Talkin' SaaS

What is NARA? An Interview with NARA's Past President Alfred C. Johnson

• Renee Moseley

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The National Association for Regulatory Administration’s Past Board President Alfred C. Johnson explains the purpose of NARA and how the organization’s mission, consumer protection through prevention, drives the organization. 

GL Solutions helps governments run, grow and adapt. For more information about GL Solutions and our modernization service for regulatory agencies, visit us on the web at www.glsolutions.com. Or connect with us via Facebook, X or LinkedIn. Reach our host, Sam Hardin, at hardin@glsolutions.com. We look forward to hearing from you.

Sam Hardin:

Hello everyone. This is Sam Hardin with GL solutions and this is theTalkin' SaaS podcast. On this podcast I talk with regulatory leaders about the important topics within the industry. Today I'm talking with Alfred Johnson with NARA. How's it going, Alfred?

Alfred C. Johnson:

It's going well, how are you doing today?

Sam Hardin:

Doing great. Well, yeah, let's, let's give me your name, position and background and, and tell me a little bit about Nara. Yeah.

Alfred C. Johnson:

So, again, Alfred Johnson. I'm currently the board president for the National Association for Regulatory Administration. Been with NARA for close to 10 years served eight years as a board member, and then the last three years as the board president. So yeah, just a little bit about Nara NARAS,

Sam Hardin:

Oh, no, yeah, international nonprofit, trade association for regulators. We started back in 1976 as a trade association. When you think about regulators, this is these are regulators from children, so providing regulatory oversight of childcare, daycare type setting also for child welfare, and then for adult care, or what we normally call in our country assisted living. So this was an organization founded by regulators for regulators. But a very unique thing that NARA does is that it does not solely think that regulators are the final solution or the solution. We believe in collaboration. So there's when you think about our membership of more than 300 people, and organizations, those members are not just regulators. They are funders. They are other providers. They are research scientists. It runs the gamut of people who are really interested in, you know, our vision, which is consumer protection through prevention. So again, consumer protection. It's not this parental oversight process that we're pushing, but we're pushing protection through prevention. And the way we do that is through a collaborative way of regulatory oversight. That's great. Thank you for that introduction and overview of NARA. So, you know, I know cuz, you know, I went to the last event, maybe not your last event, but the big annual event this year, the conference. And you guys have quite the following. I mean, there's many, many states that are that are members and associates of NARA. So can you kind of give me like, how many states are members and are you working with in the country?

Alfred C. Johnson:

We have members throughout the country. And you'll see, you think about east, west, north, south. There are members from each state. That number fluctuates, because there's a lot of change over. But throughout the country, there are people like me in Wisconsin, who serves as a deputy division administrator. There are also what we call licensing specialists or regulators or surveyors that are members. We get a big push of our membership around our annual conference. So the event that you were at in Indianapolis had a large number of new attendees. They were joining because of the topic and the subject matter. And being the further we get away from the pandemic, the more folks want to get back together with others that do similar type of work. So we have members from most of the states throughout our country. We also really interesting, we have members up in Canada, so the provinces up there. We have numerous members from there. We also have members overseas. You'll see if, as you attend our conference or participate in our webinars, you'll see folks from sometimes across the world. But the one thing that binds us all is this regulatory administration process and really sharpening our systems and operations by coming together.

Sam Hardin:

Absolutely. Yeah, I definitely saw that when I was there at the the annual conference. People from all over, you know. So tell me about any upcoming events or some stuff that you guys are looking forward to in 2024? What can we look forward to?

Alfred C. Johnson:

Yeah, so we have some a couple of really good things that are happening. First of all, I want to just put a plug out again, for our September 23, through 26th, we have our conference in Minneapolis. This is again, that similar event that we had this past year in Indianapolis, but this Minneapolis conference is going to bring a collaborative group of folks from there's a lot of research that's going on, within assisted living, oversight. So when you think about the changing, dynamic and demographics of who's being served in assisted living, there's research that's going on now. And there's research that will continue. And we're hoping to have the seminar or the conference in September, be one of the main events to kick off and help push more than just research that sits. I use a term I call it virtual dust. We don't want research to sit on a website, sit on a shelf to collect dust. We really want to look at the application of things. So those best practices, how do you care for people? How do you implement and use technology to not replace that, but to supplement and enhance that care treatment and services that are being provided. So you'll see some of that happening in September. We also have some good work going on on our childcare side. NARA is working with several states and federal entities on researching and looking at some standards there. So we're hoping as that takes place, that that conference in September will be an opportunity to not only pull apart, whatever has been developed, but also look at the application or implementation concepts. So that's a really big piece. The other thing is that throughout the year, we will have webinars. So if you go to the NARA website, the NARA members that member clicks.com or NARA licensing. If you go and Google that or do an internet search, you'll see the events and you can sign up for our listserv. And as we put out these webinars, these will be webinars centered around regulatory administration. They also will be centered around best practices. So from birth to, you know, the end of life. We have a good group of speakers and subject matter experts, national experts who are going to provide information and not just again, that one on one, but we want to move past just talking to people, but talking with people and then connecting and figuring out how can we better serve our communities by exposure to evidence based practices, actual best practices, and highlighting things that are going well, within. So we have those webinars. We have the conference coming up. NARA also is participating in a national collaborative on the adult care side. It's called quality assisted living collaborative. We are partnering with LeadingAge, NCAL, Argentum and ASHA to develop best practices and guidelines for assisted living. We just finished infection prevention and control that will be published in March. And then we're going to start with emergency preparedness. And we're working right now on some dementia training requirements. So that's a another significant piece of work that NARA is involved in.

Sam Hardin:

Gotcha. Yeah, correct me if I'm wrong, but when, you know when I think about NARA, and what you guys do, I really think about, you know, providing service, for the percentage of the population that is in the most need, you know, from, from childcare to, you know, fully through, you know, all ages. But I just, I really think about as those individuals within our communities, you know, within the nation that need the most support. So, you know, obviously children, but then adults who who need that type of care. Is that fair to characterize it that way?

Alfred C. Johnson:

Exactly. That's that piece, when you think about consumer protection through prevention. We're looking at, it doesn't matter the funding source, so if you're private, or publicly funded. It doesn't matter if you're, you know, you're walking or you're using an assistive device. If you're confined to a wheelchair. It's really looking at how do you meet the needs of that person. Often you'll hear in specially healthcare, and residential healthcare, you'll hear the term person centered. We think about it being consumer centered care. So those that need it the most, obviously, we want to make sure that that quality of life quality of care that's there, but really looking at what are the needs of the individual being served? And how can you best meet the needs while protecting the rights of that person? Be it a young person, older person, middle aged person, whoever it may be? How do you meet the needs of that person, and continue this high quality of life? We really believe, think about within NARA if you think of quality, and you think about regulatory compliance, we are continuously looking to marry the two. So that quality does equal regulatory compliance and regulatory compliance does equal quality.

Sam Hardin:

Gotcha. So yeah, you guys are starting from, you know, the agency or department level to support those as you guys, you know, consumers are individuals. And so, through that you're providing resources to, you know, these agencies and departments that the states are or the nation has, has, you know, put in place to provide the support for those individuals. And so it's as you mentioned, it's really just marrying the quality and the work that those individuals on, you know, quote, unquote, frontlines do of health care and child care, and all that type of stuff. And you talked about a little bit and some of the research you guys are doing. Are you able to share with me some of the research that you guys are are working on and coming out with? Or do we have to wait till September?

Alfred C. Johnson:

Well, let's wait till September. But, you know, I also want to encourage you, and encourage the listeners to take a look, at and participate in those webinars, because you're gonna start to see some snippets of things coming through that, you know, ultimately, in September will be this big kickoff of Okay, now we can tie it all together to share, you know, some of the research. One of the things I can share with you, is the concept that NARA has, that's a NARA product. It's called key indicator system. So when you think about an the entirety of regulatory oversight, so if a person an authority having jurisdiction is going out to conduct a survey, a licensing visit, one could believe that, hey, I'm going to walk within this setting, and I'm going to spend days. I'm going to spend weeks because the regulation set may be 100 page long. And I'm going to spend a week here, going through making sure that this location is in compliance with the regulations. We know that that's not realistic to and there's no there's not enough resources to do that work, the burden that you put upon not only the authority, having jurisdiction to do that work, but also the burden that you put upon the provider to accommodate this request for this piece of paper. Let me look behind this door. Let me interview this staff member. Let me observe this child or this adult receiving care treatment and services. It's just not realistic and it's not cost effective. So NARA has put in and it's research based, this key indicator system. So the key indicator system just says the purpose of that system is to increase the efficiency and the effectiveness of a licensing oversight process. So you refocus on those areas that have the greatest impact on the quality of care and quality of life. So if you have a 100 page regulation set there are some structural things that may need to be put in place such as you know, the building may need to have, you know, smoke detectors, sprinklers, you name it. There could be some prescriptive other things in place, such as you may have to do an assessment or an admission agreement or certain things like that. And then there's some outcome based, such as, for example, supervision, activity, programming, those types of things, those things are, you have to put those in, but they're outcome based, because they're very tailored to the needs of that person receiving the services. So the key indicator system truly takes a scientific approach to look at and wait, your regulations. Look at what has the potential for the greatest impact upon the quality of life and quality of care. You do that you get those regulation sets. You put that within your licensing system. And then that dictates when you go out to do a survey or a licensing visit. You're looking for those key areas. So those key areas could be for example, training, fire safety, first aid, infection prevention. Those are areas that you're going to look for. You may look for something structural, such as you know, accessible walkways or pathways or doorknobs. Those types of things. You don't ignore blatant issues. So if a person reports something to you, the food is cold, the food is too hot, you know those types of things, you're going to look into that. But this is a very scientific approach, and has been shown to increase the efficiency and the effectiveness of a licensing process. You combine the key indicator system with what we call a differential monitoring process that pulls all of this together. So you're not necessarily treating each and every provider, not everyone's going to get a two day, one day, week, whatever. Based upon the issues that that provider may have the history and all of that you conduct a survey accordingly. And it allows for a very effective process. That's one of the services that NARA provides, when you think about key indicator differential monitoring, and that we call it our consultative services. So we work with authorities having jurisdiction to help them evaluate their systems, and then to implement an effective system.

Sam Hardin:

Gotcha. So it's kind of taking what could be the subjective nature of maybe that licensing specialist or that surveyor, if you will, it's basically making their review and their process of of doing the survey or inspection objective, based on those indicators.

Alfred C. Johnson:

Exactly, exactly. And it also Sam, takes away the mystery. Sometimes, you know, a provider, you're waiting for your annual survey or whatever it may be. And you're wondering, what are they going to look at? And, you know, when I mentioned about the alignment, and I use the term marrying, but really the alignment of quality and regulatory compliance. You don't you should prep for a survey. But if you are taking care of the people, and you're there, there's an alignment of you got to train you got to have the building has to meet certain qualifications, and you got to meet the needs of the people receiving services there. It takes away the mystery because that information when you think about the key indicators, and that even survey process should be readily available to the provider. So not that they know when you're coming. They know what you're going to look at. But what you're looking at has significant meaning to the people that are receiving the services so you should be able to carry on as you normally would. The only thing now You had this little extra pressure of someone standing over your shoulder watching for a period of time.

Sam Hardin:

Gotcha. Now, I don't mean to put you on the spot. So you don't you don't have to answer this. But you know, is there enough funding and resources for these people and care facilities and institutions caring for these people? I mean, or specifically children? I mean, is that a problem that you see, or that you remember, seeing, in the country today? Like, do you think America has a problem, or is it a problem with the way, you know, caring for our children or caring for members of the community that are most in need or need support?

Alfred C. Johnson:

I don't know if I would classify it as a problem. But I would call it as an area of opportunity that should be continually evaluated, especially with the growing needs, you know, of our citizens that are in need of care, out of home care. So it should be something continuously evaluated, you know, unlike, say, even prior to the pandemic, where, you know, I think the pandemic really threw us up and really made a great change in how we operate and in the needs. But it should be something that's always evaluated, and, you know, on a frequent basis to determine how can we best meet the needs of this child of this adult. I heard a statement said once by a very wise person that says, you don't necessarily get more with less. So if you are having an influx, just think about examining the opportunity. If you have more children, within a given jurisdiction, who are in need of out of home care, but you're using the same resources that you used five years ago, using the same practices that you used five years ago, you're going to be behind the times. Providers in our country, are creative, innovative, and their hearts are right there. So they're going to do the best that they can. But you don't necessarily get more with less. So you have to that I think it's an opportunity, I wouldn't call it a problem. But it's an opportunity for those that are in position to make decisions, to evaluate that, to really look at the raw data, and analyze that data. And then work along think about, again, collaboration. Work along with not just the who's who, of that jurisdiction, or that community or that state, but work along with the people that are receiving the services. Hear those voices. Hear their stories, and hear the stories of those providers, that you know, cost of living is increasing. How do we have enough so that we can not only hire, but retain so that that person is not making? I'll tell you a quick story that I provider, or some regulators and providers were sharing at a recent conference. They were talking about all this effort and American Rescue Plan Act money that was injected within their community. And they say that it was really helpful for them. But they talked about the struggles of the staff that still were struggling, just paying bills, and staff sometimes would call in because they just couldn't make it to work. They didn't have the gas money. Or, you know, they were discussing about boy, what are they do for lunch? I'm starving. I'm working this 10 hour shift or eight hour shift. I'll pick up another shift, but I don't have money to buy lunch. Yes. And the provider didn't have the resources to say I can maybe give some people lunch, but I can't give everyone lunch. I can't give everyone a meal. So they were finding people were leaving, not just for an extra quarter an extra dollar an hour, but they were finding that people were leaving and switching jobs because some specialty like corporate and I'm not speaking ill of corporate providers, but a corporate provider was able to have meals. They were able to have even transportation. They were able to have all these other things that were meeting the needs of, of their staff. And they talked about the really struggle. So, again, not a problem, in the sense, but it's an an opportunity for us to examine, and figure out what how can we best meet the needs of all, and especially this increasing number of people that are coming into the system.

Sam Hardin:

Yeah, I appreciate that response. Yeah, I certainly wasn't, you know, trying to get at, coming from the negative side. But I do appreciate that response. And I do agree with that idea and sentiment, fully. I mean, you know, from my side, from the, from the IT side, or you know, IT sector, you know, I mimic what you just said. If you're not continuously improving, or looking to, you know, stay up to date with the latest IT standards or what's going on and in what normal people expect. You know, when they're using other services, you're, you're gonna fall behind, and it's gonna get very hard or more, or I guess, I would say, less efficient to do your job. You know, if you're not continuously looking at, you know, what are, you know, the IT, functionalities and software that we can put in place to support our job, and to support us to do it efficiently. And I just, I see it over and over on both sides, you know, I see departments and agencies doing a wonderful job and, you know, creating five year, you know, growth plans and initiatives and sticking to that and evaluating it. And it's, you know, I love that part, right? Because it's you know, it's forward thinking and it's moving forward. But, you know, sometimes you see the other side where their agencies and departments are not making plans, and, you know, I just have this feeling of wanting to reach out and help them. So it's like, I don't want them to fall behind. And, you know, it is from, our perspective, and, you know, IT sector, it's such a rapidly progressing, industry, you know, so it feels like every single week, new stuff is coming out, or, you know, AI is growing. And so, you know, I think I just agree with what you said. I think that's really important that you're continuously growing and then evaluating and, and, you know, staying on top of it.

Alfred C. Johnson:

Yep. Sam, if I could also just add, when you think about the differences between, especially at a government level, but I'm sure applicable to, you know, providers, you know, we get so busy looking at just what's right in front of us. So sometimes the need is so overwhelming when you talk. And I think one of the things that we've enjoyed, not so much of having the biggest best conference or having 1000s of people on a webinar. But it's been the engagement with people who are either providing the services, overseeing the services, funding the services, or receiving the services. We are so busy looking at what's right in front of us. And it becomes sometimes overwhelming, because you're trying to make ends meet that strategic planning kind of goes by the wayside. And if you happen to get caught in the wave of something moving through your state or through, you know, your country or your company, that could be a good thing. So, one of the things that's why I'm gonna be talking about our webinars and our conference, we are really trying to Okay, let's take a moment. You know, providers, regulators, funders, stakeholders, hey, let's come together if it's virtually if it's in person, and let's examine and let's look at again, remember the idea of virtual dust. You and I could do an internet search, and find all kinds of different things that are out there. The piece that we're missing is, okay, how do I do that? When I'm faced with this? What in some cases, this overwhelming need of this kid sitting right in front of me or this staff member who's in need of something. I gotta address that? I can't really think big picture. And that's what NARA is trying to help. The concept, when you can make time. Don't wait for time to slow down, because that won't happen yet. Let's slow down, let's think big picture. And let's figure out, even if it's small baby steps, let's just make some small steps to get ourselves towards specially when you think about the use of technology, technology can be a great resource.

Sam Hardin:

Yep. Yeah, it's that idea of let's make today just a little bit better than yesterday. You know? And if you do that over and over it compounds. Right? Totally. I know, you know, here internally, within GL Solutions I talk to our teams, and we talk about a lot. When we're talking about IT services, you know, we talk openly, like, when we're working with, you know, what we see as our customers you know, agencies or departments, that's probably, you know, their software is maybe their 10th priority of the day. We always try to keep in the front of our mind, it's like, there's so much going on. And these people on the front lines have to do their jobs. And IT is a tool to do their job. But they still have to do the job first. And then so when we're reaching out to him to look at this, or do this, and it's like, yes, I understand. I need to do that. But, I have this immediate scenario, or emergency right in front of my face that I have to deal with. And so I think that was a good point that you brought up, because I definitely try to talk about that within our team here and make sure that we have that understanding and, you know, realize, you know, to take an hour or two hours, three hours out of somebody's day that already has a jammed schedule, you know that's a big ask. It can really, you know, kind of derail their day. So I totally get it. Okay, well, yeah. You know, just Just last question here, you touched on a little bit, but just, you know, what have you guys seen with with, you know, coming out of COVID? Now, what are some of the effects? What, what are some how have things changed a little bit within the community? You know, any key takeaways that, you know, things came up during COVID? And it's like, gosh, this is a great idea, or we kind of want to, you know, implement this, anything like that from COVID?

Alfred C. Johnson:

Yeah, good. Good question. There are a couple of things, I would say, use the concept of lessons learned and lessons observed. So some of the lessons learned were that, especially residential type programs from a thinking of a regulatory administration, perspective, emergency preparedness, we thought we had some good requirements and things in place. The pandemic, I don't think anyone could have planned for what the pandemic brought, but seeing the the actual implementation or the response to an issue, think of just PPE. That concept, in some cases was foreign to many entities. And even government, you know, when you think of regulatory administration, you may have had an infection prevention, control regulation, but it didn't drill down into the concept of what PPE was. What would happen with visitors? What would happen if a staff member or a kid or a consumer became ill, you know, isolation, you name it, vaccination when that became available. So a lessons learned from that was looking at as people typically talk for emergency preparedness, an all hazards approach. But it should include this concept of respiratory illnesses and other things. How will you continue to operate? Because the pandemic showed that there was some mission driven services they had to continue. And now as we saw what happened during the height of the pandemic, and now as a result, how can we learn from those lessons and put things into place so that if we ever encounter maybe not a pandemic at the size that we had just recently, but maybe there are outbreaks that occur, can we be better suited to meet the needs of those that need us the most? And obviously, there are parents and loved ones who are counting on the providers to stay in operation. So that's one of the pieces. The other thing was the use of technology. What happened during the pandemic, it forced all of us to consider, even if you weren't comfortable, or if it was the 10th thing on your list. Man, I got to figure out how to get this work done. When we can't either be face to face, or I need this information. And I'm doing it the old fashioned way. I'm gonna call it the old fashioned way; I'm faxing in information. I'm, you know, holding information on this thumb drive. I'm doing all these things. And I'm doing all this data entry. And now I can't have people either in the building doing the work because it can't be right next to each other. It forced us to really examine technology. And it also forced us to increase our communication. So if I'm in Kansas, and I hear someone in California, who's figured out a way how to make this work, I'm actually reaching out to them. Or if I know that GL Solutions, or another company is doing this, I'm reaching out. And I'm trying to figure out, I have this need, you have this program. Can you get it off your shelf? Can you tailor it to ours. So I think the pandemic has shown that technology, we don't have to be afraid of technology. And even like monitoring. So you think of just doing your work of accepting applications, processing applications, communicating out decisions to people. That's one aspect. But also you think of actual the provision of care. So even the use of cameras and different things and balancing rights of people and all of that. That is shown to be an effective way to continue to make sure that people are taken care of. So from the care side to the kind of administrative side technology pandemic has kind of helped usher in the further use or further advancement of technology.

Sam Hardin:

Now, Alfred, I want to say thank you, and I really appreciate the conversation. It is really insightful. And I look forward to more in the future. So thank you so much.

Alfred C. Johnson:

Thank you