Keeping pace with a rapidly evolving profession takes agility to think several steps ahead. Using both, NAB leaders, the Bostrom team and Proexam conducted a Professional Practice Analysis (PPA) to help the National Association of Boards of Long Term Care Administrators (NAB) keep pace with the needs of a dynamic workforce and a growing number of consumers seeking long term care services. Most professions encourage ongoing professional development and many seek to be licensed and/or regulated; a PPA is often a step in one or both of these scenarios.

How Did a PPA Help NAB Chart its Course in this Evolving, Dynamic Environment?

“Our goal was to help NAB prepare for and adjust to this changing landscape,” said Randy Lindner, CAE, president and CEO, NAB. “This broad-based practice analysis helped NAB look to the future and identify common and unique professional competencies for the various lines of supports and service within the long term care profession,” he said.

NAB: Leader in Credentialing and Licensing

NAB is the nation’s leading authority on licensing, credentialing, and regulating administrators of organizations along the continuum of long term care. Its members include the regulatory boards and agencies responsible for licensure of long term care administrators in all 50 states and the District of Columbia. The mission of these state regulatory boards includes protecting the residents of America’s skilled nursing facilities, assisted living communities and consumers of home and community-based services. NAB develops standards, shared resources and tools to help members license
administrators in these different settings.


The goal of the PPA: align administrators’ professional development with growth trends in the industry and create a career advancement path to recruit and retain the highest caliber talent to help ensure public protection and quality of life. Through the PPA, NAB identified the domains of practice, tasks performed, and knowledge and skills used by individuals responsible for leadership in organizations that provide long term care support and services. By conducting a PPA, NAB uncovered the need for a new credential to enhance professional development. Specifically, NAB is developing this credential – a Licensed Health Services Executive (LHSE) – which recognizes a professional’s competency to lead and manage an organization along a broad range of services within the long term care field.

With the new credential, the next step for NAB: work with its members to implement new licensure models and promote the portability of licenses (to allow professionals to work in different states with the same credential).

PPA Process

“Working within the federal framework required an innovative approach,” said Lindner. “This new approach will help NAB break down some of the silos in the long term care field to better serve the needs of professionals – and ultimately, consumers,” he said.

Involving stakeholders throughout the process was also important, to ensure buy in and allow for discussion – rather than avoidance – of any issues.

PPA: Best Practices

If your organization is considering conducting a PPA, have a clear strategy for approaching the process. Engage stakeholders (friends and foes alike) to increase the likelihood of broad-based support. While it might be routine to work with like-minded organizations (or friends), working with adversaries can be challenging. Provide opportunities to give input and get feedback – and make sure that concerns are addressed. Likely, the end goal will include consensus and compromise in the short-term – to reach broader organizational goals.

Be realistic in your goals – in terms of how quickly your organization can implement significant change, particularly if the change requires amending statutes or regulations. Most organizations involved in high stakes credentialing conduct a PPA every five years to ensure that their practice analysis reflects contemporary practice and any changes to the practice.

Lindner emphasizes the importance of communications, particularly face-to-face communications. “There’s nothing like sitting across the table and responding to concerns immediately,” he said. “Those one-on-one meetings are real ‘game changers’ because they increase the level of buy-in and often result in ‘a-ha moments,’” said Lindner.

NAB identified this one-on-one strategy as so central to its effort that it prepared a group of people – an ambassador corps – to help articulate its messages.

One of the factors contributing to NAB’s successful PPA was that the organization not only was forward-looking – but it anticipated changes in the field and positioned itself accordingly – and as a real authority. How is your organization positioning itself for – or driving towards – the change it anticipates?