How to Adopt a Proactive Approach to Care

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We have talked a lot about the status quo. Part of that conversation is around the reactive nature of SNFs. Can you talk a little bit about the dangers of being reactive in a nursing leadership role?

“Well, being proactive is clearly better than being reactive. There are a ton of changes going on, as everyone knows. If you aren’t thinking long-term and thinking outside of the box, it’s hard to even keep up in this climate. If you aren’t thinking and planning for what is coming in the future and proactively planning, you are falling behind.

Part of being proactive is also being open to change. No one really talks about having a willingness to change, but it is absolutely crucial for skilled nursing organizations now. We have to screen every new regulation and change to our business through a filter of:

• How will this impact my organization?
• How will this impact my facilities directly?
• How can we make changes and improvements to make the negative impact as small as possible?

At Crowne, we have been very proactive to put clinical processes in place to help our nurses provide better care. This helps everything, including our hospital readmission rates. And we have been doing this for years. So when a lot of these changes came, we were already in a better position to adapt.

I think forward-thinking is the best way to manage people. When you procrastinate, you are just avoiding the inevitable and setting yourself your failure. If you decide to

• Inspire others
• Communicate your vision
• Let people know ahead of time
• Listen to concerns

I turn leadership ladder upside down. I don’t think it’s the CEO that is the manager. I think it starts with your CNA’s and Nurses. Those are your people that are truly touching the residents. And to get the best out of everybody, you need to be in constant communication in a proactive way. Our frontline team already spends a lot of their time putting out fires; they appreciate when leadership doesn’t add fires to their day.”

What are the top 5 ways to become proactive?

“Practice – “Proactive is a behavior. And it’s a learned behavior.” It’s a behavior you have to make yourself do. It takes practice. Nobody is perfect; everyone has a bad day. But, you can’t always have a bad day.”

1. Identify – The first step to becoming proactive is identifying long-term goals and changes. This is a critical step for success and it requires constant attention.

2. Prioritize – You have to look at your long-term goals and know where your visions are, then developing a plan to get to your vision. There is always a balancing act here. Everyone has short-term goals, but we have to try our best to make sure that those short-term goals are in-line with our long-term vision.

3. Communicate – After you have prioritized your goals, you have to communicate them to your team.
“The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw
Communicate. Communicate. Overcommunicate.

4. Recognize – So we have prioritized our proactive approach and goals, and we have communicated that vision to our team. Are we done?


This is where most people fail, to be frank. People want to be recognized when they’ve done a good job. And for continued success, we have to recognize achievement. And, in my opinion, recognition can come in many forms and should match the achievement. Sometimes it is a pat on the back and verbal recognition. I think that recognition can range all the way to pay increases.

Alongside recognition is general accountability. If you give your team a task or goal, it’s important to update them on their progress, successes, and shortcomings. If you don’t hold people accountable, they stop paying attention.

5. Improve – Being proactive isn’t static, I think we’ve established that. As part of any continuous improvement model, you have to adjust. There are always new challenges looming and improvements that can be made.”

When we look at 2018, what do you think the biggest opportunities and or challenges are for SNFs?

“Honestly, I don’t think that the challenges are as big as everyone thinks they are. I know a lot of people are focused on the Requirements of Participation, but this has been coming for ten years. If you’ve been a proactive organization, you’ve already become resident-centered.

I think the biggest challenge now is what is coming in 2019. We are looking at a new payment methodology. Our organization is already planning for that.

We first heard about RCS-1 last year at American Association of Nurse Assessment Coordination, AANAC ( I believe AANAC is one of the best nursing organizations around. They have a great relationship with the Centers for Medicare & Medicaid Services, CMS. So, we rely on AANAC for education, to keep us focused on the important changes coming, well in advance.”

Jeannie Bernardo, RN, MSN
Jeannie has 35 years of nursing experience. She has experience spanning from a Director of Nursing to a Director of Quality Assurance and Compliance. One of Jeannie’s areas of focus is MDS guidelines and payment systems, state and federal regulations and Medicare guidelines.

Jeannie is currently the Vice President of Clinical Services with Crown Health Care in Alabama. To learn more about Crown Health Care, click here.