Promoting Excellence In Long-term Care Leadership!



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Principles of Excellence For Leaders in Long-Term Care Administration

Responding to the needs of the times and of its members, the American College of Health Care Administrators has developed a set of principles for leaders in long-term care.

These Principles of Excellence enunciate the highest principles of leadership in long-term care. They profile an exemplar of a leader who strives constantly to pursue the highest road to excellence. Prototypes and ideals are meant to inspire and motivate, although in practice no single leader may be able to exemplify all of them to the highest degree.

All leadership may be measured against some common criteria. Still, effective leaders are driven by different personality traits and personal histories; they follow varied styles and pursue different paths; they respond to different needs of the organization they lead, and to the unique context and challenges that their organization faces. Regardless of the type of one’s leadership and one’s style, all good leadership should remain true to these Principles of Excellence.

Long-term care is quintessentially a service field that calls for unique leadership, skills and talents. The many facets of effective long-term care leadership articulated in countless books may simply be capsuled in the following traits that distinguish a long-term care leader.

  • An adherence to a clear vision of the nature and purpose of long-term care
  • An understanding that person-centered care is the ultimate goal of long-term care
  • The knowledge that an organizational culture should support the goals of long-term care
  • A conviction that a quality workplace is the necessary environment to create quality of life for the residents
  • An understanding that quality is ensured when there are skilled and devoted caregivers, supportive programs and a continued effort to improve the system
  • An appreciation that a leader, through action and words, sets the tone, mentors staff, nurtures individuals, encourages teamwork and creates a positive work setting

These Principles of Excellence focus attention on areas critical to leadership in long-term care.

Articulating a Mission and Vision for the organization

  • Creating a Culture of Quality within the organization
  • Affirming that resident’s care and quality of life must be person-centered
  • Understanding that caregivers and staff create quality for the resident
  • Realizing that many residents experience long-term care as their last home
  • Knowing that financial viability is essential to provide care and services

These Principles of Excellence set a practical framework to create, sustain and nurture our long-term care leaders.

  • Educational preparation
  • Licensure examination design
  • Ongoing educational curriculum
  • Job descriptions
  • Self assessment

Mission and Vision:

A long-term care leader:

  • Guides efforts to articulate and win support for the organization’s vision, mission and goals.
  • Develops a strategic plan to achieve the organization’s mission with measurable goals and timeframes to achieve them.
  • Encourages staff and departments to commit themselves to achieve the organization’s goals.
  • Oversees the creation and sustenance of teams committed to the organization’s mission, vision and goals.
  • Leads the staff and departments to develop collective, individual, and measurable objectives in keeping with the organization’s goals.
  • Collaboratively plans and establishes supportive systems to achieve the organization’s goals and objectives at all levels.
  • Strives to procure the necessary resources and allocates them to effectively achieve the organization’s goal.
  • Establishes a Quality Improvement process that uses proven performance improvement tools to monitor and enhance quality of all care, services and operations.
  • Remains alert to the concerns of key stakeholders and regularly receives their feedback; updates them of the progress made in achieving the organization’s goals; informs them of the effectiveness of the systems and resources deployed.
  • Maintains professional, working relationships with the governing body, regulators, surveyors, the media and legislators.
  • Promotes relations with families and the surrounding community both by being a resource to them and by inviting them to be partners in care giving.

Culture of Quality:

A long-term care leader:

  • Creates a culture that reflects the organization’s mission and priorities.
  • Creates a culture which promotes the quality of life of residents and provides them high quality of care.
  • Creates for the staff a quality work setting that affirms their individuality, respects diversity, and fosters effective teamwork.
  • In word and deed adheres to professional standards, sets proper priorities, and promotes a tone of caring in all operations.
  • Serves as a leader, mentor and coach who promotes excellence in care, services and operations.

Resident Care and Quality of Life

A long-term care leader:

  • Affirms the importance of person-centered care by establishing systems to ensure that, within reason and facility capability, resident’s choices are elicited, valued and met.
  • Affirms the primacy of each resident’s quality of life by meeting their need for security and care, by supporting their personal growth, and by promoting their intellectual and spiritual health and social well-being.
  • Encourages staff to implement systems that maximize excellent care and services by adopting state-of-the art procedures, innovations, evidence-based approaches and best practices.
  • Emphasizes the need for teamwork and interdisciplinary practices that utilize Continuous Quality Improvement (CQI) methodology.
  • Serves as an ambassador and advocate for the residents by inviting the families and community to become partners in care and services, and by encouraging their participation in religious and secular matters.
  • Promotes end-of-life care which respects the personal and spiritual preferences of each person.

Caregivers and Staff:

A long-term care leader:

  • Imparts to the managers, supervisors and staff, during orientation and throughout their employment, an understanding of the organization’s mission, vision and goals and of their role in achieving them.
  • Creates a work setting in which staff can achieve their individual objectives while contributing to the organization’s goals.
  • Imparts a clear understanding of what is expected of each manager and staff individually and collectively.
  • Encourages professional and personal growth through orientation, continuing education and by encouraging innovation.
  • Provides education, tools, resources and systemic support needed for managers and staff to achieve the organization’s mission, vision and values.
  • Hires and educates managers who are committed to the organization’s philosophy and culture; promotes education that teaches supervision, leadership, team building and mentorship.
  • Emphasizes the primacy of person-centered care; encourages creativity and accountability; supports individuality; recognizes good work and provides proper supervision.
  • Teaches a systems-approach to quality improvement by encouraging teamwork, interdisciplinary collaboration, and reliance on proven quality improvement tools.
  • Uses work assignments that facilitate person-centered care.
  • Adheres to established policies, procedures and regulatory and legal requirements.
  • Oversees the creation of systems, consistent with law and regulation, intended to keep valued employees (e.g. human resource policies, compensation, benefits and succession planning).

Creating a Home

A long-term care leader:

  • Creates a physical environment consistent with the organization’s mission and with the goal of enhancing quality of life for each resident – in short, creates "home" for each resident.
  • Oversees the maintenance of a safe, clean and appealing surrounding that adheres to codes of safety, public health and local law.
  • Oversees the development of a preventive maintenance program.
  • Oversees the creation and implementation of a safety program which includes fire, emergency, disaster, evacuation and transfer plans.


A long-term care leader:
  • Designs a budgetary plan that is consistent with the goals of the organization and each of its departments.
  • Follows sound financial management and accounting procedures that include financial supervision, checks and balances, monitoring cash flow, clearly drawn contracts and corporate compliance.
  • Oversees systems which safeguard residents’ finances.

The American College of Health Care Administrators urges you to study these Principles of Excellence and find ever new ways to use them to guide and inspire creative leadership in long-term care.

The American College of Health Care Administrators ("ACHCA") has written and approved the "Principles of Excellence For Leaders in Long-Term Care Administration" to support the provision of long-term health care services that are desired, meaningful, successful and efficient. They are intended to assist administrators in achieving these objectives and to guide and inspire creative leadership in long-term care. The principles encourage the administrator to follow a reasonable course of action based on current knowledge, available resources, and the needs of the facility so that effective and safe care can be delivered. They are aspirational in nature and intended to foster self-appraisal and continuous performance improvement. The principles are neither inflexible rules nor requirements of practice. They are not intended nor should they be used to establish a legal standard of care under any circumstances.

Changes in the facility environment due to advances in care, financing and reimbursement and regulatory framework can occur at a rapid rate. The effective date of this set of principles, as revised from time to time, should always be considered in determining its current applicability.