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Creating a Culture of Retention: Getting to the Roots
of the Workforce ShortageMarch 18, 2019 American College of Health Care Administrators
Disclosure of Commercial Interests
Consultant for PHI, “Paraprofessional Healthcare Institute”
Title: Vice President of Workforce Innovations
PHI is a national nonprofit organization based in the Bronx that aims to improve quality of care for older people and individuals with disabilities by improving jobs for those that provide that care.
We believe that caring, committed relationships between direct care workers and their clients are at the heart of quality care, and our work serves to strengthen those relationships.
Our Strategy
Learn what works – and what doesn’t.
Share lessons and implement best practices through hands-on coaching, training and consulting.
Support employers, policymakers and advocates to craft evidence-based policies and practices.
© PHI 2019
© PHI 2019
Understanding The Workforce Crisis
Raise Your Hand…
• If you are having trouble finding qualified staff
• If you’ve lost at least one DON due to unstable staffing
• If you have had to turn away new admissions due to staffing shortages
© PHI 2019
Source: PHI. 2018. U.S. Home Care Workers: Key Facts. Bronx, NY: PHI. https://phinational.org/wp-content/uploads/2018/08/U.S.-Home-Care-Workers-2018-PHI.pdf.
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000
2016 2026Home Care: PCAs Home Care: HHAs and CNAs Nursing Homes
1.4 million new jobs
Direct care job growth: 2016 to 2026
© PHI 2019
© PHI 2019
$11.00
$12.00
$11.50
$15.00
© PHI 2019
Recruit the Right Staff
Get everyone involved!
1Create mission-driven materials that reflect your unique brand
2Identify a range of potential new applicants
3Use targeted outreach strategies
4
© PHI 2019
© PHI 2019
Give all staff recruiting business cards that they can put their name on
If you hire someone who brings in a staff member’s business card, that employee gets a bonus or gift card
Form a cross functional team to lead new strategies
Consider the message
X© PHI 2019
Mission Driven Materials that Reflect your Unique Brand
“Imagine the Stories You Can be Part of…”
“Imagine the Lives you can Touch”Following the Disney Example
© PHI 2019
© PHI 2019
• Highlight direct care skills and competencies
• Recruit family caregivers
• Integrate training and job opportunities
© PHI 2019
Recruiting men to the caregiving workforce
Men comprise 53% of the labor force and 40% of family caregivers, but just 14% of the paid direct care workforce
• Recruit through schools and colleges
• Promote direct care as career entry point
• Integrate training and job opportunities
© PHI 2019
Recruiting younger workers to the caregiving workforce
51% of younger people in the labor force are also enrolled in education.
• Promote direct care as an encore career
• Capitalize on older workers’ skills
• Integrate ongoing learning opportunities
© PHI 2019
Recruiting older workers to the caregiving workforce79% of workers plan to get a job after retirement
Schools
WIBs
Social Media
© PHI 2019
Between 2016 and 2017:• The number of new applicants
increased by 33%• The number of hires increased by 46%• The number of vacant positions
decreased by 45%
© PHI 2019
Digital Campaign Case Study
The Power of Employee Voices
Improve Hiring, Welcome, and Onboarding
When interviewing candidates…
© PHI 2019
Ask values-based questions
© PHI 2019
“Tell me about a meaningful relationship you’ve had with an older person or someone with a disability. How has that relationship impacted you?”
The key to retention is to treat our employees the same way we ask them to treat the residents!
© PHI 2019
Have a Person-Centered Welcome
1. Send a welcome letter2. Include a small gift with the letter3. Include an invitation to a meal
with residents4. Personal phone call from peer
© PHI 2019
The First Week + Increase human contact
Decrease videos
Never eat alone
Ease into full
assignment
Immerse in
company culture
© PHI 2019
Engage Peer Mentors • Support new hires as they transition into
direct care roles
• Offer experienced workers a career advancement opportunity
• Encourage an organizational culture of collaboration, learning, and problem-solving
© PHI 2019
Provide free or low cost meals
1purchase diapers and formula at reduced cost
2
Create an employee pantry/share center
3
Provide free or discounted uniforms
4
Get creative with transportation
5
Include Value Added Benefits
© PHI 2019
Develop Advancement Opportunities
Ensure Effective Supervision
© PHI 2019
Turnover timeline
First week• Mismatched
expectations• Ineffective
supervisor
First 30 days• Disciplinary
action due to inadequate preparation
• Work schedule/ workload
• Ineffective supervisor
First 90 days• Lack of strong
relationships• Unmet
training/ resource needs
• Ineffective supervisor
First 6 months• No recognition or
feedback• Inadequate
communication/ engagement
• Ineffective supervisor
Source: Crescendo Strategies. 2018. “Why People Leave” Timeline. https://www.crescendostrategies.com/wp-content/uploads/2019/01/2018-Why-Employees-Leave.pdf.
© PHI 2019
First week• Mismatched
expectations• Ineffective
supervisor
First 30 days• Disciplinary
action due to inadequate preparation
• Work schedule/ workload
• Ineffective supervisor
First 90 days• Lack of strong
relationships• Unmet
training/ resource needs
• Ineffective supervisor
First 6 months• No recognition or
feedback• Inadequate
communication/ engagement
• Ineffective supervisor
Source: Crescendo Strategies. 2018. “Why People Leave” Timeline. https://www.crescendostrategies.com/wp-content/uploads/2019/01/2018-Why-Employees-Leave.pdf.
Turnover timeline
© PHI 2019
© PHI 2019
PHI Coaching Supervision®
A relational approach to managing and supporting employees and teams that helps them develop their interpersonal, critical thinking, and problem-solving skills.
© PHI 2019
Traditional Supervisors…• Raise a performance concern;
• Describe the rules and explain the consequences of breaking them;
• Offer or mandate solutions to the problem;
• Require compliance, and penalize non-compliance.
© PHI 2019
Traditional Supervisors…• Raise a performance concern;
• Describe the rules and explain the consequences of breaking them;
• Offer or mandate solutions to the problem;
• Require compliance, and penalize non-compliance.
• Establish a trusting and respectful relationship with employee;
• Raise a performance concern;
• Gather information from employee’s perspective;
• Engage employee in generating solutions;
• Help employee commit to action steps.
Coaching Supervisors…
Coaching SkillsActive Listening: Body language, paraphrasing, open curious questions
Self Awareness and Self Management: Being conscious of judgments and assumptions, controlling emotional reactivity and listening blocks
Clear Communication: Using language free of blame and judgment
© PHI 2019
© PHI 2019
Supervisors improved their ability to listen and respond objectively,
without making assumptions
and judgments
Supervisors established
better relationships with CNAs,
residents, and family
members
Supervisors were able to
better resolve performance related issues
without disciplinary
actions
Improvement in retention
State Based Initiatives
© PHI 2019
• Create a Pathway to a Living Wage
• Support a Culture of Retention
• Establish a CNA Scholarship Program
© PHI 2019
© PHI 2019
Bold, Creative Ideas Will Guide our path to a future with care for all who need it, and good jobs for all who provide it
Sue MisiorskiVice President of Workforce Innovations
© PHI 2018
400 East Fordham Road, 11th Floor • Bronx, New York 10458 • www.PHInational.org