create an environment that supports safe and effective delivery of patient care, treatment and services, continuous improvement, and innovative services that recognize the complexities presented by the current health care environment. We believe that multiple avenues must be available for voicing concerns, questioning care, resolving issues surrounding professional practice and addressing ethical dilemmas or concerns. 8

9 Patients can teach us to be better caregivers. It has opened up new vistas for all of us. Northeast Stoughton, Massachusetts 9

10 Commitment to Quality Commitment to Caring Kindred features a team of more than 15,000 dedicated employees who are passionate about the high level of care provided to our patients. The more than 8,000 nurses serving in our LTAC hospitals deliver on Kindred s promise of quality, excellence and value. Kindred LTAC nurses are among the nation s best with a clinical expertise in respiratory care, telemetry, infection control and pain management. Improved Retention Reduced Turnover We do a good job of finding and keeping great nurses. This is clear from the caliber of our entire team, and the fact that we continue to improve retention. In fact, in 2009, turnover for Kindred nursing staff in our LTAC hospitals was 26.7 percent, down from just over 31 percent in We are proud of our retention rates and credit it to the rewarding work in Kindred LTAC hospitals. This is also illustrated by high levels of caregiver satisfaction. A happy nursing staff contributes to a healthy and rewarding work environment. Satisfaction levels for registered nurses, licensed practical nurses, and certified nursing assistants all continue to improve with 2009 RN satisfaction rates at nearly 70 percent and CNA satisfaction registering at almost 76 percent. Another assessment of the environment in Kindred s LTAC hospitals is the high satisfaction ratings we consistently receive from our patients and their family members. The positive environment and top-notch nurses delivering the life-saving and lifesustaining care in our hospitals results in very pleased patients and families. 10

11 PATIENT/FAMILY SATISFACTION SCORES (1 = Poor, 5 = Excellent) Overall Recommendation Overall Care Pain Management Skill and Experience of Nursing Staff Call Light Response EMPLOYEE SATISFACTION SCORES 57.1% 68.5% 52.8% 69% 75.7% 63.2% RN LPN CNA 11

12 Investing in Nurse Leaders Our goal is to attract, retain and develop outstanding nurses and to provide them with the tools and training to continue to excel in their field and grow professionally. Nurse Leadership Program In October 2009, Kindred launched the Nurse Leadership program attracting nearly 60 Chief Clinical Officers and Directors of Nursing from our hospitals and nursing and rehabilitation centers. This leadership program provides training in leadership, delegation, performance management, conflict management, and team building. Based upon the overwhelming and positive reaction from the past attendees, Kindred hosted another nurse Leadership Program in December 2009, and three more will be conducted in Clinical Impact Symposium In order to enhance and improve the clinical practice of our nurses along the post-acute spectrum, Kindred developed Clinical Impact Symposium to advance as a leader in clinical excellence. In November 2009, Kindred held our initial clinical symposium, which focused on Wound Management and attracted more than 350 of our Kindred colleagues, across all divisions, to learn best practices and gain from one another s knowledge and experience. The conference also featured some of our nation s premiere experts in wound care. Coming in November 2010, we will host another clinical symposium in Louisville, Kentucky. This second annual conference will focus on Respiratory Care and will bring together nurses, respiratory therapists, physical therapists and occupational therapists to learn from one another and from leading experts. These symposia help us enhance clinical skills and provide Kindred caregivers the training to best serve our patients and residents. Ongoing Educational Opportunities s provide continuing education, in-service education and quality improvement education. Education programs are provided to maintain staff competency and enrich staff knowledge for enhancing quality patient care. The important message of the [Clinical Impact] symposium is the level of expertise our nationally known presenters offered, the focus on evidencebased practice, and the involvement and learning of our direct caregivers who attended. Barbara Baylis, RN, MSN, Senior Vice President of Clinical Operations for Kindred Health Services Division 12

13 Educational programs are based on Kindred s mission, the case mix of patients served, the technology utilized, the identified learning needs of the staff (on an individual, departmental, and organizational basis), the required and personal competency needs of the staff, learning needs related to expertise development and the identified issues that influence staff recruitment and retention, and issues that may have been identified in the Corporate Compliance agreement. Educational Assistance Program Additionally, Kindred provides ongoing support and encouragement for our employees to take advantage of educational opportunities outside of scheduled work hours. The Company provides a program to reimburse eligible employees, each calendar year, for classes taken related to their jobs or future plans within the Company. The Educational Assistance program is available to all full-time employees who have completed 90-days of employment and are taking courses or pursuing a degree program that is job-related. For grades of C or above, individuals may be reimbursed up to $2,500 per calendar year for books, lab fees and tuition. Participation in the program must be approved in advance and will be determined based upon the needs of the Company, budget and employee s standing. 13

14 Poster Session at 2009 Wound Care Symposium The Clinical Impact Symposium on Wound Care, held November 9-12 in Louisville, Kentucky, included a poster session detailing some of the specific initiatives that have been implemented at specific facilities. Categories for posters included wound management, ostomy challenges, fistula management, incontinence and skin care. Kindred encouraged participation and believed in providing nurses the opportunity to share their findings. The poster session was used as a forum for communicating creative nursing interventions, new models of delivery of services and innovative research projects in a relatively short amount of time to a wide audience. It allowed many to share the great things they have done at their facility, but it also allowed for time to network. A special thank you to the participants in the poster session, which included: Annabella Badgewell Fort Worth Southwest, TX Debridement and Antimicrobial Coverage with Santyl & Bactroban Teresa Grossfield Boston, MA A Diamond in the Rough Teresa Hernandez Hollywood, FL Using Platelet Rich Plasma (PRP) Gel to Manage Complex Wounds in an LTAC Julie Ho Scottsdale, AZ Planned Surgical Interventions Avoided in Necrotizing Fasciitis and MRSA Wounds: A Case Series Using Non- Contact Low-Frequency Ultrasound Silvia Jimenez and Lisa Vandenberg Westminster, CA WOW: War on Wounds Judy Laky, Nancy Bryan and Debra Fox, St. Petersburg, FL Turning and Positioning for Pressure Relief Leslie Linder New Orleans, LA The Krewe of Kindred Presents: It s Only Skin Deep Denise Mah and Gem Lindsay Santa Ana, CA Road Map to Healing: An Incredible Journey Evelyn McLaughlin and Michelle Mackey Los Angeles, CA Creative Strategies in Improving Wound Care Rita Neff Louisville, KY When to Choose Convexity Martha Ondrejko Denver, CO Process-Performance- Products: Creating a Custom Visual Wound Guide to Improve Nursing Documentation Kindred Healthcare Hospital Division- National Initiative Braden Risk Assessment: Driving Your Plan of Care 14

15 This investment in clinical quality improvement will improve our operations, thereby improving our value to each patient, resident, family member, customer, employee and shareholder. Anthony Disser, Senior Vice President of Clinical Operations, Hospital Division When I attend conferences, I try to identify at least one thing that I can take back and implement immediately. I have identified something implementable from every speaker I ve heard. Darlene Cunha, Chief Clinical Officer, Northeast Stoughton 15

16 Ensuring a Safe Environment for All Promoting Caregiver Safety Slips, trips and falls are a common occurrence in all hospital settings, but Kindred is committed to reducing these incidents through our Slip Resistant Footwear Initiative. We are working to create a safer workplace environment through the promotion and use of slipresistant shoes. The Slip Resistant Footwear Initiative was piloted February to August In assessing the site-specific program success, the incidents of slips and falls were compared from 2007 to The number of employees injured due to slips, trips and falls decreased by 50 percent and the severity of the injuries sustained dramatically decreased by 69 percent, proving the effectiveness of the Slip Resistant Footwear Initiative. As Kindred requires slip-resistant shoes to be worn, we now participate in the voluntary discount program, Shoes for Crews, to incentivize the purchase of this important footwear. Kindred hopes that the added bonuses of discount pricing and convenience, where payroll deduction, online ordering and facility delivery can all be utilized, will assist employees. 16

17 Preventing Patient Falls Falls are not only dangerous for nurses and caregivers, but patients as well particularly the very sick and elderly that we care for in our hospitals. Kindred established the SAFETY program as one of its many tools to reduce patient falls. The program features a colorful flyer, clearly displayed for all patients to see, which details actions a patient can and should take in order to inform the nursing staff of what is going on. With patient safety as a top priority for Kindred hospitals, the SAFETY program stands for: Spills on the floor may cause falls. Patients are to report wet or slippery floors. Always allow the staff to assist you out of bed. Patients may be weaker than they realize. Footwear with non-skid soles should be worn while you are up. If patients don t have them, they are to ask a nurse to provide them. Every time you need help, use the call bell at your bedside table or in the bathroom. Try to be patient and remain in your bed or chair while waiting for help. Patients should not attempt to get up by themselves. You should walk slowly and not lean on rolling objects such as IV poles or your bedside table for support. At Kindred we remain committed to ensuring our hospitals provide a safe environment in which to work and be cared for. 17

18 Kindred Clinical Councils In order to continue to provide top-notch care and services and provide a professional environment that attracts premier nursing staff, Division has developed an array of councils that work to support and develop clinical operations and management improvement. We foster and implement best practices with the ultimate goal of improving patient outcomes. Some examples of the many councils include: NATIONAL NURSING COUNCIL PATIENT CARE COUNCIL The purpose of the National Nursing Council is to provide a foundation of support through a uniform and consistent voice for quality patient care. The council serves to standardize best practices and processes, participate in product selection and evaluation and provide leadership and advice to clinical operations. To best support Kindred s patient-centered care model, this council supports interdisciplinary processes for the delivery of patient care, which provides effective and efficient clinical practices for quality patient care delivery. This council produces policies and standards that help deliver on our goal of improved outcomes and care excellence. WOUND CARE ADVISORY COUNCIL CLINICAL OPERATIONS LEADERSHIP TEAM This council serves as the Advisory Council for wound prevention and management with a special focus on standards of care and practice, policies and procedures, products and equipment and clinical competencies. The Clinical Operations Leadership Team (COLT) is the executive leadership team of clinical operations for Kindred hospitals. This team affirms and implements standardization and practices and oversees the other clinical councils and teams. 18

19 The average age of a Kindred nurse in 2009 was 43 Kindred nurses gender 15% 85% Male Female Kindred NURSES BY THE NUMBERS Number of nurses (FT/PT/PD) 6,421 7,272 7,467 7,587 8, The average years of service of a Kindred nurse in 2009 was 3 years The racial makeup of Kindred nurses in % 32 % 22 % 1 %.8 %.5 %.4 %.3 % White African American Asian Hispanic/Latino Two or More Races Native American Unknown Hawaiian 19

20 Kindred HOSPITAL DIRECTORY ARIZONA Arizona Northwest Phoenix N. Plaza Del Rio Blvd. Peoria, AZ Arizona Phoenix 40 East Indianola Avenue Phoenix, AZ Arizona Scottsdale N. 92nd Street Scottsdale, AZ Tucson 355 North Wilmot Road Tucson, AZ CALIFORNIA Brea 875 North Brea Blvd Brea, CA La Mirada E. Imperial Highway La Mirada, CA Los Angeles 5525 West Slauson Avenue Los Angeles, CA Ontario 550 North Monterey Avenue Ontario, CA Sacramento 330 Montrose Drive Folsom, CA San Diego 1940 El Cajon Boulevard San Diego, CA San Francisco Bay Area 2800 Benedict Drive San Leandro, CA San Gabriel Valley 845 North Lark Ellen West Covina, CA Santa Ana 1901 N. College Avenue Santa Ana, CA Westminster 200 Hospital Circle Westminster, CA COLORADO Denver 1920 High Street Denver, CO FLORIDA Bay Area St. Petersburg th Street South St. Petersburg, FL Bay Area Tampa 4555 South Manhattan Avenue Tampa, FL Central Tampa 4801 North Howard Ave Tampa, FL North Florida 801 Oak Street Green Cove Springs, FL

21 Ocala 1500 Southwest 1st Avenue, 5th Fl Ocala, FL South Florida Coral Gables 5190 Southwest Eighth Street Coral Gables, FL South Florida Ft. Lauderdale 1516 East Las Olas Boulevard Ft. Lauderdale, FL South Florida Hollywood 1859 Van Buren Street Hollywood, FL The Palm Beaches 5555 West Blue Heron Boulevard Riviera Beach, FL Melbourne 765 West Nasa Boulevard Melbourne, FL GEORGIA Atlanta 705 Juniper Street NE Atlanta, GA ILLINOIS Kindred Chicago Central Hospital 4058 West Melrose Street Chicago, IL Kindred Chicago Lakeshore 6130 North Sheridan Road Chicago, IL Chicago North 2544 West Montrose Avenue Chicago, IL Chicago Northlake 365 East North Avenue Northlake, IL Sycamore 225 Edward Street Sycamore, IL INDIANA Indianapolis 1700 West 10th Street Indianapolis, IN Indianapolis South 607 South Greenwood Springs Drive Greenwood, IN KENTUCKY Louisville 1313 St. Anthony Place Louisville, KY Louisville at Jewish Hospital 200 Abraham Flexner Way Louisville, KY jewish.com LOUISIANA New Orleans 3601 Coliseum Street New Orleans, LA MASSACHUSETTS Boston 1515 Commonwealth Avenue Boston, MA Boston North Shore 15 King Street Peabody, MA Northeast Natick 67 Union Street Natick, MA Northeast Stoughton 909 Sumner Street Stoughton, MA Northeast Waltham 9 Hope Avenue Waltham, MA Park View 1400 State Street Springfield, MA Park View Central Massachusetts 111 Huntoon Memorial Highway Rochdale, MA

22 MISSOURI Kansas City 8701 Troost Avenue Kansas City, MO New Jersey Rahway 865 Stone Street Rahway, NJ OKLAHOMA Oklahoma City 1407 North Robinson Avenue Oklahoma City, OK St. Louis 4930 Lindell Boulevard St. Louis, MO St. Louis St. Anthony s Kennerly Road St. Louis, MO NEVADA Las Vegas Flamingo Campus 2250 East Flamingo Road Las Vegas, NV Las Vegas Sahara 5110 West Sahara Avenue Las Vegas, NV Las Vegas at Desert Springs Hospital 2075 East Flamingo Road Las Vegas, NV NEW JERSEY New Jersey Morris County 400 West Blackwell Street Dover, NJ New Jersey Wayne 224 Hamburg Turnpike Wayne, NJ NEW MEXICO Albuquerque 700 High Street NE Albuquerque, NM NORTH CAROLINA Greensboro 2401 Southside Boulevard Greensboro, NC OHIO Cleveland Fairhill Road Cleveland, OH Cleveland Gateway 2351 East 22nd Street Cleveland, OH Dayton One Elizabeth Place Dayton, OH Oklahoma City South 2129 Southwest 59th Street Oklahoma City, OK PENNSYLVANIA at Heritage Valley 1000 Dutch Ridge Road, 2nd Flr., A Tower Beaver, PA Delaware County 1500 Lansdowne Ave Darby, PA Philadelphia 6129 Palmetto Street Philadelphia, PA Philadelphia Havertown 2000 Old West Chester Pike Havertown, PA havertown.com Pittsburgh 7777 Steubenville Pike Oakdale, PA

23 Pittsburgh North Shore 1004 Arch Street Pittsburgh, PA Wyoming Valley 575 North River Street Wilkes-Barre, PA SOUTH CAROLINA Charleston 326 Calhoun Street Charleston, SC TENNESSEE Chattanooga 709 Walnut Street Chattanooga, TN Nashville 1412 County Hospital Road Nashville, TN Corpus Christi 6226 Saratoga Boulevard Corpus Christi, TX Dallas 9525 Greenville Avenue Dallas, TX Fort Worth 815 Eighth Avenue Fort Worth, TX Houston 6441 Main Street Houston, TX Houston Northwest Fallbrook Drive Houston, TX Mansfield 1802 Highway 157 North Mansfield, TX Tarrant County Arlington 1000 North Cooper Arlington, TX Tarrant County Fort Worth Southwest 7800 Oakmont Blvd. Fort Worth, TX White Rock 9440 Poppy Drive Dallas, TX VIRGINIA Richmond 2220 Edward Holland Drive Richmond, VA WASHINGTON Seattle th Avenue Seattle, WA TEXAS Bay Area 4801 East Sam Houston Parkway S. Pasadena, TX San Antonio 3636 Medical Drive San Antonio, TX WISCONSIN Milwaukee 5017 South 110th Street Greenfield, WI

24 Dedicated to Hope, Healing and Recovery FSC COPYRIGHT 2010 Kindred Healthcare Operating, Inc. CSR118212

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