TheBigUneasy:Katrina’sUnsungHeroesFacilitator’sGuide

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TheBigUneasy:

Katrina’sUnsungHeroes

Facilitator’sGuide

ProducedbyCathieBrady&BarbaraFrank

B&FConsulting,Incand

SusanWehry,MD

June2009

FundingwasprovidedbyagrantfromtheLouisianaDepartmentofHealthandHospitals,usingcivilmoneypenaltiespaidintotheNursingHomeResidents’TrustFund.

ThegrantwasadministeredbytheGovernor’sOfficeofElderlyAffairs.

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ACKNOWLEDGEMENTSThisfilmisapartoftheNursingHomeStaffingProjectinitiatedafterHurricaneKatrinatoaddressstaffingneedsofNewOrleansareanursinghomes.TheprojectwasundertakenbytheWorkforceIssuesWorkgroup.TheWorkgroupwasavoluntarycollaborationamongorganizationsandindividualsconcernedaboutthewell‐beingofnursinghomes,staffandresidentsinthegreaterNewOrleansarea.ThegroupworkedtogetheronfindingsolutionstothenursinghomeworkforceissuesthatconfrontLouisiana.SponsoredbytheLouisianaHealthCareReview,theWorkgrouphadnolegislativemandate,formalstructure,orgovernmentalfunction.Stateagenciesandlong‐termcareorganizationsthatworkedtogethertohelpstabilizestaffinginnursinghomesafterKatrinathroughtheNewOrleansNursingHomeStaffingProjectinclude:

GulfStatesAssociationofHomesandServicesfortheAging

LouisianaDepartmentofHealthandHospitalsLouisianaHealthCareReview

LouisianaNursingHomeAssociationOfficeoftheStateLong‐TermCareOmbudsman,Governor’sOfficeofElderlyAffairs

ProjectFaculty:

CathieBradyandBarbaraFrank,B&FConsultingwww.BandFConsultingInc.com

SusanWehry,MDhttp://web.me.com/swehrymd

Allmaterialsfromthisprojectareavailableatwww.lhcr.org

Formoreinformation,contact:

LindaSadden,StateLong‐TermCareOmbudsmanGovernor’sOfficeofElderlyAffairs

412N.4thStreet,3rdFloorP.O.Box61

BatonRouge,LA70821Tel:(866)632‐0922Fax:(225)342‐7144

website:http://www.louisiana.gov/elderlyaffairs/LTCombudsman.html

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TheBigUneasy:Katrina’sUnsungHeroes

Facilitator’sGuide

TableofContents

Acknowledgements 2

Introduction 3

UsingtheFilm 5

DiscussionGuide 7

PriortoShowingtheFilm 7AfterShowingtheFilm 7

o GeneralDiscussion 7

o PsychologicalPreparedness 7

o GoodPracticesinanEmergency 9

o PersonalPreparedness 10

o LessonsinLeadership 10

o ThreeKeyResourcesonLeadership 11

Resources 14

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IntroductionWorsethanDesertStorm…Emergenciescanhappenanywhere.ThelessonslearnedfromKatrina,duringthestormanditsprotractedaftermath,haveuniversalapplicability.Theheroismofnursinghomestaffprovideslessonsinhumanityandcourage.Theleadershippracticesthatpreparedstafftorisetothechallengesexemplifythebestinleadership,inemergenciesandalsoindailyoperations.ThisfilmisapartofaprojectinitiatedafterHurricaneKatrinatoaddressthestaffingneedsofNewOrleansareanursinghomes.Theseneedsbecameparticularlyacuteinthemonthsthatfollowedthestormasresidentsandstaffbeganreturningtothedevastatedarea.Manyhomesevacuatedbeforethestorm;othersdidnotorcouldnotevacuateandstayeduntiltheywererescuedafterthecitywasmadeuninhabitable.Someneverstoppedoperations,despitethechaosaroundthem.Allfacedchallengesastheyworkedtoreturntofulloperation.Theirexperiencesvariedandyethadcommonthreads.Overthecourseofthreeyears,theprojectprovidedon‐siteassistanceandsharedlearningsessionstofacilitiesintheaffectedareas.Asthehomescomparedexperiences,theybecameawareofhowtheirowngoodpracticescontributedtopositiveresults.Togethertheysharedwaysofbuildingontheirexperiencesincrisisastheyworkedtoreturntonormaloperations.Sixofthehomesgraciouslyallowedustocapturetheirstoriesonfilmasawaytosharelessonslearned.Alltoldtheirstoriesinhopesofhelpingothers.Inthecourseoftheirtelling,bothextraordinarycharacterandexemplaryleadershiparerevealed.Whatemergedmostclearlyfromthestorieswasthatstrongleadershipandcommitmenttostaffbuiltbeforethestormservednursinghomeswellinatimeofcrisis.Wewitnessedcreativeandparticipatorydecision‐makingandthefosteringofrelationshipsthatallowedhomestobecomeemotionalhavensintimesofextremestress.Themostenduringtruthwelearnedisthis:Everynursinghomeisvulnerabletodisasters–bothnaturalandman‐made–andnoplanisinfallible.Thebestpreparation–andthebestresponse–istocareforstaff,becausepeopledobestinaclimateoftrustandteamwork,andwhentheyhavethesupporttheyneedtotakecareofresidents.ThisfilmisalsointendedasatributetothestaffofLouisiana’snursinghomeswhobroughtthousandsofresidentssafelythroughthestormandthedifficultiesthatfollowed.Oneofthestaffinthefilmsays,“disasterdoesn’tbuildcharacter,itrevealscharacter.”Whilethosestaffmembersinterviewedforthisfilmdisplayeddeepintegrityandcommitment,mostnursinghomesonmostdayshavethesamekindofpeoplefillingtheirranks.Mostnursinghomestafffindthattheworkofcaringforothersistrulyacallingthattheyrespondtoeveryday.

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UsingthisFilmThisfilmisintendedtopromotediscussion,generateideas,andserveasalearningtool.Thisguidehelpsyouextractlessonsfromthefilmaboutleadershippracticesandrelatedemergencypreparednesspractices.Itprovidesguidingquestions,highlightsgoodpractices,andidentifiesresources.MostpeopleheardsomestoriesaboutnursinghomesinNewOrleansduringKatrina.Almostallthecoveragefocusedontherareoccurrencesoftragedyandlostlives.Thisfilmtellsadifferentstory.Itisthestoryofnursinghomestaffwhokeptotherssafeandcaredfor,evenwhiletheirownsafetyandtheirownfamily’ssafetywasuncertain.Whataudiencesaresaying:

“Itshowedthecompassion”“Asareceivingfacilityitwasgoodtoseethewholepictureofwhatpeoplewentthroughtogettous–weknew‐butnotreally”“It’snotjustthetragedy–youshowedthepositives”

ThesearejustasamplingofcommentsheardwhenthefilmpremieredinLouisianainJune2009.Somenursinghomesplantousethefilmtohelpbuildteamwork;otherstoinspireempathy,compassionandunderstanding.Stillotherswilluseittohelptheirstaffhaverealisticexpectationsofwhatmaybeaskedoftheminanemergency,orwhenreceivingotherswho’vebeenthroughanemergencyevacuation.Thefilmcanbeusedinmanydifferentwaysbyanyoneaffiliatedwithnursinghomesandbythoseinterestedinarealstoryofhumanstrength,courageandcommitment.Usethefilmfor:

• Inspiration,Motivation,Appreciation–tosharewithstaff,asaninspirationalfilm,depictingthededicationofnursinghomestaff

• PreparationandEducation–tohelpstaffinnursinghomesandothercaresettingsthroughoutthecountrybeawareofwhatmaybecalledforintimesofdisasterorinbeingareceivingfacilitythattakespeopleinafteradisaster

• LeadershipDevelopment–toteachaboutanddevelopgoodleadershippractices• TeachingTeamwork–toarticulateconceptsandpracticesfor“beinginittogether”• Teachingwaystonurtureresilience–tosupportpsychologicalpreparedness;“steady

todaymeansreadytomorrow;”tobereadyforgoodleadershipandteamworkpracticesinacrisisbymakingthesepracticespartoftheday‐to‐day

• PlanningandCommunityAwareness–topromoteunderstandinginthecommunityaboutthesupportpeoplelivingandworkinginnursinghomesmayneedinadisaster

• SocialHistory–forknowledgeaboutahistoricalevent:howtheNewOrleansareanursinghomesrespondedduringKatrina

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Werecommendshowingthefilminitsentirety.TopicareasareeasilyaccessedsoyoucanreturntosectionsduringdiscussionusingthemenuprovidedontheCD.Theguidefocusesdiscussiononthethreeprimarythemes:

1. Preparation2. Nurturingresilience3. Practicinggoodleadership

Thefilmis49minuteslongandhasanintroductionandtwoparts:PartI:“Youcan’tjusthopeforthebest”

PartItellsthestoryofthesixnursinghomes’experiencesduringKatrinaanditsaftermath.Itdescribestheirpreparationfortheirstorm,gettingthroughthestormitself,andthenfacinganunprecedentedsetofchallengesasthecrisisgrewaroundthem.Thefilmcapturesbothindividualandorganizationalchallenges.Hearingdirectlyfromstaffastheytalkabouttheirexperienceshighlightstheseverityofthedifficultiespeoplefacedandhowtheysurvivedbyworkingtogether.Thissectionalsoillustratesthedegreeofplanning,preparation,andteamworkneededtosuccessfullyexecuteanevacuationofanursinghome.Ithelpsviewersthinkabouthowtheywouldpersonallyrespondtoasimilarsituation,andprovidesinformationabouteffectivepracticesindoingso.ItisthefoundationfordiscussionofwhatworkedinPartII.

PartII:“Sharingwhatworks”

PartIIcapturesreflectionsofstaffmembersfromthesamesixhomesastheysharewhatworked,anddescribesomeofthepracticesthatallowedthemtogetthroughthisdisasterandbackontheirfeet.Clearlyleadershipmadeadifferenceinhowthesesixhomesfared.Theirstoriesrevealleadershippracticesessentialtotheirsurvival,whichhadrootsintheireverydaywaysofleading.

FACILITATORTIPS:

• Asfacilitator,previewthefilmbeforeshowingittoagroup.• Allowparticipantsforreflectivetimepriortoandafterviewingthefilmtoabsorbits

emotionalimpact• Usepairedconversationand/orsmallgroupdiscussiontoallowspacefortheintimate

natureofthereflectionthefilmgenerates,inanysizegroup.• Theguideprovidessuggesteddiscussiontopics,andincludesresourcesonleadership.

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DiscussionGuidePriortoShowingtheFilmINTRODUCEFILM:

• Shareinformationabouthowandwhythefilmcameabout,usingthebackgroundfromtheAcknowledgementsandIntroductionsections.

• ShareanycurrentinformationyouhaveaboutrebuildingprogressinNewOrleans.DISCUSSION:AsktheaudiencetotalkinpairsaboutKatrina.Allowthisdiscussiontotaketime–itisapersonalreflectiontime.Possiblediscussionquestions:

1. WherewereyouwhenyoufirstheardofthedevastationinNewOrleans?Whatdoyourememberseeing?

2. WhatdoyourememberhearingaboutnursinghomesduringKatrina?

AfterShowingtheFilmGENERALDISCUSSIONAFTERVIEWING:Somepeoplemayhaveanemotionalreactiontothisfilm.Allowapauseafterthefilmends.Thenbeforeanyfocuseddiscussion,givetheaudienceafewminutestogathertheirthoughtsandshareinpairsorsmallgroupsbyinvitingpeopletodebriefonwhattheyjustviewed.Additionalgeneraldiscussion:asktheaudiencetoreflectbackonthediscussiontheyhadbeforeviewingthefilm.Askifafterviewingthefilm,theychangedwhattheyhadthoughtaboutthesituation.Havethemstartthisdiscussionintheiroriginalpairs,orinsmallgroups.

PSYCHOLOGICALPREPAREDNESSAskpeopletotalkinpairsforafewminutesabouthowtheymentallyprepareforsomethingstressfulorworrisome.ResourceInformation:Emergencypreparednessismultilayeredandeachlayeriscriticaltosuccess.Evacuationplans,shelteringplans,contingencyplansareallfornaughtifstaffandleaderslacktheemotionalreserveandfortitudetocarryoutthoseplans.Whenstaffsarepsychologicallyprepared,theyfeelconfident,competentandcaredabout,andnotonlycarryoutthoseplansbutdosoagainstallodds.Thiscapacityisoftencalledresilienceandisacapacitythatcanbedevelopedandnourished.AswithotherlessonsthatemergedfromKatrina,nurturingresilience‐whichwehavecalledpsychologicalpreparedness–beforethestorm,servednursinghomeswellinatimeofcrisis.Ifwearesteadytoday,wearereadytomorrow,nomatterwhattomorrowmaybring.

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Psychologicalpreparednesshasthreekeyingredients:1. Asenseofteam: WeareinthistogetherLeadersreinforcethisbybeingadailyvisiblepresence.Bywalkingabout,sayinghello,learningandaddressingresidentsandstaffbyname,sayingthanks,leadersconveyasenseofbeinginittogether. LeadersreinforcethisbyensuringtheneedsofstaffandtheirfamiliesaretakenintoaccountwhendevelopingevacuationplansLeadersreinforcethisbyrollinguptheirsleevesandworkingsidebysidewithstaff.Inshort,practicinggoodleadershipskillsbuildsasenseofteam.2. Asenseofconfidence: WecandothisStaffneedtohaveconfidenceinleadershipaswellasinthemselvesandeachother.Leadersearnconfidencebyregularlyprovidingaccurateinformationaboutemergencyplans,communicatingclearlyandoften,andestablishingclearroles.Leadersbuildconfidencebybeingcrediblewhichincludesbeingfair,consistentandreliable.Staffdevelopconfidencewhenleadersnoticeandpraiseajobwelldone(“catchmedoin’somethinggood”)androutinelysolicitandutilizetheirideas.3.Emotionalreserves: Wevalueyourhealth Promotingwellness‐instaffaswellasinresidents‐isahottopicinhealthcareandiscrucialtopsychologicalpreparedness.Goodhealthincludesbothphysicalandmentalhealth.Goodhealthhabitsandstressmanagementskillsboostbrainpowerandhelppreventdepletionofcriticalbrainreservesduringacrisis.Leaderssupporthealthinavarietyofwaysrangingfromprovidinghealthbenefitstoprovidingnutritiousfoodandensuringadequatesuppliestodothejob(astraightforwardwaytoreducestress).Leaderssupporthealthbymodelinggoodself‐care(“youroxygenmaskgoesonfirst”)andmaintaininganattitudeofoptimism.Leaderssupporthealthbyincorporatingstressbustersintotheworkplace(deepbreathing,laughing,stretching,takingabreak).DISCUSSION:Embeddedinthefilmarestepsleaderstooktoensurepsychologicalpreparedness:Howmanycanyouspot?Whatdoesyourorganizationhaveinplaceforpsychologicallypreparedness?

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GOODPRACTICESINANEMERGENCYYoucan’tjusthopeforthebestEmbeddedthroughoutthefilmareexamplesofgoodpracticesforevacuationsinadisaster.Livingthesepracticeshelpedthehomestogetthroughtryingtimesandmaintaintheirabilitytoprovidegoodcareevenonagymnasiumfloor.Thesesamepracticeshelpedstaffdealwiththecrisesthatensuedwhentheirbestlaidplansfellthrough.Theimportanceofbeingpreparedrunsthroughthisfilm.Thisfilmisidealasanaidfordisasterplanningorwhenyoureviewyourfacility’splanwithstaff.Ifyouareusingthisfilmasatoolfordisasterpreparedness,asktheviewerstowatchwithapencilinhandandtojotdownexamplesofgoodpracticesastheyseethem.Hereareexamplesofgoodpracticesthatyoucanhighlightandusetopromptdiscussionamongparticipantsaboutbestpractices.Theyarelistedalongwithsubsectiontitlesinthefilmsoyoucanreplaythemifyouwanttofocusinonaparticularareafordiscussion.DISCUSSION:Encourageparticipantstosharetipsandbestpractices,tohelpeveryonebebetterprepared.

• Onthebus:[Firstsectionin“Youcan’tjusthopeforthebest”]o Loadingabus:Thisisphysicallydifficultandisanenormousorganizational

undertaking.Haveyoueverdoneadrillinloadingabus?o Staffingonthebus:“Wehadnurses,CNAsandadministratorsonthebus.”Not

knowinghowlongtheridetotheirevacuationsitewouldtake,theymadesurethatthebushadadequatestaff,nomatterhowlongthejourney.

o Suppliesonthebus:“Wetookthemedicineincasearesidenthadaseizure.”EventhoughtheridetoBatonRougewasusuallylessthananhour,thestaffknewthatinaneventlikethiswouldtakemuchlonger.Sohavingmedicine,water,food,coolers,andcare‐relatedsuppliesonthebuswasanecessity.

o Systemsofchecksandbalances:Asystemforcheckingresidents,medications,andsupplieswasadheredto—“Youbringtheresidentstothebus,pickupthemedsfromthemedcartandcheckoffthattheresidentisonboard.”Tomakesurenooneisleftbehind,everywhere,includingclosetsarecarefullychecked.

• Attheevacuationsite:[“settingupshop”]

o Creatingasafespace:Astheypreparedtosetupshoponagymfloor,thehousekeepingstaffdisinfectedthemattresses.Keepingtheareawherecareisprovidedcleanisimportant.Howelsedidstaffinthefilmmaintaincleanliness?

o Communityassistance:“Wefindthatiftherearevolunteersinthecommunityatthereceivingend,peoplefeelwelcome.It’sjustsuchanupliftingthinganditreallyhelpsalotandthenifwecan[have]policemen,nationalguardsmentheretohelpoffloadthepatientsitreallydoesrelievealotofstress.’Doyouhavethe

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communitycontactsinplacetomakethishappen?Howdoyoudevelopthesecontacts?

• Planning,andHavingPlanB:[bestlaidplansand“I’mnotleavinganybody”]o Whenplanschange:RememberhowPatrickandKathyhadtomakePlanBwhen

theirevacuationsitewaschangedtoonethatcouldn’tsupportthem.Doyouhaveaback‐upplan?

o Courageinthefaceoftheunexpected:StaffatSt.Margaret’sDaughtersHomemovedresidentswhenthestormblewofftheroofoftheirshelter.StaffatChateauLivingCenterreadiedtomovetheirresidentswhentheyheardfloodwaterswerecomingtheirway.

o EmergencySuppliesandContingencies:[“itwashot”]Doyouhavethecapacitytocareforpeopleinapoweroutage?Doyouhaveworkingrelationshipswithrescuerswhocanbackyouupifyouneedit?

• CommunicationandStaffSupport:o Staff’sfamilies:[“Icouldn’tfindmyson”]Askstaffiftheyandtheirfamilieshave

createdanemergencyplan.Thisfilmcanbeusedasaspringboardfordiscussionabouthowyouplantosupportthosewhoevacuatewithyou.

o Backupcommunicationsystems:Howwouldyougetintouchwithpeopleandhowwouldtheygetintouchwithyou,intheeventofaregionaldisaster?

PERSONALPREPAREDNESSIfyouwouldliketoaskpeopletofocusontheirpersonalpreparednessandtothinkaboutwhatnursinghomestaffwentthroughasindividuals,herearesomesamplediscussionquestions:

1. Haveyouthoughtaboutwhatmighthappeninyournursinghomeifyouwereeverforcedtoevacuate?

2. Wouldyouchoosetoevacuatewiththehome,ortostaywithyourownfamily?3. Ifyoucould,wouldyoubringyourownfamilywiththehomeinanevacuation?4. Ifyouelectedtogowiththehome,whatwouldyoutake?5. Whatwouldthehomeneedtodotomakeitsoyouwouldchoosetogo?6. Couldyouliveinawingofanursinghome?Howmightyouseethingsdifferentlyifyou

livedwhereyouwork?7. Isyourfamilypreparedforadisaster?Doyouhaveplansforrelocationand

communication?8. Howdoyoukeepyourspiritsupwhenthingsarenotgoingwell?9. Doyouidentifywithanyoneinthefilm,andwhy?

LESSONSINLEADERSHIPTheleadershippracticesexemplifiedinthisfilmarerelevantnotonlytoemergencypreparednessbutalsotoeverydayleadership.Thesepracticescreateworkplaceswhere

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individualworkersthrive,andworkwellwitheachother.Workingwelltogetheriscrucialtobeingabletoprepareforandrespondtoanemergency.Itisalsocrucialforstaffretention.Goodleadershipisaskill,andlikeanyotherskill,themorewepracticeit,thebetterwegetatit.Katrinagavepeoplemanyopportunitiestoexerciseleadershipskills.MostofthetimelifedoesnotcomeatusquiteasfastasitdidforthosewholivedthroughKatrinaanditsaftermath.AdisastersuchasKatrinachallengespeoplecaughtinittobehaveinwaysthatordinarylifedoesnotcallforustodo.Clearlyleadershipmadeadifferenceinhowthesesixhomesfared.Theirstoriesrevealleadershippracticesessentialtotheirsurvival,whichhadrootsintheireverydaywaysofleading.Theirpracticesechothe“Level5leaders”JimCollinsdescribesinGoodtoGreat,JimCollinsasseeminglyordinarypeoplequietlyproducingextraordinaryresults.

THREEKEYRESOURCESONLEADERSHIPJimCollins,inhisbookGoodtoGreat,foundLevel5leadershiptobethemainingredientincompaniesthatwereabletomaketheleapfromgoodtogreat.SomeofthecharacteristicsofLevel5maybesurprising.Hetalksabouttheleadersbeinghumble,shy,gracious,self‐effacingandunderstated,yetfanaticallydriventopositiveoutcomesfortheirorganizations.CollinsnotedthatLevel5leaderschanneltheiregoneedsfromthemselvesandintothelargergoalofbuildingagreatcompany.HeespeciallyhighlightedthewayLevel5leaders“createaclimatewherethetruthcanbeheard,”usingfourkeypractices:

• Leadwithquestions,notanswers• Engageindialogueanddebate,notcoercion• Conductautopsieswithoutblame• Build“redflag”mechanisms

InTheLeadershipChallenge,apopularevidencebasedmanualonleadership,KouzesandPosnerfoundfivefundamentalpracticesthatenabledleaderstogetextraordinarythingsdone:

• Modeltheway• Inspireasharedvision• Challengetheprocess• Enableotherstoact• Encouragetheheart

SusanEaton,inher2002CMS‐fundedstudy,Whatadifferencemanagementmakes!,appliedleadershipconceptstonursinghomes,comparinghighandlowturnoverhomes.Sheidentifiedthefollowingkeymanagementpracticesatnursinghomeswithhighretentionandhighperformance:

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SeeResourceSectionformoreinformationabouthowtoobtaintheseresources.DISCUSSION:YoucanintroduceKouzesandPosner,andEatonpriortoshowingthefilmandaskviewerstowatchforexamplesoftheseleadershippractices,oryoucansharethisleadershipinformationafterthefilmisviewed.Askpeopleaboutleadershippracticestheysawinthefilm,and/ortosharebestpracticesinleadershiptheyareawareofintheirownworkplaces.LinktothepracticesdescribedinthesectiononPsychologicalPreparedness,aseverydaygoodleadershippractices.Youcanreplaysectionsthathighlightcertainpractices(asnotedbelow).Useanycombinationofthesepracticesasaspringboardforfurtherprobing.Otherpossiblediscussionquestions,withreferencestosubsectionsoftheguide,include:

• GoodLeadership:Whatmakesagoodleader?Selectquotesfromfilmthatspeaktothisissue“intheirownwords.”

• Goodleadershippriortoanevent/Goodpreparation:[“What’sthestory?What’stheplan?”]Askviewerstorespondtothefollowingquotefromthefilm:“Ifyoueverhavetohaveanevacuationoryouhavetogothroughsomethingtothisextent,Ihopethatyouhaveyourdailybusinessincheck.Becauseifyoudon’t,youwillprobablyfail.”Whatdotheythinkaboutthis?Whatisneededinthedailybusinessofleadershipinordertobesuccessfulinanevacuation?

• Communication:[“What’sthestory?What’stheplan?”]Communicationisessentialforanyorganization’ssuccess–whetherinsurvivingadisasterorretainingstaff.Identifyspecificexamplesofgoodcommunicationpracticesbysomeoftheleadersinthisfilm.

• ValuingStaff:[“Iknowwhatyou’regoingthrough”]Wouldyousaytheleadersinthisfilmvaluedtheirstaff?Respectedthem?Discovered–orre‐discovered–theircommonhumanity?Giveexamplesofeach.

Five Organizational/Management Practices Associated with High Retention, Attendance, and Performance From What a difference management makes! by Susan Eaton, 2002

“A Positive Chain” of high quality

leadership throughout the organization

Organizational practices that value staff in

policy and practice, in word

and deed

Human resource policies and

practices that invest in and support staff

Organization and work design to

reinforce intrinsic motivation of staff to

care for residents

Sufficient staffing and resources to provide humane

care

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• EnablingOtherstoAct:[“Ithinkwecanrunwiththis”]Onekeydimensionofgoodleadershipisenablingotherstoact.Discussexamplesinthefilmandthendiscussthewaysinyourorganizationthatyouenableotherstoact.

• ParticipatoryLeadership:[“Ithinkwecanrunwiththis”]o WhatdidyouthinkwhenBobsaid“I’llstealanyidea.Ifit’sworkingsomewhere,

I’llstealit,I’mnotproud.” Self‐check:Doyouseekoutgoodideasfromyourstaff?Ifso,whatis

yourmethodforgettinggoodideasfromstaff?Doyourewardgoodideas?

o DiscusswhatKellieandDenasaid,that,”Everyonehassomethingtoofferandyouvaluetheiropinion.Andwe’vecarriedthatforwardalotsincewe’vebeenback.Whenwe’remakingpolicychangeorbigdecisions,weinvitethepeopleinit’sgoingtoeffectandsayhowwillthisreallyaffectyoubecauseyoudothejobdaytoday.”Howdoyou/canyoumakethatoperationalwhereyouwork?

• TakingCareofStaff:Somenursinghomesdescribedprovidinghousingfortheirstaffafterthestorm.Whatdoyouthinkofthat?Howisitacomponentofgoodleadership?

• Ingenuity:[“Ithinkwecanrunwiththis”]Inthefilmtherewerenumerousexamplesofingenuity.[PortaJohns,cuttingupthetowels,themake‐shiftlaundry,buildingashower,contaminationsigns]

o Whatstruckyouasparticularlyingenious?o Self‐check:Areyourstaffabletotakeinitiative?Ifso,howdoyouencourage

them?Whathappensifagoodideadoesn’tworkoutaswellashoped?• DevelopingLeadershipinOthers:Howdidtheofficialleadersinthesehomesdevelop

theleadershipabilitiesofthosearoundthem?• BeinginCommunity:[“inittogether”and“eggsalad”]

o Whatdidstaffsayaboutteamworkandhowleaderspromotedit?o HowdidleadersModeltheWay?o Whatrelationshipsdoesyournursinghomehavewithothersinthecommunity

whoareresponsibleforcoordinatinglocalorregionaldisasters?

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ResourcesOtherresourcesthatyoumightfindhelpful:WhatYouDoMattersACurriculumforStaffStabilityThistrainingcurriculumistheculminationoftheLakeCharlesNursingHomeStaffingProject,ayear‐longlearningcollaborativedesignedtohelpnursinghomesintheLakeCharlesregionstabilizestaffingandresumetheirculturechangejourneyafterHurricaneRita.Themanualgivesparticipatinghomesawaytoreviewandrenewtheirworkandprovidesanopportunityfornon‐participatinghomestounderstandandusetheworktomakepositivechanges.Themanualincludesallofthematerialspresentedatthefourlearningsessionsalongwithinstructionsfortheiruse.ItisavailablebycontactingtheGovernor’sOfficeonElderAffairs,OfficeoftheStateLongTermCareOmbudsman,atlasadden@goea.la.gov.

StaffStabilityToolKitbyB&FConsultingforQualityPartnersofRhodeIsland:Providespracticalguidanceforimprovingretentionandstabilizingday‐to‐daystaffing.Availableatwww.riqualitypartners.org.Clickon“HATChmodel”andthenon“Workforce.”GoodtoGreatbyJimCollinsarticulateswhatittakestogofromjustbeinggoodtobeinggreat.Itdescribesleadershipandorganizationalpracticesthathelpcompaniesexcel.TheLeadershipChallengebyJamesKouzesandBarryPosner:Writtenasafieldguidetoleadership,itidentifiesfivepracticesofexemplaryleadersanddescribeshowtoimplementthesepracticesineverydayleadership.Whatadifferencemanagementmakes!bySusanC.Eaton,commissionedin2002bytheCentersforMedicareandMedicaidServices(CMS):Comparesnursinghomeswithhighandlowturnovertoidentifymanagementpracticesthatcontributetoturnoverandpracticesthatcontributetostability.Availableonthewebat:www.BandFConsultingInc.comFromInstitutionaltoIndividualizedCarePartFour:The“How”ofChange:Whatadifferencemanagementmakes!aCentersforMedicareandMedicaidServices(CMS)SatelliteBroadcastandWebcastairedonFriday,September14,2007.Identifiespracticesthatsupportgoodleadershipintimesofchangeavailablethroughwww.Pioneernetwork.net

NewOrleansNursingHomeStaffingProject:ResourcesandmaterialsusedforlearningsessionsfromNovember2,2006throughJune30,2009,canbefoundat:http://www.lhcr.org.Clickon“NursingHomes”andthen“Workforce.”

Formoreinformationcontact:

B&FConsulting,Inc.‐‐www.BandFconsultinginc.com

SusanWehryMD‐‐http://web.me.com/swehrymd