A Partnership For Quality

A Partnership For Quality

OCTOBER 5, 2008 • NASHVILLE, TN

AND

Objectives» The participant will be able to:

– Identify three issues which staff say cause them to recommend assisted living as a ‘good place to work’

– Articulate three ways My InnerView can assist NCAL members in achieving their quality goals

– Describe three areas where satisfaction level of resident’s family member is correlated to employee satisfaction

To provide long-term care leaders evidence-based

management tools to better achieve their organization’s goals

Sources of data

» Largest private dataset of resident and family satisfaction in nation

» From mailed resident and family surveys returned to third-party

» Respondents rate communities using four-point scale (excellent, good, fair or poor)

Evidence-based philosophy

Evidence-based management calls for a paradigm shift in the approach to quality improvement: An appreciation of data, the ability to turn data into information and knowledge, and to use that information and knowledge to improve quality.

Turn plan into

action: improveprocess

Turn knowledge

into plan:apply new wisdom

to process

Turninformation into

knowledge:study current

process

Collect

data:ensure validity,

organize

Turn data into

information:benchmark, study

variation

Evaluate

outcomes:measurevariation

My InnerView’sevidence-

basedpath to quality

AN EXERCISE:

WhatMatters Most

QUADRANT ANALYSIS: A DISCOVERY TOOL

MY INNERVIEW’S GOAL

Help providers achieve their quality targets

OUR APPROACH

Help providers:• Turn data into information

— discover patterns• Turn information into knowledge

— discover their roots• Turn knowledge into action

— plan, mobilize, act

QUADRANT ANALYSIS: AN EFFECTIVE TOOL

QUADRANT ANALYSIS: TWO KEY CONCEPTS

1. How residents, families and staff rate your care and services

Your average score on each item:1 – 4: “Poor” “Fair” “Good” “Excellent”

Rank order all items by average score:1 – 100: Lowest to highest ranking score

2. How much each item influences residents,families and staff to recommend to others

Correlate each item with “Recommendation:0 – 1: No correlation to strongest correlation

Rank order all items by correlational strength:1 – 100: Lowest to highest ranking correlation

1 ----- Lowest to highest ranking correlation ------ 100

Su

cces

ses

You have little control over customer expectations

Yo

u c

an m

eet

cust

om

er e

xpec

tati

on

s

C.

Secondary opportunities

D.

Primary opportunities

B.

Primary strengths

A.

Secondary strengths

Ch

alle

ng

es

1 -

Lo

wes

t to

hig

hes

t ra

nki

ng

sco

re

100

QUADRANT AND ACTION PRIORITIES

Voice of Residents and

Family Members

ASSISTED LIVING

1 Choices/preferences

2 Respectfulness of staff

3 Respect for privacy

4 Resident-to-resident friendships

5 Resident-to-staff friendships

6 Meaningfulness of activities

7 Religious/spiritual opportunities

8 Sufficiency of healthcare needs

9 Sufficiency of personal assistance

10 Home-like atmosphere

11 Responsiveness of staff

12 Commitment to family updates

13 Competency of staff

14 Care (concern) of staff

15 Responsiveness of management

16 Safety of facility

17 Security of personal belongings

18 Cleanliness of room/surroundings

19 Control of room temperature

20 Variety of meals

21 Appeal of food

22 Sufficiency of dietary needs

23 Courteousness of dining staff

24 Comfort of room/surroundings

25 Community life opportunities

26 “Grow as person” opportunities

27 Quality of laundry services

28 Adequacy of storage space

29 Sufficiency of transportation

30 Quality of amenities

31 Accuracy of bills for services

32 Comparison of charges

Survey items

ASSISTED LIVING RESIDENT AND FAMILY


49%FAMILIES

51%RESIDENTS

22,090VOICES HEARDNATIONWIDE

DATABYTE

20

1

17

13

2A B

C D

SE

CO

ND

AR

Y S

TR

EN

GT

HS

SE

CO

ND

AR

Y O

PP

OR

TU

NIT

IES

PR

IMA

RY

ST

RE

NG

TH

SP

RIM

AR

Y O

PP

OR

TU

NIT

IES

16

4

7

10

319

8

15

14

512

9

21

22

18

6

RESIDENT

11

23 24

25

26

27

28

29

3031

32

A B

C D

SE

CO

ND

AR

Y S

TR

EN

GT

HS

SE

CO

ND

AR

Y O

PP

OR

TU

NIT

IES

PR

IMA

RY

ST

RE

NG

TH

SP

RIM

AR

Y O

PP

OR

TU

NIT

IES

FAMILY

20

1

17

13

216

4

7

103

19

8

15

14

5

12 9

21

22

18

6

11

23 24

26

29

25

27

28

32

3130

20

1

17

13

2A B

C D

SE

CO

ND

AR

Y S

TR

EN

GT

HS

SE

CO

ND

AR

Y O

PP

OR

TU

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IES

PR

IMA

RY

ST

RE

NG

TH

SP

RIM

AR

Y O

PP

OR

TU

NIT

IES

16

4

7

10

319

8

15

14

512

9

21

22

18

6

FAMILYRESIDENT

11

20

1

17

13

216

4

7

103

19

8

15

14

5

12 9

21

22

18

6

11

23 24

25

26

27

28

29

3031

32

23 24

26

29

25

27

28

32

3130

Sufficiency ofhealthcare needs

Competencyof staff

Care (concern)of staff

Comfort of room/surroundings

13

2A BS

EC

ON

DA

RY

ST

RE

NG

TH

S PR

IMA

RY

ST

RE

NG

TH

S

16

4

319

8

14

512

918

FAMILYRESIDENT

11 13

216

4 1038

14

5

23 2423 24

3130

Responsivenessof staff

10

D

PR

IMA

RY

OP

PO

RT

UN

ITIE

S

5

Resident-to-stafffriendship

A BS

EC

ON

DA

RY

ST

RE

NG

TH

S PR

IMA

RY

ST

RE

NG

TH

S

5

9

FAMILYRESIDENT

11

105

9 11

Sufficiency ofpersonal assistance 10

D

PR

IMA

RY

OP

PO

RT

UN

ITIE

S

A BS

EC

ON

DA

RY

ST

RE

NG

TH

S PR

IMA

RY

ST

RE

NG

TH

S

9

FAMILYRESIDENT

10

9

Homelikeatmosphere

D

Choices/preferences

Responsivenessof management

“Grow as person”

opportunities

Comparisonof charges

2120

1

17

CSE

CO

ND

AR

Y O

PP

OR

TU

NIT

IES P

RIM

AR

Y O

PP

OR

TU

NIT

IES

7

1522

620

1

17

7

19

15

12

21

22

18

6

25

26

27

28

29

3031

32

26

29

25

27

28

32

FAMILYRESIDENT

Commitmentto family updates

D

Quality ofamenities

2120

17

CSE

CO

ND

AR

Y O

PP

OR

TU

NIT

IES P

RIM

AR

Y O

PP

OR

TU

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IES

7

22

620

17

7

1912

21

22

18

6

25

27

28

29

3031

29

25

27

28

FAMILYRESIDENT

AS

EC

ON

DA

RY

ST

RE

NG

TH

S

3012

Voice of Employees

ASSISTED LIVING

1 Quality of orientation

2 Support of career

3 Quality of skill training

4 Comparison of benefits

5 Comparison of pay

6 Care (concern) of supervisor

7 Appreciation of supervisor

8 Communication by supervisor

9 Clear expectations of management

10 Care (concern) of management

11 Attentiveness of management

12 Adequacy of equipment/supplies

13 Sense of accomplishment

14 Quality of teamwork

15 Staff-to-staff communication


17 Assistance with job stress

18 Fairness of evaluations

Survey items


DATABYTE

FACTORS THAT DRIVEWORKFORCE RECOMMENDATION

Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

Ranked correlations (p <05) between assisted living employee workplace recommendation and employee satisfaction items

1 Management cares

2 Management listens

3 Help with job stress and burnout

4 Clear expectations by management

5 Fairness of evaluations

6 Support of career

7 Quality of skill training

8 Supervisor appreciates

9 Supervisor cares

10 Supervisor communicates

0.69

0.66

0.65

0.61

0.60

0.59

0.57

0.56

0.55

0.55

FACTORS THAT DRIVEWORKFORCE RECOMMENDATION


Continued

11 Staff-to-staff communication

12 Adequate equipment/supplies

13 Quality of orientation

14 Comparison of pay

15 Comparison of benefits

16 Quality of teamwork

17 Sense of accomplishment


0.54

0.54

0.51

0.51

0.50

0.46

0.46

0.43

1

17

13

2

A B

C D

SE

CO

ND

AR

Y S

TR

EN

GT

HS

SE

CO

ND

AR

Y O

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OR

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IES

PR

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RY

ST

RE

NG

TH

SP

RIM

AR

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PP

OR

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IES

16

4

7

103

8

15

14

5

129

18

6

EMPLOYEE

11

17

2

B

D

PR

IMA

RY

ST

RE

NG

TH

SP

RIM

AR

Y O

PP

OR

TU

NIT

IES

7

103

918

6

EMPLOYEE

11

Clear guidelines by management

Fairness of evaluation

Appreciation of supervisor

Care (concern) of supervisor

Care (concern) of management

Support of career

Quality of skill training

Attentiveness of management

Assistance with job stress

ASSISTED LIVING EMPLOYEE

8,923VOICES HEARDNATIONWIDE

45%40 ormore years

EMPLOYEE’S AGE

17%30–39years

6%19 or under

23%40–49years

21%Less than30 years

22%50–59years

11%60 or older


50%Personal

Care/Nursing

EMPLOYEE’S JOB CATEGORY


28%Personal

Care

17%Food

Service

Recreation, Activities, other position

11%

Supervisor,Business Office,Administration

12%

Housekeeping,Maintenance,Laundry,Transportation

11%

22%Nursing

44%1 to 5years

LENGTH OF EMPLOYMENT


27%2 to 5years

12%

6%

3 monthsor less

More than10 years 16%

5 to 10years

17%1 to 2years

22%3 monthsto 1 year

Satisfaction

ASSISTED LIVING


DATABYTE

SATISFIED ASSISTED LIVINGEMPLOYEES BY CATEGORY


50%

60%

70%

80%

90%

Supervisor/Business

Office/Administration

Based on the percent of total weighted respondents in each job category who rated their overall satisfaction as “excellent” or “good”

Hskpg./Maint./

Laundry/Transp.

FoodService

Recreation/Activities/

Otherposition

PersonalCare/

Nursing

RECOMMENDATION OF ASSISTED LIVING EMPLOYEES BY CATEGORY


50%

60%

70%

80%

90%

Supervisor/Business

Office/Administration

Based on the percent of total weighted respondents in each job category who rated their willingness to recommend the facility as a place to work as “excellent” or “good”

Hskpg./Maint./

Laundry/Transp.

FoodService

Recreation/Activities/

Otherposition

PersonalCare/

Nursing

PRIORITY ITEMS


Ranked by average scores and correlations with workplace recommendation

1Assistance with stress

2Quality of skill training

2Staff-to-staff communication

3 Support of career

3 Clear guidelines by management

ADMINISTRATOR

1Assistance with stress

2Care (concern) of management

3Attentiveness of management

4Support of career

5Quality of skill training

PERSONAL CARE

RECOMMENDATION FOR CARE

82% satisfied

41%EXCELLENT

FAIR

13%POOR

4%

41%GOOD

Does not total 100% due to rounding


RECOMMENDATION FOR JOB

73% satisfied

29%EXCELLENT

FAIR

20%POOR

7%

44%GOOD


OVERALL SATISFACTION

71% satisfied

24%EXCELLENT

FAIR

22%

POOR

6%

47%GOOD

Does not total 100% due to rounding


TRAINING


May not total 100% due to rounding

Quality of orientation

Support of career

Quality of skill training

OVERALL AVERAGE

EXCELLENT

21%

19%

19%

19%

GOOD

50%

45%

43%

46%

FAIR

22%

25%

27%

25%

POOR

8%

11%

12%

10%

WORK ENVIRONMENT


Comparison of benefits

Comparison of pay

Clear expectations by management

Adequacy of equipment/supplies

Sense of accomplishment

Quality of teamwork

Staff-to-staff communication

Respectfulness of staff

Assistance with job stress

Fairness of evaluations

OVERALL AVERAGE

EXCELLENT

14%

10%

20%

22%

49%

29%

17%

46%

13%

23%

24%

GOOD

35%

31%

46%

43%

42%

40%

42%

43%

37%

45%

40%

FAIR

30%

34%

24%

24%

8%

22%

28%

8%

30%

21%

23%

POOR

21%

26%

9%

11%

1%

9%

13%

2%

21%

11%

12%

SUPERVISION



Supervisor cares

Supervisor appreciates

Supervisor informs

OVERALL AVERAGE

EXCELLENT

41%

36%

33%

37%

GOOD

33%

32%

40%

35%

FAIR

17%

18%

19%

18%

POOR

9%

13%

9%

10%

MANAGEMENT



Management cares

Management listens

OVERALL AVERAGE

EXCELLENT

22%

20%

21%

GOOD

40%

37%

39%

FAIR

25%

26%

25%

POOR

13%

16%

15%

What aboutemployee data?

What do weknow today?

Source: Assisted living family and employee satisfaction surveys conducted in 2007 by My InnerView Inc.

Communities with higher family satisfactionhave better work environments

48

52

56

60

64

Lowest Low High Highest< 69.4% 69.4% to 78.8% 78.8% to 85.7% > 85.7%

Mean = 58.8

EM

PL

OY

EE

EN

VIR

ON

ME

NT

SC

OR

E (

%)

FAMILY SATISFACTION


Communities with higher family satisfactionhave better employee training

48

52

56

60

64


Mean = 58.2

EM

PL

OY

EE

TR

AIN

ING

SC

OR

E (

%)

FAMILY SATISFACTION


Communities with higher family satisfactionhave better supervision

56

60

64

68

72


Mean = 66.1

EM

PL

OY

EE

SU

PE

RV

ISIO

N S

CO

RE

(%

)

FAMILY SATISFACTION


Communities with higher family satisfactionhave better management

44

48

52

56

60


Mean = 55.5

EM

PL

OY

EE

MA

NA

GE

ME

NT

SC

OR

E (

%)

FAMILY SATISFACTION


Communities with higher family satisfactionhave better employee global satisfaction

50

60

70

80


Mean = 66.9

EM

PL

OY

EE

SA

TIS

FA

CT

ION

SC

OR

E (

%)

FAMILY SATISFACTION

NCAL’sGuiding Principles

NCAL’s definitionof quality

“The totality of featuresand characteristics of

a service to meetor exceed the

customer’s expectations”

Guiding principles

» Person-centered care

» Ethical practices and financial stewardship

» Facility vision and mission statements

» Quality improvement

» Workforce

HowMy InnerView

will support NCAL members achieve

the goals of their Guiding Principles

Person-centered care• Meeting the

resident’s need

• Staff knows each resident

• Staff and management knows each resident, their history, their needs, preferences and expectations

• Staff form meaningful relationship with the residents and their families

Sufficiency of personal assistance (Q9)

Responsiveness of staff (Q11)

Choices and preferences (Q1)

Resident to staff friendships (Q5)

Person-centered care• Maximizing resident’s safety

• Developing positive/meaningful relationships with families

• Maximizing resident’s privacy

• Encouraging the personal development of residents

Safety of facility (Q16)

Commitment to family updates (Q12)

Respect for privacy (Q3)

“Grow as person” opportunities (Q26)

Ethical practicesOperations should be based on a foundation of trust. This can be achieved through “consumer disclosure.” Providers will operate their communities and provide service with integrity.

Use of My InnerView’s assisted living products provide concrete proof to consumers that providers are operating their organization with an openness and willingness to receive feedback and act on it.

Ethical practicesVision statements focus on resident, family and staff satisfaction and drive for progress and continuous improvement …

My InnerView’s resident, family and staff satisfaction surveys give meaning to an organization’s vision and mission statement(s)

Quality improvementData collection in selected areas

My InnerView’s Quality Profile Metrics collects data from AL in:

• Customer satisfaction• Quality of life• Quality of care• Employee

commitment• Financial health

Quality improvementAssisted living providers may choose to define their own benchmarks once they have baseline in data or they may define their benchmarks on a local, state or national level, depending on availability of data

My InnerView provides opportunity for user to benchmark their scores again:

• Their corporation• Their state• Entire MIV database• Ownership• Several others

Quality improvementAnalysis of the community’s performance against defined objectives and benchmarks

Identification, development and implementation of process improvements

Quality Profile allows each AL to set own benchmarks against others in database

Satisfaction reports support decision of which processes need improvement

Website contains tools facility staff can use to identify their opportunities for improvement, development of plans and ways to monitor implementation of process improvement

Quality Profile metrics

Currently in use by assisted living providers nationwide

STANDARD METRICS

Added by organization’s to meet their specific needs

CUSTOM METRICS


All My InnerView metrics are reported in the positive

STANDARD METRICS

Residents without falls

Residents without medication errors

Residents without unplanned weight loss


» Residents without falls» Residents without acquired pressure ulcers» Residents without unplanned weight loss» Residents without unplanned weight gain» Residents without medication errors» Staff stability» Staff without absenteeism» Staff without turnover» Occupancy» Overall satisfaction – family» Overall satisfaction – resident» Overall satisfaction – employee» Quality of life measures (13) – resident/family

STANDARD METRICS

WorkforceResearch and experience

has shown that a higher level of satisfaction amongassisted living staff

directly correlates withhigher levels of satisfaction

among residents andtheir family members

Workforce

» These components may contribute to an enhanced work environment for staff:– Organizational commitment to staff

– Management training for all supervisory-level staff

– Timely and concise communication from facility leadership

– Career ladders and lattices that provide career advancement

Workforce Continued

– Training and education for all levels

– Recognition and rewards program

– Resources needed to complete job available on timely basis

– Employee satisfaction surveys

Workforce

» Workforce Quality Profile Metrics reinforce importance of organizational commitment of staff:– Staff stability

– Staff without absenteeism

– Staff without turnover

ITEMS IN TRAINING DOMAIN

Quality of orientation (Q1)

Support of career (Q2)

Quality of skill training (Q3)

Care (concern) of supervisor (Q6)

Appreciation of supervisor (Q7)

Care (concern) of management (Q10)

RECOGNITION AND REWARDS:

Adequacy of equipment/supplies (Q12)

RESOURCES:

ITEMS IN TRAINING DOMAIN

Attentiveness of management (Q11)

Fairness of evaluations (Q18)

Assistance with job stress (Q17)

MANAGEMENT TRAINING FOR SUPERVISORS:

Communication by supervisor (Q8)

Staff-to-staff communication (Q15)

Quality of teamwork (Q14)

COMMUNICATION:

Reports for employeesatisfaction surveys

turn responses into informationthat can be used by

leaders and managers toimprove the work environment

for employees

We did the best we could,

with what we knew,

And when we knew better,

we did better.

MAYA ANGELOU

Thank you,

Questions? 715-848-2713

A Partnership For Quality

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