TOPS: the Optimum Performance Scale approach to improving nursing home performance.

Although nursing homes, a major and expensive institution in American life, are dedicated to caring for our elders when they need nursing care, they largely fail in that mission. Instead, nursing homes are widely feared as the place where elders go to die, neglected. Staffing is chronically short, as staff do not see nursing homes as preferred places to work. Society's efforts to cure this situation have generally failed, in that we all paid for decades of foundation support, academic research, expert consultants, and government financial support and regulation in an effort to improve nursing homes, without getting significant results. Nursing homes taken as a whole have proven strongly resistant to even incremental improvements, let alone wholesale change, and as a result the failure persists. Most nursing homes are blind to the possibility of success. The issue and problem highlighted by these general failures of outside pressure to bring improvement, coupled with general blindness to potential success is: How can we get the nursing home industry to improve itself. The response outlined in this article is TOPS, The Optimum Performance System. TOPS works by delivering to participating managers (and their staff and board) a personal computer application (the TOPS Tool) that compares the performance of the participant to its peers, including descriptions of what all participants have done to produce their performance. The comparison is holistic, measuring all the main components of performance (quality of living medical health, and cost) and all the sources of performance (management and operations, facilities, and community relations). The instinctual competitive needs of each manager will urge them to use this knowledge to improve their own performance.