Training Tomorrow's Top Managers.

Interview with Paul R. Willging, PhD, Director, Johns Hopkins University/NIC Seniors Housing & Care Program

Long-term care management training has set off in a new direction with the advent of a graduate-level course cosponsored by Johns Hopkins University and the National Investment Center for the Seniors Housing & Care Industries (NIC). Scheduled to begin its first course this month, the Seniors Housing & Care Program will offer at least four 4-day seminars throughout the year addressing the entire long-term care continuum, from independent living to skilled nursing care. Topics will include finance and development, sales and marketing, operations management and the overall business of seniors housing and care. In terms of scope and concentration, it represents the most ambitious academic program yet addressing the long-term care field. Fittingly, since long-term care encompasses both healthcare and real estate, the program is housed in the Real Estate Department of Johns Hopkins' Graduate Division of Business and Management, but headed by a familiar name to long-term care providers, Paul R. Willging, PhD, who u ntil his 1999 retirement served for 15 years as president and CEO of the American Health Care Association (AHCA). Recently Dr. Willging fielded questions from Nursing Homes/Long Term Care Management Editor Richard L. Peck on the purpose and direction of this new program and the perspective he brings to it from his years as a top spokesperson for nursing homes.

Peck: What was the rationale for the Seniors Housing & Care Program?

Dr. Willging: Conceptually it began when the leadership at the NIC, looking at the brief history of assisted living and congregate care, and the not-so-brief but fast-changing field of nursing home care, saw a need for an academic center providing in-depth management training and research in this field. The model was the Cornell University School of Hotel Administration, which has done so much to bring professionalism to the hospitality field.

From my own perspective, I've thought for some time that an academic tie-in would do a great deal to enhance the credibility and legitimacy of our field. When I was offered this position, I not only liked the vision involved, but also saw it as a chance to pull off something we hadn't been able to do at AHCA.

Peck: How does this program differ from the training programs being offered to long-term care administrators by various organizations and institutions?

Dr. Willging: Basically, the seminars are aimed at senior-level people who want to move beyond day-today operations and toward leadership positions in the field. We don't propose to compete with organizations like the Assisted Living Federation of American (ALFA) or the American College of Health Care Administrators (ACHCA), which have been running excellent courses for some time; we don't propose to focus on the nuts-and-bolts of running facilities. Rather, the program will offer in-depth information about such issues as real estate development and financing, demographics, marketing research, management strategies and technologies, staffing approaches and risk management.

As for academic credits, the course can be taken as a concentration in the Hopkins Masters of Business Administration and Masters of Science in Real Estate programs or for certification in seniors housing and care. Or people can pick and choose among seminars simply to enhance their knowledge about a particular topic.

As it happens, most of the people enrolled in our first course--we're limiting attendance to 20 for improved class interaction--already hold management positions in various long-term care organizations. They fall roughly into two groups. First, there are people who are coming from other industries and want a quick immersion in their new field; one attendee, for example, is a corporate compliance officer for an assisted living chain who has a background in home healthcare. Second, there are upper-level managers whose companies see them as capable of advancing to broader roles--a DON ready for general management, or a general manager ready to move into senior management, for example.

Peck: How do you think long-term care management training has evolved over the past 15 years or so?

Dr. Willging: Fifteen years ago administrators learned pretty much by doing. I give the professional and trade associations a great deal of credit for recognizing the need for formal training at least in the functions of running a facility. In recent years, these organizations have moved into certification programs; ALFA, ACHCA and the American Association of Homes and Services for the Aging (AAHSA) have all gone in this direction. As I mentioned, we're trying to take it to the next step by broadening the training of senior managers.

Our goal is to emulate, at least to some degree, the Cornell University School of Hotel Administration. There are companies in the hospitality field--Marriott, for one--where one cannot presume to move into senior management without having coursework at Cornell. We would like to achieve that status with our program.

Peck: For those managers who won't be fortunate enough to be able to travel to Baltimore for the Hopkins courses, do you have any suggestions regarding training?

Dr. Willging: Nursing homes, in particular, are facing an increasingly competitive environment. If they don't emphasize focusing on the "customer"--i.e., residents and families--they will be dead in the water. That means, in a nutshell, quality management. Whether you call it CQI (continuous quality improvement) or TQM (total quality management) doesn't really matter; it can involve a variety of approaches. I see the Eden Alternative, for example, as simply another manifestation of quality management: You're doing your damnedest to keep the customer happy--and if it happens to involve livestock, so be it!

Peck: What about those nursing home operators who say that, as much as they would like to be more customer-focused, they have to deal with so much regulatory paperwork that they don't have the time?

Dr. Willging: To some extent, what they say is true. And yet one can observe nursing home companies that do make that extra effort and end up having better survey results, lower staff turnover and an overall better experience with the regulatory process in total. Maybe you can't fulfill the entire promise of quality management because of these onerous regulations, but it's amazing how far you can go.

Examples I could point to include Vetter Health Services in Kansas and the facilities operated by Dale Thompson at Benedictine Health Dimensions. Dale, former chairman of AHCA, and Jack Vetter have both shown what can be done. (Both, by the way, are sponsors of our program at Johns Hopkins.) We can't use the excuse of government regulation to avoid applying the principles of quality management. If we do, we're in deep trouble.

I will say this, particularly in view of a new presidential administration moving into Washington: The field encountered a serious dilemma in July 1998, when Senator Grassley, President Clinton and the Health Care Financing Administration all tried to outdo each other in being "tough on nursing homes." That would have been very well and good if they had limited their focus to those facilities that deserved it (and there certainly are some). But all facilities were enveloped in a punitive atmosphere that threatened the very core of quality care. If that sort of destructive crusade continues, the nursing home field might well be beyond salvation. That approach hasn't improved care; in my view, it has made it worse because it created an environment in which no one wishes to operate, including quality-oriented but increasingly demoralized caregivers. Somebody in Washington has to recognize this.

The Seniors Housing & Care Program, though, is pointing in a positive new direction. It is looking to be one small, but significant, part of restoring America's faith in the field. If we can enhance the professionalism and, thereby, the perceived legitimacy of long-term care, we will have done our job.