About three months ago, a resident of an Alexandria assisted living facility made a late-night call to 911 when he was unable to summon anyone to help him with a catheter. Police found two residents in distress -- and three workers who had slept through the sirens and a burglar alarm that the officers set off as they forced their way into the building.

In the shadow of such tales, representatives from Maryland and District nursing homes gathered at a conference last week to learn from their peers' successes and failures.

"The status quo isn't benign," said keynote speaker Peter Pronovost of Johns Hopkins University. Addressing leaders in hospitals, nursing homes and home health care agencies, he said, "We have failed to view the delivery of health care as a science." Consequently, he said, "most of the bad outcomes that we blame on patients are actually preventable" with improved teamwork, communication and standardization of processes.

Sharon Mills, of Hadley Memorial Hospital in the District, said her organization has committed to "making sure that the things you already know work -- like turning the patient every two hours -- actually get done. . . . It's really vigilance, vigilance, vigilance."

One star of the meeting was Rockville's National Lutheran Home, commended for improving patient care by attending to a staffing issue.

The 300-bed institution was beset with a high staff turnover rate -- 83 percent annually, said Norma Spinella, nursing director of the nonprofit home. "When you're working under those conditions," she said, "you're not getting quality care, you're getting a revolving door."

Spinella said her home decided to encourage stability by rewarding people for staying on the team: Every staffer receives a 5 percent raise every five years, in addition to annual increases of 4 to 5 percent.

The result of these and other sweeteners is a highly stable staff. Instead of retaining only 17 percent of its caregivers annually, Spinella said, National Lutheran kept 94 percent of its people last year.

With a stable staff, "you have less mistakes, and people are well taken care of," Spinella said. And that improved quality is demonstrable: "Within the past five years, we've had four deficit-free surveys," she said.

(Of course, National Lutheran is not perfect. According to information on Medicare's "Nursing Homes Compare" Web site, a January inspection found six relatively minor deficiencies affecting or potentially affecting at least a few residents.)

National Lutheran presents an attractive model, but its success did not occur overnight: Spinella, who has worked at the home for 23 years, said the anti-turnover drive started in 1989.

-- Tom Graham

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