In a small rural town in Missouri, set against the splendor of the Ozark Mountains, the employees of a long term care center must be celebrating. They certainly have great cause. These individuals undertook a journey—a lengthy, arduous, often exhausting and frustrating journey—so they could give their residents the very best care possible.

And Golden LivingCenter - St. James (GLC-St. James) already had an impressive record of providing care and services at a level of quality superior to all but a small percentage of its peers nationwide.

Their list of accomplishments includes:

■ Earning and keeping a Five-Star rating from the Centers for Medicare & Medicaid Services without a single lapse since December 2008—and hence being named one of the nation’s top nursing homes in U.S. News and World Report every year since 2008; and

■ Ranking in the top 10 percent—both state- and nationwide—for many key quality measures, such as acquired pressure ulcers and the elimination of physical restraints.

This year they added another item to that list. One that demanded far more from everyone involved, but produced results far greater than any they’d achieved in the past. It was truly a red letter day when GLC - St. James learned it had earned the 2014 Gold National Quality Award from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). It’s the highest quality award the long term care profession can bestow, and over the 18 years since the award’s inception, the Gold has only been achieved by 24 providers.

Six of those gold awards were earned this year. The five centers that joined GLC-St. James in this very exclusive circle are:

■ Altercare of Louisville Center for Rehabilitation and Nursing Care (Louisville, Ohio)

■ South Davis Community Hospital (Bountiful, Utah)

■ Stonebrook Healthcare Center (Concord, Calif.)

■ Glen Hill Center - Genesis HealthCare (Danbury, Conn.)

■ Oregon Veterans Home (The Dalles, Ore.)

AHCA/NCAL’s National Quality Awards Program, based on the exacting and comprehensive Baldrige Health Care Criteria for Performance Excellence, requires applicants to move through three levels of progressively rigorous criteria. All applicants must start at the beginning and take each level in order. Only after achieving the first level’s award—the Bronze Commitment to Quality Award—will an applicant be eligible to apply for the second level and from there to the third.

Providers that embark on this three-level program of criteria will find themselves on what so many award-winning providers describe as a “journey” that leads them through obstacles to a solid understanding of how to design processes and systems that reliably lead to consistent and sustainable quality improvement. This improvement in turn results in improved outcomes and performance excellence throughout the organization’s culture.

It’s an intense learning process, to which Renee Ridling, executive director of GLC-St. James, can attest. “Going from Bronze to Gold is very much a journey of learning,” says Ridling.

“It made us take a step back and say, ‘We have really good outcomes in whatever the indicator is. How did we get those?’” says Ridling. “It meant really learning about our facility, defining its systems and processes, looking at and analyzing what we’re doing to be a quality organization and deliver a quality service to all of your stakeholders. It really makes you think.”

Working toward the Gold award results not just in earning a particular award, but in a center’s staff gaining that fundamental knowledge of quality that allows them to perform center tasks not by just doing what’s always been done, but understanding what the goal is, how to achieve it, and why what they did worked.

“My staff and I can all sit down and talk about what it is that makes us better,” says Ridling, “and they can say exactly what it is that makes us better than our competitors, and why people come to St. James.

“I can sit down and say to the team, ‘Do you understand what and why we do what we do? Do you understand what the steps are that we take, and why they get us there? And they really do understand.”

Staff who really understand what actions result in improved quality and why they do is immeasurably valuable, Ridling says.

“Because quality doesn’t just happen,” she says. “It’s not a matter of, ‘Here’s what we do, and we just do it because.’ It’s really a matter of knowing how did we get there, what steps did we take, and what did we learn at each step along the way to get to this point.”

All that learning will pay off big far into the future, “because the goal is to have a repeatable process that creates a sustainable organization,” Ridling says. “If you left today, how would the facility go on? Would the staff and leadership team know how to keep growing and sustaining the organization? Your organization’s process has to ensure it can be sustained.”

And that’s why staff who have a thorough understanding of how it all works are so

essential.

“If any piece is pulled out but you understand how to sustain that growth, you can plug somebody in there and you’ll continue to grow and sustain,” Ridling says.

Ridling says working through the exhaustive awards program has proven extremely valuable to GLC-St. James’ efforts to instill constantly advancing quality throughout their services.

It was a tad taxing, she admits.

“It’s a very arduous process that you go through to achieve this level of recognition and excellence. Our team invested a lot of time and energy. But you really learn about your organization from the inside,” Ridling says.

“This is not just a surface award. This program really is an intensive look at every area of your operation to determine how to be successful,” Ridling concludes.

Kathleen Lourde is a freelance writer based in Dacoma, Okla.