what makes a resident or family member satisfied? handout.pdfmary tellis-nayak, rn, msn, mph vp of...

3/22/2017

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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

[email protected]

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


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


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



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EMPLOYEE: ASSISTANCE WITH JOB STRESS



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

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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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Quality workplace earns familyrecommendation

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Quality workplace creates quality of life for resident As staff

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so will the elders be treated.

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Quality workplace creates quality of service for resident

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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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associated with




the organization



deed

High performance,


Work systems


al goals


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?



associated with




the organization



deed

High performance,


Work systems


al goals


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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associated with




the organization



deed

High performance,


Work systems


al goals


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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associated with




the organization



deed

High performance,


Work systems


al goals


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

2 2 M a r c h 2 0 1 7 74

2 2 M a r c h 2 0 1 7 75

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

what makes a resident or family member satisfied? handout.pdfmary tellis-nayak, rn, msn, mph vp of...

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