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The anatomy of a team

August 27, 2015
by Pamela Tabar, Editor-in-Chief
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“Team-based care” and “cross-discipline leadership” are terms that are used so commonly that we’ve almost debased what it takes to perform them well. I’ve recently had the pleasure of spending two and a half days at a skilled nursing facility that practices the true definition of both every day.

Silvercrest Center for Nursing and Rehabilitation, Briarwood, N.Y., is not the average skilled nursing facility (SNF). Here, nearly half of the residents use a ventilator or have a tracheostomy tube. Few residents are mobile. Yet despite the extremely high acuity of its population, the facility has been able to reduce its hospitalization rates in the ventilator units by a stunning 54 percent over the past 18 months.

This achievement has been possible, I believe, because the staff has mastered the concept of the cross-discipline team care, and asks every employee—from the on-call physicians and nurses to the housekeeping staff—to take an active role in it.

Nurses and department leaders meet daily to discuss residents’ clinical needs. There’s no such thing as an ancillary service here—practically every department has a role in the hospitalization reduction initiatives.

CNAs take turns working on the “difficult floors,” meaning the two floors occupied by the residents on ventilators. They’re trained to deal with breathing emergencies and to notice the slightest changes in vital signs, which can quickly become bigger problems for residents of this acuity level.

The administrators encourage the nursing staff to gain higher education and training—and provide the time off for it. As a result, 95 percent of Silvercrest’s nurses have a bachelor’s degree in nursing. And it’s no secret why turnover isn’t much of a problem here.

Silvercrest’s team-based approach isn’t limited to clinical teams. Even the housekeeping and maintenance staff are trained to recognize signs of resident distress, and to know the protocols of what to do if a resident is having trouble breathing or looks ill. Every staffer is trained to report anything amiss to the nearest clinical care person, even if it turns out to be nothing.

This all-hands-on-deck approach has led to successful interventions that have saved resident lives, not to mention reducing unnecessary trips to the emergency room. The model also instills a refreshing camaraderie among the staff, allying everyone in the mission of improving residents’ quality of life, and setting egos and hierarchical titles aside for the sake of better processes and resident outcomes.

So, why can’t every SNF do that?


pamela tabar


pamela tabar


Pamela Tabar is editor-in-chief of Long-Term Living. She has worked as a writer and...