What makes a resident or family member satisfied? handout.pdfMary Tellis-Nayak, RN, MSN, MPH VP of...
Transcript of What makes a resident or family member satisfied? handout.pdfMary Tellis-Nayak, RN, MSN, MPH VP of...
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April 19, 2017
Fort Wayne, INIHCA
Turning Staff into CARE-givers: A DON’s Challenge
Corporate Headquarters1245 Q St. Lincoln, NE 68508800.388.4264Local: 402.475.2525
Mary Tellis-Nayak, RN, MSN, MPH
VP of Quality Initiatives - MyInnerView
773-942-7525
“A resident’s satisfaction with his/her relationship to nursing staff was found to be significantly related to the proportion of CNAs on the resident’s unit who said they intended to stay in the job, and to the proportion of CNAs who had positive relationships with their supervisors.”
- Bishop, October 2006
What makesa resident
or family membersatisfied?
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NATIONWIDE
Voice of Residents
Top Drivers for Recommendation to Others2015
Independent Living Resident Assisted Living Resident
Home-Like Atmosphere .61 Responsiveness of Management .61
Responsiveness of Management .59 Choices/Preferences .60
Commitment to Independence .58 Comparison of Charges .59
Care (Concern) of Staff .57 Competency of Staff .59
Responsiveness of Staff .56 Care (Concern) of Staff .58
Nursing Home Resident Short Stay Residents
Care (concern) of Staff .63 Care (Concern) of Staff .77
Competency of Staff .63 Competency of Staff .77
Responsiveness of Management .61 Choices/Preferences .74
Choices/Preferences .59 Responsiveness of Management .72
RV/LVN/LPN Care .58 Quality of Medical Care .72
Resident Satisfaction
Studies have repeatedly confirmed that residents and their family members valuethe quality of the relationships they have with the frontline caregivers higher that the quality of the medical care and the quality of the food.
NCCNHR, Public Health Institute
I hope for the day when everyone who lives in any l ong-term care situation knows there is someone waiting for him or her each morning after the journey of sleep one takes each night.
And I yearn for the day when each staff person, mos t especially CNAs, know that there are people who are waiting for a morning greeting, interested in learn ing how the CNA fared in the hours they were apart.
Carter Williams
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A wonderful sweet elderly resident passed away at the community I work at tonight. A woman who never complained, always had a smile, and said thank you to all us aides for helping her out. She spoke with a very soft voice. She had no visitors ever , which breaks my heart ♥The other 3 caring aides I worked with tonight all sat on her bed.holding her hand, praying and letting her know she wasn't alone. 9:45pm This wonderful sweet lady is now at peace.
NATIONWIDE
Voice of Families
Top Drivers for Recommendation to Others
Assisted Living Family Skilled Nursing Family
Competency of Staff .72 Care (Concern) of Staff .76
Care (Concern) of Staff .72 Competency of Staff .75
Responsiveness of Management .70 Choices/Preferences .72
Choices/Preferences .69 Responsiveness of Management .71
Responsiveness of Staff .68 RV/LVN/LPN Care .71
It is the compassionate connection between a caregiver and a resident that elevates common courtesy into something more tender and unforgettable than good, routine care
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NATIONWIDE
Voice of Employees
Top Drivers for Recommendation to Others
Independent Living Employee Assisted Living Employee
Care (Concern) of Management .61 Care (Concern) of Management .69
Assistance with Job Stress .59 Assistance with Job Stress .67
Attentiveness of Management .58 Attentiveness of Management .66
Clear Expectations by Management .57 Clear Expectations by Management .64
Support of Career .56 Fairness of Evaluations .62
Skilled Nursing Employee
Care (Concern) of Management .73
Attentiveness of Management .71
Assistance with Job Stress .69
Safety of Workplace .63
Fairness of Evaluations .61
EMPLOYEE: CARE (CONCERN) OF MANAGEMENT
EXCELLENT GOOD FAIR POOR
Based on 2010 satisfaction surveys conducted nationwide by My InnerView
EMPLOYEE: ATTENTIVENESS OF MANAGEMENT
EXCELLENT GOOD FAIR POOR
Based on 2010 satisfaction surveys conducted nationwide by My InnerView
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EMPLOYEE: ASSISTANCE WITH JOB STRESS
EXCELLENT GOOD FAIR POOR
Based on 2010 satisfaction surveys conducted nationwide by My InnerView
Handout
What doesresearch have to
tell us aboutthe workplace? • Based on satisfaction surveys conducted by My InnerView:
– 78,547 CNAs/NAs
– 144,098 family members• 3,216 skilled nursing facilities ranked in four groups based on
percentiles (lowest, 2nd lowest, 2nd highest and highest)
The voice of CNAs
Quality of leadership and quality of the workplace
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1. Pay compared to other nursing homes
2. Safety of workplace
3. Adequate equipment and supplies to do your job
4. Work allows you to make a difference in people's lives
5. Co-workers work together as a team
6. Fair performance evaluations
7. Respect shown for resident by staff
8. Help you get to deal with job stress and burnout
9. Staff communication between shifts
Indicators of quality workplace
Lead
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Quality leaders produce a quality workplace
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Quality workplace earns staffrecommendation
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Quality workplace earns familyrecommendation
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Quality workplace creates quality of life for resident As staff
are treated,
so will the elders be treated.
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Quality workplace creates quality of care for resident
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Quality workplace creates quality of service for resident
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Com
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Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.
Sur
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Quality workplace results in better state surveys
Use the Workplace Scaleas Starting Point
• Safety of workplace• Adequate equipment and supplies to do your job well• Work allows you to make a difference in people's li ves• Co-workers work as a team• Fair performance evaluations• Staff are respectful of residents• Helps you get to deal with job stress• Communication between shifts• Pay compared to other nursing homes
Whether individuals feelrespect in the workplace
is largely a function of how they are treated
by their supervisors,their clients and family members
or advocates and,many times, their peers,
particularly for new workers.
Studies suggestthat the quality
of these relationshipshas a defining impacton workers’ decisions
to stay on the jobor leave to pursue
opportunities elsewhere.
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A Studyon Turnover
Is this your idea of employee retention?
The study
• Paired facilities• Same geographical location
• Several different states• High and low turnover facilities
General observationsin low turnover facilities
• Less odor or urine • Residents wearing fresh unstained clothing• Clean and well groomed• Few behavioral problems• Few people wandering aimlessly or sitting lined
up in wheelchairs by nurses’ stations• Residents were attuned to particular staff members• Residents were likely to speak to visitors showing
they felt safe and not frightened
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General observationsin high turnover facilities
• Desperate and chaotic air• Staff were rushing around or hard to find• Residents were calling out, crying and screaming• Call lights were typically buzzing, flashing or ringing
with no one appearing to pay attention• Few smiles in evidence• Entire parts of the home seemed to be abandoned
by staff• Break rooms were gloomy, dark and dingy
In general, if a visitor
walked blindfolded into
the selected pair of facilities
in each community and
sat in the lobby or dining room
for less than one hour,
he or she could have
accurately predicted
which was the
high turnover workplace
Five areas stand out as
distinguishing facilities with low
nursing staff turnover
What a difference management makes!
Five management practices
associated with
low turnover, high attendance
and high performance:
High quality leadership at all levels of
the organization
Valuing staff day-to-day in
policy and practice, word and
deed
High performance,
high commitment HR policies
Work systems
aligned with and serving organization
al goals
Sufficiency of staff and resources
to care humanely
Eaton, 2002
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Leadership:The Key to
Caring Employees
Administrator and DON: The architects of excellence
W. EDWARDS DEMING
An organizationexcels or fails because of you
“80% of all quality problems
are the fault of managers”
Administrator and DON are
The architects of excellence
The manager maintains
The manager has a short-range view
The manager focuses on systems and structure
The manager asks how and when
The manager accepts the status quo
The manager does things right
The leader develops
The leader has a long-range perspective
The leader focuses on people
The leader asks what and why
The leader challenges it (the status quo)
The leader does the right thing
MANAGER LEADERVS
Think of someone
in your life
who
has been
an effective leader
What qualities did he/she have?
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High quality leadership and management
• Tenure of administration• The best leaders have clear sense of mission and
philosophy that connected residents and workers• “I spend as much time as I can on the floors. I am
a soldier, not a general…We should spend our money on staff, not agency or corporate offices or furnishings”
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Who is good leader or manager?
• Someone with a strong vision or mission and sense of goal
• Someone who sets standards and keeps others accountable
• Someone who listens to others and spends time on floors
• Someone who values the contributions and work of others while demanding commitment and high performance
• Someone who tries to create a chain of positive supervision all the way to the front line while being open to new and non-traditional ideas
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What a difference management makes!
Five management practices
associated with
low turnover, high attendance
and high performance:
High quality leadership at all levels of
the organization
Valuing staff day-to-day in
policy and practice, word and
deed
High performance,
high commitment HR policies
Work systems
aligned with and serving organization
al goals
Sufficiency of staff and resources
to care humanely
Eaton, 2002
Respect for nursing caregivers
• Demonstrated in many ways:– Bulletin boards recognizing long service– Photos of new staff with information containing things others
should know about him or her– New residents also had bulletin board
• Attending to needs of the job:– Supplies and education– Assistance both on and off the job
• Flexible scheduling• Emergency loans
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Lessons Learned Practical Suggestions
• Take a “relationships inventory”• Listen to what workers say about respect• Identify changes necessary to “operationalize” resp ect• Think in terms of maximizing human potential• Understand the needs of new immigrants and non-Engl ish
speakers• Commit to making continuous improvement
Take a “relationships inventory”
• Do managers at all levels of your organization have positive and professional relationships with the pe ople they supervise?
• Does the disciplinary action make up a large portio n of interaction between frontline staff and managers?
• Do direct care staff see managers as mentors they f eel comfortable going to for advice and problem solving ?
Without a foundation of healthy relationships among frontline workers and between direct care workers and their supervisors, other initiative to create a more resp ectful work environment are unlikely to be successful.
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Respect for nursing caregivers 2
Hardly anyone had left the staff in last year because they were unhappy in the homes where they felt respected!
Valuing relationships
• Between workers themselves
• Between residents• Between workers and residents
• With families
This quality was noticeably absent
in high-turnover facilities
Listen to what workers say about respect
• When workers say they feel a lack of respect, it of ten reflects their sense that no one is listening to th em.
• Everyone knows how to listen but knowing how to listen to information that is emotionally charged i s difficult.
• Responding without blaming or being judgmental requires training and practice.
Identify changes necessary to “operationalize” respect
• Review existing P&Ps to understand what changes, bi g or small, will make workers feel more respected, value d and heard.
• Do you have a process in place to provide emotional support to workers who are caring for consumers or encounte ring family members who are verbally or physically abusi ve?
• How does your organization support workers who feel they are being discriminated against?
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Think in terms of maximizing human potential.
• When workers have the opportunity to improve themselves, personally or professionally, they feel better about themselves and have a more positive attitude about their workplace.
• Do you have a career track for direct care workers?
• Do you offer educational opportunities through scholarships or on-site distance learning?
What a difference management makes!
Five management practices
associated with
low turnover, high attendance
and high performance:
High quality leadership at all levels of
the organization
Valuing staff day-to-day in
policy and practice, word and
deed
High performance,
high commitment HR policies
Work systems
aligned with and serving organization
al goals
Sufficiency of staff and resources
to care humanely
Eaton, 2002
Positive Human Resource policies
• Compensations was NOT key factor distinguishing facilities from one another
• Wages were often comparable between high and low turnover facilities
• “People who do this work want to care for people. It’s their calling. They still have to be able to enjoy their co-workers.”
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Results of Employee Satisfaction Surveys2015
Quadrant Analysis
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SNF Employee
Quadrant Analysis: Quadrant B
11 � Safety of Workplace
8 � Communication by Supervisor
15 � Fairness of Evaluations
SNF Employee
Quadrant Analysis: Quadrant D
12 � Adequacy of Equipment/Supplies
3 � Quality of Resident-Related Training
10 � Care (Concern) of Management
9 � Attentiveness of Management
18 � Staff-to-Staff Communication
17 � Assistance with Job Stress
Results of Employee Satisfaction Surveys2015
Quadrant AnalysisPolicies which matter!
• Recruitment process — greater selection in hiring is imperative• Orientation times ranged from one shift or less at high turnover
facilities to 10 days or more at low-turnover facilities
• “I didn’t get orientation because the lady that does it was on sick leave”
• Mentoring• Evaluations, feedback, rewards• Managerial training for supervisory personnel
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What a difference management makes!
Five management practices
associated with
low turnover, high attendance
and high performance:
High quality leadership at all levels of
the organization
Valuing staff day-to-day in
policy and practice, word and
deed
High performance,
high commitment HR policies
Work systems
aligned with and serving organization
al goals
Sufficiency of staff and resources
to care humanely
Eaton, 2002
Effective work organization
• Consistent assignments between residents and CNAs
• Sufficient staffing• Careful attention to emotional and religious passages in
life• Organizing eating and bathing in ways
that rarely caused conflict and distress for residents or caregivers alike
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Effective work organization
• Involvement of aides in care planning meetings• Seeking their input into the decisions about care for
residents they know well• Celebrations
4 In general,positive caregiving
practiceswere more likely linked
to decentralizeddecision-making and
an absence of arbitrarychanges withoutinvolvement of or
explanationto nursing staff
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What a difference management makes!
Five management practices
associated with
low turnover, high attendance
and high performance:
High quality leadership at all levels of
the organization
Valuing staff day-to-day in
policy and practice, word and
deed
High performance,
high commitment HR policies
Work systems
aligned with and serving organization
al goals
Sufficiency of staff and resources
to care humanely
Eaton, 2002
Adequate staffing ratios
• In workplaces where people stayed longer over time, aides had 5, 6 or 7 residents to care for on a typical day shift
• In high-turnover facilities, their assignments were more typically 8, 9, 10 or even 12
• The issue of having enough staff was described as basic• Staff often leave because of “working short”
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DOES ANYONE CARE?• Question which is “always” being answered• It is a manager’s actions that determine how the question will
be answered – Compassion for employees– Caring for employees– Noting their sacrifices– Honoring their contributions
Employees need to know
their manager cares about them
and the job they’re doing
How do you show you care about your
employees?
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Who is a patient in a Nursing Home?
Patient = a person sufferingHealer = one who makes the patient whole again
1. The patient is a patient Has a chronic condition
2. The family is a patient Needs emotional healing
3. The doctor is a patient Shaken by a new malpractice suit
4. The nurse is a patient She hears her sick baby crying for the mother
5. The manager is a patient Worried about the shortfall in revenue
Who is a Patient in a Nursing Home? Who is the Person in Person-Centered Care
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Everyone is a Patient, Everyone is a Healer
• Our private troubles follow us everywhere we go, even to work
• They disturb our work, fellow workers and the care-recipients
• A caring work setting, is a healing place--friends share each others’ burden and aches
• A healing climate has a family feeling; docs, RNs, CNAs, residents, families know, care for and heal each other
• We are all patients called to be healers
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Return of Compassion to Healthcare
V. Tellis-Nayak, Ph.D.Mary Tellis-Nayak, RN, M.S.N., M.P.H.
To order, please visit: amazon.comBook_Return_of_Compassionto_Healthcare
The biggest investment is TIME
1. Schedule time to
focus on employee development
6. Remember birthdays and service
anniversaries
2. Ask about interests outside of
work
7. Support employees in
times of crisis
3. Treat everyone with respect and
dignity
8. Be available when people need
you
4. Say “thank you” 9. Help co-workers become more
effective
5. Get employees involved and ask
for their opinion
10. Surround good people with other
good people
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Whether individuals feelrespect in the workplace
is largely a function of how they are treated
by their supervisors,their clients and family members
or advocates and,many times, their peers,
particularly for new workers.
but to keep asking the questions.but to keep asking the questions.
The real job of management is not to have all the answers,
The real job of management is not to have all the answers,
We did the best we could,
with what we knew,
And when we knew better,
we did better.
MAYA ANGELOU