As the Administrator of Palmetto Patriots Home in Gaffney, South Carolina, Chris Palmer has built a novel State Veterans Home (SVH) culture. Administrators are not just administrators, clinicians are not just focused on the clinical aspects of caring for residents. Instead, the entire staff operates as a true care team.
Palmer exemplifies that culture. Recently, he took off his administrator’s shoes and stepped into nursing footwear — he is a nurse by training — to quickly and safely care for a resident experiencing serious respiratory issues.
That’s just one of many examples. Palmetto Patriots Home’s care team model also consistently drives the organization to new heights: it earned both a Five-Star rating from the Centers for Medicare and Medicaid Services, and a Bronze Award from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).
HMR Veterans Services Vice President of Corporate Operations Russell Keogler spoke with Palmer about the SVHs success, what achieving Five-Star recognition means to him and the entire team, and how he fosters a culture of care teams striving for continuous quality improvement.
Keogler: First of all, congratulations on these awards and the coveted Five-Star rating from CMS. What do these achievements mean to you and your team at Palmetto?
Palmer: It means a lot to the entire team to earn the Five-Star rating because it definitely takes every single person in this building to achieve great outcomes. We work hard on a day-to-day basis to treat every day as if it’s a survey day. Every day. And we are proud because it demonstrates to the VA world that we are taking excellent care of our veteran residents. But I also believe that ‘as much is given, much is required’. So while Five-Stars is great, as that rating is given, it is going to require a lot of work to keep Five-Stars.
Keogler: Now in thinking about the Five-Star rating and the Bronze award, together they illustrate two sides of excellent performance…
Palmer: I agree with that 110%. The Five-Star rating is a results-driven score, whereas the Bronze Award provides affirmation of clinical processes that drive those results.
Keogler: That brings us to the question of how. How did Palmetto Patriots achieve the Five-Star rating?
Palmer: We really had a hard focus on taking a true deep dive into our Quality Assurance and Performance Improvement (QAPI) processes. We pull data from CASPER reports and our VA analytics to monitor where we stand in terms of quality. Once we gather that information, we use it to determine what we need to deliver the highest-quality care. When it comes to QAPI, we are very serious. I tell the team that, ‘I want you to think of all the negatives and bring them to the table’ because I want to hear the negatives.
Keogler: Following that, how do you as a leader foster a culture where people feel comfortable bringing the negatives forward, all in the name of continuous quality improvement?
Palmer: One main thing is my open door policy that’s for any staff member in this building, no matter what department. Yes, we follow a chain of command, but I let all staff know it’s okay to come talk to me and I’ll listen to their opinions and ideas. So that communication and open door policy is critical because managers are not always right, I’m not always right. We can improve too, and we can’t do that without their voices pointing out where they find flaws or see ways to improve. It’s really a matter of fostering professionalism through communication and respect, because in my eyes there should never be anything professionally that we cannot discuss, particularly to keep us out of any kind of regulatory compliance issues.
Keogler: So looking ahead, how do you plan to leverage this momentum and continue advancing quality and services?
Palmer: It makes a big difference to the team when they feel celebrated for their success. When they’ve been celebrated, they feel good about coming to work, and they want to keep doing well and to keep up all the positive work.
I’m also very thankful for the HMR support center because we build on our success with the Honor Health Career Program, which is our career development program that enables CNAs to complete and move up to an LPN degree while continuing to work — all sponsored by us and free to them. HCCP definitely helps our CNAs and people feel that they have a chance to grow within the organization and to better their lifestyle, their families, their financial status, among other things.
Keogler: One of our colleagues said recently that Palmetto Patriots would not be where it is today without you as its Administrator. Specifically, her point was that Palmetto was able to earn deficiency-free surveys twice in a row, which is rare, because of the level of commitment you give operations, administration, and the clinical aspects. So what drives the consistency in Palmetto’s success?
Palmer: That’s very nice to hear but overall our success is still a team-wide approach. Earning deficiency-free surveys doesn’t just speak about nursing or administrative, it speaks about every single department. You can’t get a deficiency-free survey if they found something in dietary, housekeeping, or any other department. It takes every single person, and I give kudos to everyone for making that happen on a day-to-day basis.
In terms of our consistency, it starts from the top. While I’m not perfect by any means, I try to lead by example. Of course our veterans are a priority here, but we let staff know they’re cared about too because, in my opinion, that carries a lot of weight. Yes, I’m going to hold you to the expectation that you need to complete your job. No, I won’t do it for you. But I also let people know that I don’t mind getting my hands dirty with you so we’re going to work hard together. I don’t mind if I have to clean a room. I don’t mind if I have to do whatever to make it work. Absolutely, if people on the team are in the trenches, I should be in there with them when it’s needed.
Keogler: Palmetto Patriots also achieves low employee turnover rates. Is there a common denominator or characteristic that has created such an elite team? Is it compassion? Is it the focus on helping veterans continue their story with dignity?
Palmer: We’ve been very blessed with our employee retention. We also have great patient-to-nurse and CNA ratios that are lower than almost all nursing homes. Both that and our high retention rates come from creating the culture where people want to stay and a significant part of that culture is our mission to help veterans live their best lives with the dignity they deserve. Our culture is the driving factor in everything we achieve.
