'It's all about leadership ...' interview with Marianna Kern Grachek, president and CEO, American College of Health Care Administrators (ACHCA).

No one ever said life would be easy. For Marianna Kern Grachek, the past few years have meant assuming significant leadership responsibilities in two major long-term care--oriented organizations while caring for her elderly mother at home hundreds of miles away from either office. And in her most recent executive position, this has meant restoring a challenged professional association to health during difficult and complicated times. This summer she accepted the position of president and CEO of the American College of Health Care Administrators (ACHCA), moving over from a position she had occupied for nearly 10 years as director of long-term care accreditation for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In her new position she is seeking to revitalize an association dedicated to improving long-term care leadership at a time when superior administrative skills and qualifications are needed more than ever. Recently she shared her view on ACHCA's outlook and purpose with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Peck: How does ACHCA see its mission in the 21st century?

Grachek: The College's mission is, as always, about promoting excellence in long-term care leadership. This is particularly important these days, with so much emphasis on regulatory compliance and baby boomer expectations regarding person-centered culture change. The way we now do business and provide care is very different from the habits and practices that were ingrained in many clinicians and frontline workers in the past. To change these behaviors, we have to change the way we think about our work. This shift in thinking must start at the top and find its way to those who touch the resident. Leaders must be knowledgeable and interpersonally competent to model expected behaviors and best practices, to motivate change, and to hold people accountable for outcomes. ACHCA is the professional membership association that supports the individual administrator in this leadership role.

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Peck: Just to make sure that readers understand, ACHCA is not just for nursing home administrators, is it?

Grachek: ACHCA changed its name from "Nursing Home Administrators" to "Health Care Administrators" back in 1982 to expand its scope to all long-term and post-acute care administrators. Now College members come from assisted living, skilled nursing, and home healthcare settings and from single owner/operator facilities to multifacility corporations.

Peck: What do you believe the primary training needs to be for your membership?

Grachek: Primary training for LTC administrators must be geared to the individual and his or her level of achievement and focus on environmental trends and sound business practices. Training and education must be relevant to what is going on in the industry. It must meet the individual's "just-in-time" training needs resulting from regulatory, business, quality, and safety demands. One of our popular training tools is a self-assessment on our Web site called The Ideal Administrator. This tool enables administrators to assess themselves on leadership domains as compared with their peers nationwide and identify their personal training needs. The College also conducts two national conferences each year, in addition to state chapter forums and conferences. These meetings offer educational content from experienced administrators and other experts in the field, as well as provide excellent networking opportunities with colleagues.

Peck: Is there an online component to the training?

Grachek: We do offer CE self-study courses on the ACHCA Web site, and we have very active partnerships, including one with your magazine that offers a monthly CE test (see, for example, "American College of Health Care Administrators Continuing Education Test #114," p. 68). The College also supports a popular "Peer2Peer" online feature, which allows individual administrators to raise questions and get answers from their peers almost immediately. For example, there have been cases in which an administrator undergoing a state agency survey needs immediate advice or a quick "policy" and has gotten an immediate response from their peers.

Peck: How does ACHCA plan to collaborate with other long-term care organizations in regard to long-term care policy making at the national level?

Grachek: One of College Chairman Larry Slatky's goals is closer collaboration with the trade and professional associations in long-term care. To that end, the College has taken a leadership role in convening LTC professional associations around advancing quality initiatives and promoting the importance of leadership to realizing sustained culture change. The Long Term Care Professional Leadership Council first met in September to explore ways to collaborate across our associations to strengthen LTC leadership. Members besides ACHCA include AMDA (American Medical Directors Association), NADONA (National Association of Directors of Nursing Administration), and ASCP (American Society of Consultant Pharmacists). The Council expects to announce cross-association initiatives in the near future. ACHCA also works closely with NAB (National Association of Boards of Examiners of Long Term Care Administrators) to assist in the development of formal curricula for academic settings and to promote standardization of licensure requirements. We have also recently added academic representation to our board of directors.

Peck: As one who has been closely involved with evaluating long-term care administration for the past decade, what is your personal perspective on your new role?

Grachek: Long-term care has been my passion through the years, and the move to the College was a natural progression for me. JCAHO accreditation is all about organizational excellence and ACHCA is all about leadership excellence. You need excellent committed leaders to achieve excellent organizations. They go hand in hand.

Peck: What do you view as the personal traits of an excellent long-term care leader?

Grachek: Foremost, knowledge of the field is essential. But, more than ever, today's leader has to be interpersonally competent. Books provide a path to cognitive learning, but affective and psychomotor learning come through real-life experience. The challenge is to be skillful in moving staff and others toward achieving the organization's goals, while at the same time meeting their individual needs. The leader has to be able to see the big picture through a variety of perspectives so that barriers to success can be identified and dealt with. The leader must be approachable and good at communicating both vertically and horizontally in the organization. Enlisting corporate or governing leadership commitment to organizational initiatives is as important as enlisting staff buy-in. If the administrator fails in this role, the result is organizational inconsistencies and breakdowns. Committed leaders also take steps to differentiate themselves from their peers by becoming professionally certified. Certification goes beyond entry-level licensure and demonstrates to others in the field and to the public that the leader has raised the bar on his or her performance. I have been ACHCA-certified in both nursing home and assisted living administration, so I speak with conviction.

For further information on the American College of Health Care Administrators, phone [phone] or visit www.achca.org. To send your comments to the editors, please e-mail [e-mail].