Morning Meeting Makeover

Nursing home companies each have their own version of how a morning meeting is supposed to be run.  The format is usually put together by a clinician or by someone who just doesn’t have the right kind of exerience needed for this task.  As a result, I have found most morning meeting formats to be unacceptable and lacking in basic, necessary information.

You also have some old school administrators who will tell you that no morning meeting should ever last more than 15 minutes. Umm… where did this come from?  Did someone tell them that 15 minutes was the magical number and they just used it going forward without asking questions.  Should we have someone sitting at the end of the table with a stopwatch and when we hit 15 minutes – that’s it?  Everyone stops and goes back to work regardless of what hasn’t been covered? 

Well, I’m here to tell you if you want to run a good nursing home, sometimes 15 minutes doesn’t cut it.  The meeting lasts as long as is necessary to set the priorities for the day, get the necessary information to make the best possible decisions for your residents, and share this information with the team members.  I’m not suggesting you let the meeting drag on indefinitely; you have to keep things moving along and on track.  However, keep in mind what’s more important – wrapping it up in 15 minutes or finding out that one of your family members is upset and thinking of calling the State.  One of the biggest obstacles in any organization is communication.  Ensure that in your morning meeting, proper communication is allowed to take place. 

My morning meetings do typically last 15 to 20 minutes.  If there isn’t much going on, maybe only 10 minutes is needed.  However, many times there are situations that I have to stay on top of; things that require me to ask many questions in order to get an idea of what the next step is.  Occasionally, depending on the issue, my morning stand-up meeting may run for 30-45 minutes.  I may not necessarily expect all my department heads to stay.  If the issue being discussed is clinical, I may only keep my nursing administration team to discuss it, allowing the rest of the department heads to get back to work.

There are a number of things I cover in the morning meeting on a daily basis.  They are:

  1. Census and census mix.  I need to know on a daily basis what my census is and what my Medicare/managed care or Q-mix number is.  I also need to know any census changes and payor source changes.  Any admissions, scheduled discharges, unplanned hospital discharges, expirations. Any current referrals and where we’re at on them.  Any bedholds or out-on-pass patients.  Who’s currently in the hospital.
  2. Any special arrangements or equipment any scheduled admissions may need and what room they’re going to to ensure a pre-admission room check is completed and they have a smooth admission.
  3. Any room changes today or scheduled this week.
  4. Any meetings scheduled today, any special visitors we’ll have, any conference calls we have to be on, or any specific reports that are due.
  5. Staffing and labor review.  I need to know how many nurses and CNAs we have today, if we’re meeting the minimum ppd requirements or exceeding our budgeted ppds, any call-ins, any open positions, and if the department heads need to assist in passing meal trays or making up beds if direct care is runing low today.  I also need to know if we made our numbers the prior day.  (Note:  depending on the size of your facility and what time you hold the stand-up meeting, your payroll director may not have all the corrections received and input into the payroll system.  This may need to be reviewed later in the day).
  6. Grievances.  I need to know of any grievances, complaints, concerns, or allegations and where we are in getting them resolved.
  7. Behaviors.  I need to know if there were any resident behaviors that need to be addressed.
  8. I need to know if there are any employees that need to be recognized or sent a thank you card for their positive behavior.
  9. I need to know if there are any transportation issues for the day.
  10. Close to the end of the month, I ask what our AR collection percentage is.  I need for us to hit 100% if not more.
  11. Any key events or announcements.
  12. Any special assignments such as dining room duty.
  13. Any other problems or equipment issues.
  14. Any staff education that is needed.
  15. Any new hires, orientation, or inservice taking place.
  16. Any focus areas or focus rounds.
  17. Any QA updates.
  18. F-tag review where one of the department heads researches an F-tag of the day and presents it to the group.
  19. Quick review of Medicare patients and any issues with minutes or participation.
  20. Ask for any Part B referrals.

I usually don’t hold everyone for the clinical portion of the morning meeting – just the IDT team and nurse administration.  We’ll cover:

  1. The 24 Hour report.
  2. Any accidents or incidents.
  3. Any changes of condition; notification.
  4. Any critical residents.
  5. Anyone on isolation.
  6. Telephone orders; notification.
  7. Labs, x-ray results.
  8. Any new skin issues or new weightloss identified.
  9. Ensure care plan updates are completed.
  10. Make any therapy referrals necessary.

This is a typical morning meeting breakout for me.  Feel free to use it as an example to ensure you’re covering everything you need and not missing out on vital information in your morning meetings.

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