In this episode, host Debbie Stadtler sits down with with Renee Ridling, Executive Director of the Gingerbread House, to explore quality improvement and the AHCA/NCAL Quality Award program. Ridling shares her journey into long-term care—from marketing to licensure—and her experience helping organizations earn Bronze, Silver, and Missouri’s first Gold award. They break down the progression of the program, from defining an organization’s identity (Bronze), to documenting processes and data (Silver), to achieving results through a rigorous Baldrige-based framework (Gold). Along the way, Ridling highlights common pitfalls—especially focusing too much on “what” instead of “how”—and underscores the importance of repeatable processes, team engagement, and using feedback reports as a tool for sustained improvement. Perspectives in Long Term Care is produced by Association Briefings. Transcript Debbie Stadtler: Improving quality is always a goal in long-term care. Hear more about the ins and outs of the continuous quality improvement journey in this episode of Perspectives in Long-Term Care. Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Healthcare Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long-Term Care, a monthly podcast produced by AHCA and NCAL. Each month we'll talk with long-term care and assisted living professionals about the opportunities and challenges impacting the long-term and post-acute care profession. My guest today is Renee Ridling, executive director of Gingerbread House, a nonprofit provider for high acuity, medically fragile, developmentally disabled individuals in Rolla, Missouri. Renee has served as a silver and gold level examiner for the AHCA and NCAL Quality Award program for eight years. She joined the quality award panel of judges in 2018 and continues to serve as a judge for the program. She has also successfully led two skilled nursing facilities to two bronze and two silver quality awards, and in 2014, her facility became the first facility in Missouri to achieve the gold quality award. Welcome, Renee. Thanks for being with us. Renee Ridling: Thank you for having me. Debbie Stadtler: Those are some awesome accomplishments, and I want to talk much more about the Quality Award program. But first, tell us about your career journey. How did you get into the field? What led you to choose this career? Renee Ridling: I actually got into long-term care by accident. I'd always wanted to work in healthcare, and I had a background in marketing. I interviewed for a position in marketing with a long-term care facility and I fell in love with it. And I worked at that time for Beverly Enterprises, a company that had over 200 facilities nationwide at that time. And I was asked if I would be interested in the AIT program and. It was intriguing, so I said yes, and the rest, as they say, is history. I obtained my license in late 1992, early 93, and I've been working in long-term care consistently since then. I just fell in love with everything about the people that we care for and the challenges that we face as an industry every day. Debbie Stadtler: It's amazing, and as I talk to folks about their career and how they get started, it's so evident that there is a love and a passion for the industry and for the people that are in it. So I can see that is reflected in your career as well. But let's talk about the quality improvement journey. You have a unique perspective because you've seen it from both sides, both as an applicant and recipient, but also as an examiner and a judge. So give us a quick overview of the program and your experience with it. Renee Ridling: Well, I actually became an examiner after we received our bronze quality award in 2008 for my facility here in Missouri. And I wanted to learn more about the criteria, wanted to be able to help my organization to understand the process better and just to do a better job of learning and finding out what the quality improvement journey was all about. So that's when I became an examiner. I've stayed an examiner because I found it to be helpful in learning about my organization, how continuous improvement can benefit all aspects of the organization, not just the leadership part of it, not my job, but quality improvement continuously. Looking at opportunities to get better can help everybody, my residents, my staff, and really just became a student of that criteria. I really enjoyed the silver. And then I became a gold examiner. I've been a team lead at both levels. And then I was approached to be a judge, and that was a really interesting term. So it's been a really great opportunity for me not only to learn about myself, but to also learn about the organizations that I've had the opportunity to work with. Debbie Stadtler: I love how you mentioned that becoming an examiner was a way for you to learn the knowledge for your facilities, firsthand knowledge of seeing what they're looking for. But that's a great point though that each level of the quality improvement journey and each level of the Quality Award program are looking for different things. And so what advice would you give to those aiming for each of the three levels or applying for each of the three levels? What's the difference there? Renee Ridling: I think beginning at the level we're really asking: What is your organization all about? Who are your customers? What are your key services? What challenges do you face? What advantages do you have over your competition? Then you take that piece and you move it into silver, and then we start digging into those questions about, okay, we, we know who you are and we know what you do, so tell us now how you do it. I think that's probably the biggest jump from bronze to silver. So those questions are how do you lead your organization? How do you make sure that you are focused on your customers. And then moving into the gold, that's a big trick. You go from the bronze, which is five pages, and then you go into silver, which is 26, and starting to be asked for some data, and then you open up the Baldrige framework for healthcare criteria and then you're asked to provide 55 pages of a response. So you now have basic questions and you have overall questions just like you had in silver. But now you have those multiple levels that really dig in and help you to identify gaps within your organization and opportunities to get better. It's just, it's, wow, I've never thought about that for my organization, but now I am, and I think we need a process for that. And so I think the biggest difference is just learning at each level what is expected, how to address what is expected of you, and then moving into gold. It's really challenging for your whole organization to become better, the results throughout your goal. But what's presented in category seven is really a visual representation. You're like, wow, we did that. We really are getting better at what we do. For me, the biggest thing is just that moving from face to face along that journey and seeing at each level how we can grow and get better. Debbie Stadtler: I like how you described it, that each piece builds on the previous one, so you're not just thrown into the deep end on day one, where you start with the bronze and it's more introductory, basic questions, a shorter application, a good starting point. And then by the time you're ready for silver, you have more data, you have more information, more details, things of that sort, so you're building. And then by the time you're ready to stretch for that gold, then you really can put all of that on display and showcase your organization. Renee Ridling: Yes, I think that's a good summary. It is just the only way we talk about the journey, and I know sometimes people look at us strangely, but the honest truth is that it really is a journey and really you're moving from step to step. I think that's one of the great things about the AHCA/NCAL Quality Award program is that it is progressive. As a Baldrige recipient at the national program level for Baldrige, you start at the top. You start with that full criteria. You don't get that opportunity to start small and grow. And I think that the way AHCA in has developed this quality award program over the years has been really well thought out and just phenomenal in that it gives organizations an opportunity to move through those progressive levels and gain understanding throughout. Debbie Stadtler: I always hear people describe it as a journey, and I think that's really the most accurate word there. From the examiner and the judge side. What are some common issues with applicants? What are some sticking points that a lot of folks get caught up in? Renee Ridling: I think probably the biggest thing that we see at the silver and the gold especially is we know what we do as organizations. If we ask someone a question, how do you do something? They can tell us what they do. They can tell us we do this, but the real question is how do you do it? So the how question is really indicative of process steps. First we do this, then we do this, then we do this, and then we achieve an outcome. So all of those what things, those meetings that we have and that interaction that we have with one-on-one, with that resident or that family, all of those things that we do. Those what things. Go into the how, but the steps have to be there. And the important part about those steps is that they need to be well ordered. They need to have a first, a second, a third, a fourth. They need to be repeatable, they need to be consistent so that you're doing things the same way all the time to produce consistent results. Because that's really what we want, is we want those outcomes to be consistent and we want them to get better. And