four part cms satellite broadcast from institutional to individualized care

Four Part CMS Satellite BroadcastFrom Institutional to Individualized Care

This material was designed by Quality Partners, the Medicare Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. Contents do not necessarily represent CMS policy. 8SOW-RI-NHQIOSC-072006

Part 4

The How of Change:

What a difference management makes!

Marguerite M. McLaughlin

Manager of Educational Development,

Quality Partners of Rhode Island

3Quality Partners of Rhode Island

CMS Satellite Broadcast Series: From Institutional to Individualized Care

• Part 1, November 3, 2006: Integrating individualized Care with Quality Improvement

• Part 2, May 4, 2007: Transforming Systems to Achieve Better Clinical Outcomes

• Part 3, May 18, 2007: Clinical Case Studies in Culture Change Case Examples

• Today: The How of Change: What a difference management makes!

Cathie Brady

Co-founder, B&F Consulting

Consultant, Quality Partners of RI

Barbara Frank

Co-founder, B&F ConsultingConsultant, Quality Partners of RI


Thomas Hamilton

Director, Survey & Certification Group

Center For Medicaid and State Operations

Centers For Medicare & Medicaid Services


Goals:

1. Describe a change process

2. Explore the importance of inclusive leadership

3. Identify workplace practices to achieve staff stability

4. Demonstrate why of individualized care is better care

Basic Premise

Good care needs to be individualized

That requires good relationships between residents and staff


Sections

• Section 1: The How of Change

• Section 2: A Positive Chain of Leadership

• Section 3: Achieving Staff Stability

• Section 4: Individualized Care: The Path to OBRA


The How of Change• Personalize

• See how it is for residents and staff

• What’s working – keep it

• Open dialogue to change what’s not working

• Look at the data

• Pilot test

• Mid-course adjustments

• Spread

Build this slide

Bathing Without a Battle

www.bathingwithoutabattle.unc.edu


Ways to personalize the experience

• sit in a shower chair

• wear a chair alarm

• lie in a resident’s bed

• take a shower in the shower room

• eat a meal


Sources

• The Leadership Challenge by Jim Kouzes and Barry Posner

• What a difference management makes! by Susan Eaton

Build


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

organizational goals

Sufficiency of staff and resources

to care humanely

Eaton, 2002


A Positive Chain of Leadership

• Encouragement and Valuing

• Positive Presence

• People Development

• Personal Growth as a Leader

build


Facilities with higher employee satisfaction have:• More residents without falls

• More residents without pressure ulcers

• More residents without acquired catheters

• Less nurse turnover

• Less CNA and nurse absenteeism

• Higher occupancyMy InnerView

2007


Encouragement:

• Set clear standards

• Expect the best

• Pay attention and tune in to people

• Personalized recognition

build


Effective praise is:

• Timely

• Specific

• Sincere

• Proportional

• PositiveOne Minute Manager

Ken Blanchard


Achieving Staff Stability

• Maximizing Financial Resources to Invest in Staff Stability

• Attendance policies

• Hiring practices

• Consistent assignment

build


Snapshot of Current SituationComposition of the current staff

Position Total FT PT PD Baylor

RN - 30 8 4 14 4

LPN - 27 15 0 5 7

CNA - 77 37 8 7 25


Financial Incentives:

Bonus Extra Per Hr. Annual

Baylor (work two 12’s, paid for 30 hours)

RN -- $7

LPN -- $5

CNA -- $3

$268,944

Last minute assignment

RN, LPN --$10

CNA -- $5

$360,000

Perfect attendance $0 $0


Terminations by Length of Service

Position 1 day – 1 mo

1 – 3 mo

3 - 6 mo

6 mo – 1 yr

RN 18% 18% 18% 27%

LPN 7% 13% 33% 27%

CNA 23% 30% 23% 16%

Other 8% 27% 39% 12%


Incentives Bonus Amt Offered Quarter - Annual

Sign-on bonus

Paid after 6 mos.

RN -- $2000

LPN -- $500

CNA -- $250

$12,500 - $50,000

Referral bonus

Paid after 6 mos.

RN, LPN --$1000

CNA -- $500

$6,000

Longevity $0 $0

Raises Average 2% $90,710


Turnover Costs:

Position Per Person Annual Cost

RN $4,899 $53,889

LPN $4,193 $62,895

CNA $3,207 $205,248

Other $2,692 $131,908

Total 2004 $453,940


Instability vs. StabilityLast minute bonus $360,000

Perfect attendance $ 0

Baylors

$268,994

Raises @ 2%

$90,710

Sign-on bonuses

$50,000

Referral bonuses

$6,000

Turnover costs

$453,940

Longevity bonus

$0

Total:

$1,132,934

Total:

$96,710


Stage 2: Staff Stabilization Plan

Goals:

–more full-time positions

–Improve attendance

–Improve percent of new hires who stay


New Wage Package

For Full-time Staff

Old Wage Range

New Wage Range

Raise Amount

CNA $9.25 to $10.50

$11.50 to 12.75

+ $2.25

LPN $15.00 to $16.70

$18.00 to $20.50

+ $3.00 to $3.80

RN $18.00 to $20.50

$23.50 to $26.00

+ $5.50


As a result: Increase in FT Staff

Date # of FT

nursing staff

June 2005 60

Dec 2005 80

Dec 2006 96


RN LPN LNA

Status 2005Dec. 2006 2005

Dec. 2006 2005

Dec. 2006

Full Time 27% 71% 56% 84% 48% 83%

Part Time 13% 17% 0% 3% 10% 3%

Per Diem 47% 8% 18% 3% 9% 4%

Baylor 13% 4% 26% 9% 32% 10%

Increase in Percent of Nurses and CNAs Working Full-time


Case Study and Tools Available from:

• Better Jobs Better Care – www.bjbc.org

• COVE – Coalition of Vermont Elders – 802-229-4731

• Quality Partners of Rhode Island – www.riqualitypartners.org


http://cms.internetstreaming.com


National Technical Information Services

5285 Port Royal Road

Rm. 1008 Sills Bldg.

Springfield VA 22161

(703) 605-6186

four part cms satellite broadcast from institutional to individualized care

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