A Strategic Operational Approach to Staff Retention Susan Gilster, PhD, FACHCA [email protected] .

A Strategic Operational Approach to Staff Retention

Susan Gilster, PhD, [email protected]

www.alois.comwww.careleadership.com

mailto:[email protected]

http://www.alois.com/

Susan D. Gilster, PhD


Turnover in LTC

• Most report 40-400% annually in AL/NF

• Turnover Adm-43%, DON 38%, RN’s 41%, LPN’s 50%, CNA’s 66% (AHCA 07)

• Shortage of other personnel, nurses, dietary, housekeeping, activities…

• Fluctuates somewhat with economy but will continue to get worse


Cost of Turnover

• Cost $2,000, 5,000, $11,000 per employee and as much as 150% of employees annual total compensation-professionals

• Must consider direct and indirect costs• Impact on existing staff decreased satisfaction,

increased work load, poor morale• Residents and families-decreased satisfaction,

increased resident care issues, medications


Real Cost of Staff Turnover

• CCRC with 235 resident accommodations

• DON @ 150% of $75,000=$112,500• RN’s 16 (41%) 6.5 leave @ 150% of

$43,000=$419,250• LPN’s 28 (50%) 14 leave @ 150% of

$37,000=$777,000• CNA’s 72 (66%) 47.5 leave@ $5000 =$237,599 • TOTAL=$1,546,349.00 per year


Real Cost of Staff Turnover

• NF with 102 room accommodations

– DON @150 % $75,000=$112,500– 6 RN’s 2.5 @ 150% of $47,000=$117,500– 10 LPN 5 @ 150% of $37,000=$277,500– 35 CNA 23 @ $5000=$115,000

– TOTAL= $622,500.00 per year


NHA-Staff Turnover-Castle’s

• Castle-Adm turnover 2007-2.3X higher• CCRC with 235 resident accommodations

– 16 RN 12 @ 150% of $43,000=$784,320.00– 28 LPN 22 @ 150% of $37,000=1,212,120.00– 72 CNA 77 @ $5000=$385,200.00

– TOTAL=$2,381,640.00 per year


Staff-Research-what do we know?

• You cannot buy quality staff: money comes in 3rd or 4th on most surveys and has done so for the past few decades

• Staff satisfaction leads to resident and family satisfaction which leads to a higher census and improved financials


Staff Research-what do they want?

They want non-tangibles:– Respect and appreciation– Meaningful work-to make a difference– Education and to know expectations – They want to know what to do and why– Input into decisions, process and plans-a” voice” – Communication-routine, open, honest– Pay and promotion-health benefits


Organizational/Leadership Frameworks Business and Health Care

Greenleaf

Servant Leadership Model

Kotter General Leadership (Kouzes &

Posner)

Baldridge Criteria for

Performance Excellence –

Concepts

S.E.R.V.I.C.E. Model (Gilster)

Core Principles (Senge)

Technical (Stewardship)

A Sense of Urgency Never let up

Challenging the Process

Customer Driven Excellence

Focus on results, value

Service Personal Vision

Vision Vision Inspiring a Shared Vision

Visionary Leadership, valuing

employees/partners

Vision Shared Vision

Change (Commitment to Growth)

Empowerment Enabling Others to Act Organizational & Personal Learning

Agility & Management for innovation and by

fact

Education/Inclusion Team Learning

Visible Presence (empathy, awareness,

healing)

Guiding Team Encouraging the Heart Social Responsibility Respect Mental Models

Communication (Listening)

Communication

Short-term wins

Modeling the Way Systems Perspective

Focus on the future

Communication & Enrichment

Personal Mastery

Susan D. Gilster, PhDSusan D. Gilster, PhDSusan D. Gilster, PhD

Key to Retention is an Organizational Model

• All leadership models speak to quality-service • All address education and learning as an

ongoing necessary process• Open, honest and routine communication • Leaders are only as good as the people they

select, prepare, educate, include, respect and value, trust, nurture, support and monitor

• Organizationally driven, staff take over tasks allowing leaders to lead




Strategic Operational Approach S.E.R.V.I.C.E

• S ervice (Greenleaf, Blanchard, Kouzes…)• E ducation (Deming, Crosby, Teresi…..)• R espect (Annison, Longest, Palmer…)• V ision (Senge, Kouzes, Buckingham…)• I nclusion (Collins, Wheatley, Autry…)• C ommunication (Helgesen, Goleman……..)• E nrichment (Conger, Bennis, DuPree…)


Successful Staff Selection

• Choose only those whose beliefs are consistent with vision, values

• Person vs. experience-I can teach skills, but can’t teach someone to care

• Expectation wear “all hats” do whatever it takes

• High standards and expectations


Role of Vision

• Vision is a dream, mental image of “what” creating

• Staff retention is enhanced by a vision• Vision is a motivator and driver-gives staff

something to work towards-destination• If no vision-nothing that binds staff, excites or

unites, simply come to work, do their own thing and leave

• Vision encourages interdepartmental teamwork


Job Preparation and Orientation

• Cannot assume that employees know what to do or what you expect

• Orientation-mandatory regardless of length of time in field

• History, vision, service, departmental roles, performance expectations-working with the best


Ongoing Education and Support

• They will not learn all they need to know in orientation

• Learning from each other-problem solving• Keeps all leaders in touch with staff needs• Educational programs provides the information

staff need to make their own decisions • Gives staff an opportunity to understand the

needs and issues in other departments when educated collectively-enhances interdepartmental work


RESPECT

• Lack of respect is repeatedly mentioned in staff satisfaction surveys

• A lack of respect is often why staff leave

• Respect for all-staff to residents & families Staff to staff, families to staff

• Respect does not cost anything simply commitment


Inclusion-Participation & Ownership

• Employees want a voice in the organization

• Decisions are better with their input

• Outcomes are better with staff input

• Staff will work hard to see an outcome successful when involved in the decision


COMMUNICATION

• Communication is critical-but often gets the least emphasis and attention

• How do staff know how to contribute if they do not know what is happening

• Open, honest, invite critique, differing opinions make organizations stronger

• Sustainable, routine, all inclusive meetings


ENRICHMENT

• Leaders, managers and staff need to seek self-awareness, know what is important to them in life and work

• Everyone requires time to relax, think, reflect, plan-short and long term

• No person can give when they are empty

• Time should be scheduled like a meeting


Recognizing and Celebrating Accomplishments

• Recognize staff accomplishments-skills, education, kindness, thoughtfulness

• Seize every opportunity to recognize exceptional acts and staff in the facility

• Local community, state, national–multiple opportunities

• Not all facilities take the time to apply


Celebrations cont.

• Planned and spontaneous events• Special days, Bengals, Reds, Opening

day, cookouts, raffles, “biggest loser”• Interdepartmental relationship builds• FUN is critical while engaging in quality

work and enhances retention• If you are not having fun-do something

else


SERVICE Model as an Intervention

• Two facilities-both CCRC’s-200+accomodations

• Facility A-Administrator turnover q 1-2 yrs-new Administrator-inconsistent commitment

• Facility B-Administrator in organization in various roles for 13 yrs –consistent commitment and reinforcement


SERVICE Model Intervention

• Leadership agreement with 7 domains of SERVICE • Implementation at their own pace in their own way• Measured staff and family survey, turnover, agency

utilization, census, financials @ 3,6,9,12 (18, 24) • Staff survey (54) assigned work-10, work conditions-8,

policies and procedures-10, work relationships-16, training and education-5, overall satisfaction-5

• Comments and non-tangibles-notes on atmosphere, staff and family comments


Respect from supervisor…

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

Baseline 3months

6months

9months

1 year

ABC


Compliments from supervisor…

2.62.72.82.9

33.13.23.33.43.5

Baseline 3months

6months

9months

1 year

ABC


Respect from my department…

2.9

3

3.1

3.2

3.3

3.4

Baseline 3months

6months

9months

1 year

ABc


Respect from own shift…

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

Baseline 3 months 6 months 9 months 1 year

ABC


Respect from other departments…

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3


ABC


Know making a difference…

3.3

3.4

3.5

3.6

3.7

3.8


ABC


Job prep at orientation…

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5


ABC


Frequency of ongoing inservice/education…

2.52.62.72.82.9

33.13.23.33.43.5


ABC


Feeling part of team…

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5


ABC


Frequency of staff meetings…

2.42.52.62.72.82.9

33.13.23.33.43.5


ABC


Availability of Administrators…

2.42.52.62.72.82.9

33.13.23.33.43.5


ABC


Wages/pay received…

22.12.22.32.42.52.62.72.82.9

3


ABC


Overall satisfaction…

2.72.82.9

33.13.23.33.43.53.63.7


ABC


Would advise friend to apply…

2.52.62.72.82.9

33.13.23.33.43.5


ABC


I think of changing jobs…

1.71.81.9

22.12.22.32.42.52.62.72.82.9

3


ABC


Census and Finances

• Facility A-end of the first year – Highest census ever– Decreased turnover, decreased agency use– Increased staff satisfaction-statistically significant at

one year

• Facility B– Maintained a high census, – Staff satisfaction continued on upward trend,– Cut turnover in half, decreased agency


Facility C

• Census has been maintained for years-currently undergoing second expansion

• Staff satisfaction remains high-continuous effort (53 item survey, 90% response rate=3.4 average out of 4 “very happy” and 3.6 for overall satisfaction)

• Family satisfaction very high (84 item survey,75% response rate=3.8 out of 4 “very happy” and 3.8 for willing to recommend)


Impact of model on staffing costs

• Facility A – Saved $688,000.00 staff turnover in one year– Decreased agency by tens of thousands dollars– Agency costs ranged ($10,000-50,000/mth)

• Facility B – Cut turnover by more than half in one year with projected

savings of $1,120,000.00– Decreased agency use

• Facility C– Turnover single digits for years– No agency use


Impact of model on staff turnover

• Facility A – Saved $688,000.00 in staff turnover in one

year– Decreased agency by tens of thousands

dollars– Ranged ($10,000.00-50,000.00/month)

• Facility B– Cut turnover by more than half in one year

with projected savings of $1,120,000.00


Lessons learned

• Organizational operational approach addresses staff desires enhances satisfaction & retention

• Millions of dollars are lost each year in staff turnover and related costs

• Sustainability is key-do not start and stop programs


Conclusion (cont)

• MOST IMPORTANT• Impact on the people we serve, their

quality of life and happiness• Impact on the families, they are secure in

knowing that their family members are cared by consistent staff, happy and loved

• For staff who deserve respect, dignity, a quality place in which to work

A Strategic Operational Approach to Staff Retention Susan Gilster, PhD, FACHCA [email protected] .

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