Outcomes of a Leadership Intervention in Long-Term Care Q-3 Tuesday, October 9, 2007 Susan Gilster, PhD Jennifer Dalessandro, BS Alois Alzheimer Center www.alois.com [email protected] www.careleadership.com
Dec 28, 2015
Outcomes of a Leadership Intervention in Long-Term Care
Q-3Tuesday, October 9, 2007
Susan Gilster, PhDJennifer Dalessandro, BS
Alois Alzheimer Centerwww.alois.com
Susan D. Gilster, PhDSusan D. Gilster, PhD
Our Belief:Our Belief:
Creating a successful workforce takes an Creating a successful workforce takes an organizational approach, thus it is leadership organizational approach, thus it is leadership drivendriven
Leadership is key to the success of any Leadership is key to the success of any organization. It is critical in the recruitment and organization. It is critical in the recruitment and retention of staff. retention of staff.
Leadership is in the hands of the person who is at Leadership is in the hands of the person who is at the top, the administrator, executive director, CEO, the top, the administrator, executive director, CEO, etc. It will not happen without their blessing. etc. It will not happen without their blessing.
Susan D. Gilster, PhDSusan D. Gilster, PhD
Leaders in Long-Term CareLeaders in Long-Term Care
The Administrator The Administrator isis the one who the one who leads the organization – license on leads the organization – license on the line.the line.
Like it or not, they determine what Like it or not, they determine what happens in the facility.happens in the facility.
While the President or CEO of a While the President or CEO of a corporation might set the agenda, corporation might set the agenda, the Administrator puts the plan into the Administrator puts the plan into operation-OR NOToperation-OR NOT
Susan D. Gilster, PhDSusan D. Gilster, PhD
Leadership Model Leadership Model
Qualitative, historical case studyQualitative, historical case study Extensive review of literature-Extensive review of literature-
business, no health care leadership business, no health care leadership literature in LTC literature in LTC
First leadership literature in 2002First leadership literature in 2002 Grounded in business literatureGrounded in business literature Identified important organizational Identified important organizational
elements elements
Susan D. Gilster, PhDSusan D. Gilster, PhD
Leadership ModelLeadership Model
Long-term care administrator researchLong-term care administrator research Popular leadership concepts – Administrator Popular leadership concepts – Administrator
perspectives- 2004perspectives- 2004 Knew what they should be doing but did not Knew what they should be doing but did not
know HOWknow HOW
Consistent with research, National Quality Consistent with research, National Quality Award Criteria and Baldridge CriteriaAward Criteria and Baldridge Criteria
Susan D. Gilster, PhDSusan D. Gilster, PhD
Service Oriented Leadership Service Oriented Leadership ModelModel
S.E.R.V.I.C.E.S.E.R.V.I.C.E. S S ervice (Greenleaf, Blanchard, Kouzes…)ervice (Greenleaf, Blanchard, Kouzes…) E E ducation (Deming, Crosby…..)ducation (Deming, Crosby…..) R R espect (Annison, Longest…)espect (Annison, Longest…) V V ision (Senge, Kouzes…)ision (Senge, Kouzes…) I I nclusion (Collins, Wheatley, Autry…)nclusion (Collins, Wheatley, Autry…) C C ommunication (Helgesen, Goleman……..)ommunication (Helgesen, Goleman……..) E E nrichment (Conger, Bennis, DuPree, nrichment (Conger, Bennis, DuPree,
Jawarski…..)Jawarski…..)
Susan D. Gilster, PhDSusan D. Gilster, PhD
S.E.R.V.I.C.E. Leadership S.E.R.V.I.C.E. Leadership ModelModel
Service: Using all gifts & talents to Service: Using all gifts & talents to serve others & the visionserve others & the vision
Working for a purpose higher than self; serving others rather than being served; Working for a purpose higher than self; serving others rather than being served; being a servant, teacher, coach mentor; living by the Golden Rule; valuing the being a servant, teacher, coach mentor; living by the Golden Rule; valuing the empowerment & growth of others; taking personal ownership of work, caring empowerment & growth of others; taking personal ownership of work, caring about othersabout others
Education: Valuing & promoting Education: Valuing & promoting education & learning as a lifelong education & learning as a lifelong process for self and othersprocess for self and others
Being skilled, knowledgeable, the best for self/others; providing mentoring/role Being skilled, knowledgeable, the best for self/others; providing mentoring/role modeling; preparing staff for their roles; facilitating ongoing modeling; preparing staff for their roles; facilitating ongoing personal/professional education/support; challenging/encouraging others to personal/professional education/support; challenging/encouraging others to achieve; choosing education over discipline; collective learningachieve; choosing education over discipline; collective learning
Respect: Valuing & promoting Respect: Valuing & promoting respect, dignity & personhood of respect, dignity & personhood of othersothers
Establishing respect as core value; conducting discussions in private space, Establishing respect as core value; conducting discussions in private space, maintaining fair, consistent practices; treating all with respect; maintaining fair, consistent practices; treating all with respect; recognizing/celebrating accomplishments; giving creditrecognizing/celebrating accomplishments; giving credit
Vision: Creating a total picture of Vision: Creating a total picture of what you dream of developing what you dream of developing including guiding principles & including guiding principles & valuesvalues
Creating vision, mission & philosophy, being the best; establishing guiding Creating vision, mission & philosophy, being the best; establishing guiding principles, values; looking at the whole vs. part; long-term & short-term planning principles, values; looking at the whole vs. part; long-term & short-term planning vs. reacting to daily crisis; keeping the vision alive.vs. reacting to daily crisis; keeping the vision alive.
Inclusion: Involving everyone as a Inclusion: Involving everyone as a partner in the evolution & partner in the evolution & progression of the projectprogression of the project
Respecting, appreciating, recognizing input/contribution of others; staying Respecting, appreciating, recognizing input/contribution of others; staying connected to staff; seeking right persons/trusting them; communicating connected to staff; seeking right persons/trusting them; communicating expectations/requiring accountability; creating formal & informal dialogueexpectations/requiring accountability; creating formal & informal dialogue
Communication: establishing an Communication: establishing an environment involving the active environment involving the active interchange of ideas & interchange of ideas & expectationsexpectations
Communicating expectations/information to staff; remaining open and listening Communicating expectations/information to staff; remaining open and listening to comments, concerns/suggestions; creating opportunities to dialogue re: new to comments, concerns/suggestions; creating opportunities to dialogue re: new programs/innovations/solutions; surveying for initiativesprograms/innovations/solutions; surveying for initiatives
Enrichment: Generating self Enrichment: Generating self knowledge & conducting ongoing knowledge & conducting ongoing work with your self/spiritwork with your self/spirit
Knowing who you and/what makes you tick; performing with integrity, Knowing who you and/what makes you tick; performing with integrity, maintaining personal values; listening to inner voice/intuition; being open, maintaining personal values; listening to inner voice/intuition; being open, having confidence/trusting in own ability; taking risks, creating “balance” in your having confidence/trusting in own ability; taking risks, creating “balance” in your life, maintaining self through contemplation, reflectionlife, maintaining self through contemplation, reflection
Susan D. Gilster, PhDSusan D. Gilster, PhD
ResearchResearch
Consulting in Continuing Care CommunityConsulting in Continuing Care Community Facility in troubleFacility in trouble Administrator turnover – 1-2 yearsAdministrator turnover – 1-2 years Attractive building and good location Attractive building and good location
(1987)(1987) Census – up and downCensus – up and down High staff turnoverHigh staff turnover High utilization of agency staffHigh utilization of agency staff
Susan D. Gilster, PhDSusan D. Gilster, PhD
Research MethodResearch Method
Involved in Administrator selection Involved in Administrator selection prior to studyprior to study
Identified an Administrator with Identified an Administrator with SERVICE orientationSERVICE orientation
Administrator familiar with SERVICE Administrator familiar with SERVICE model but was not given instruction model but was not given instruction on how or what to implementon how or what to implement
Susan D. Gilster, PhDSusan D. Gilster, PhD
Research MethodResearch Method
Staff and family satisfaction surveys Staff and family satisfaction surveys conducted prior to announcement of the conducted prior to announcement of the hiring of new administratorhiring of new administrator
Staff surveys were conducted at baseline, 3 Staff surveys were conducted at baseline, 3 & 6 months, and at 1 year& 6 months, and at 1 year
Staff surveys – anonymous, placed in Staff surveys – anonymous, placed in sealed boxsealed box
Staff listed department only-no namesStaff listed department only-no names Family surveys at baseline-to PO Box Family surveys at baseline-to PO Box
Susan D. Gilster, PhDSusan D. Gilster, PhD
Staff Survey InstrumentStaff Survey Instrument
Consistent survey each sessionConsistent survey each session Consisted of:Consisted of:
Assigned work (10)Assigned work (10) Work conditions (8)Work conditions (8) Facility policies & procedures (9)Facility policies & procedures (9) Relationships with others (16)Relationships with others (16) Training and education (5)Training and education (5) Overall satisfaction and referral (5)Overall satisfaction and referral (5) Open ended questions (6)Open ended questions (6)
Susan D. Gilster, PhDSusan D. Gilster, PhD
ResultsResults
Return/Participation Rates:Return/Participation Rates:
Staff – All departmentsStaff – All departments 77% (n=118) at baseline 77% (n=118) at baseline (5 days)(5 days) 78% (n=119) at 3 months (2 days)78% (n=119) at 3 months (2 days) 70% (n=116) at 6 months (2 days)70% (n=116) at 6 months (2 days) 75% (n=119) at 1 year (2 days)75% (n=119) at 1 year (2 days)
Families – 63% (n=116) at baselineFamilies – 63% (n=116) at baseline
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Assigned Work About Your Assigned Work (10)(10)
About your assigned work:About your assigned work: Very Very HappyHappy
HappyHappy UnhappUnhappyy
Very Very UnhappyUnhappy
Amount of responsibility…Amount of responsibility…
3.08*3.08*2.912.91
Ability to make decisions…Ability to make decisions… 3.093.09
3.20*3.20*
Understanding of my part in care…Understanding of my part in care… 3.263.26
3.35*3.35*
What is expected of me…What is expected of me… 3.113.11
3.21*3.21*
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Assigned Work About Your Assigned Work (10)(10)
About your assigned work:About your assigned work: Very Very HappyHappy
HappyHappy UnhappUnhappyy
Very Very UnhappyUnhappy
My part in defining My part in defining purpose/direction…purpose/direction… 3.05*3.05*
2.912.91
Importance of work…Importance of work… 3.373.37
3.43*3.43*
Ability to use trainingAbility to use training 3.283.28
3.34*3.34*
Ability to use talents…Ability to use talents… 3.263.26
3.38*3.38*
Ability to do different things…Ability to do different things… 3.133.13
3.21*3.21*
Perform to professional Perform to professional standards…standards…
3.013.01
3.30*3.30*
Susan D. Gilster, PhDSusan D. Gilster, PhD
Assigned Work CommentsAssigned Work Comments
Baseline Comments:Baseline Comments: Themes - Lack of respect and communicationThemes - Lack of respect and communication ““I’m just a clerk”I’m just a clerk” ““We are not heard a lot of the time”We are not heard a lot of the time”
12 Month Comments:12 Month Comments: Themes – Responsibilities and communicationThemes – Responsibilities and communication ““I feel as if I am given room to do my job”I feel as if I am given room to do my job” ““It’s a big improvement since last year”It’s a big improvement since last year”
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Work Conditions About Your Work Conditions (8)(8)
About your work conditions:About your work conditions: Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Amount of work assigned…Amount of work assigned… 2.562.56
2.58*2.58*
Number of staff assigned…Number of staff assigned… 2.442.44
2.51*2.51*
Time to complete work…Time to complete work… 2.742.74
2.88*2.88*
Recognition I receive…Recognition I receive… 2.442.44
2.73*2.73*
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Work Conditions About Your Work Conditions (8)(8)
About your work conditions:About your work conditions: Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Help/direction…Help/direction… 2.742.74
2.90*2.90*
Participate in care decisions…Participate in care decisions… 2.862.86
2.95*2.95*
Equipment/supplies…Equipment/supplies… 2.732.73
2.87*2.87*
Feelings of safety…Feelings of safety… 3.033.03
3.11*3.11*
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Facility About Facility Policies/Procedures (9)Policies/Procedures (9)
About facility policies/procedures…About facility policies/procedures… Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Chance to move up…Chance to move up… 2.652.65
2.68*2.68*
Uniform allowance…Uniform allowance… 2.802.80
2.79*2.79*
Wages/pay…Wages/pay… 2.442.44
2.51*2.51*
Profit Sharing plan…Profit Sharing plan… 2.752.75
2.78*2.78*
Job is secure…Job is secure… 2.512.51
2.54*2.54*
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Facility About Facility Policies/Procedures (9)Policies/Procedures (9)
About facility policies/procedures…About facility policies/procedures… Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Personal time off…Personal time off… 2.712.71
2.79*2.79*
Yearly review process…Yearly review process… 2.722.72
2.71*2.71*
Disciplinary process…Disciplinary process… 2.532.53
2.66*2.66*
How well communicated…How well communicated… 2.462.46
2.58*2.58*
Susan D. Gilster, PhDSusan D. Gilster, PhD
Policy/Procedure CommentsPolicy/Procedure Comments
Baseline Comments:Baseline Comments: ““HR is too one-sided when you disagree with mg”HR is too one-sided when you disagree with mg” Applies to a select few, all rules are not for everyone.”Applies to a select few, all rules are not for everyone.” ““Wondering everyday if I will get that phone call – fired Wondering everyday if I will get that phone call – fired
with no just cause”with no just cause”
12 Month Comments:12 Month Comments: ““Communication is still an issue at time, but I feel Communication is still an issue at time, but I feel
attempts are being made to improve things”attempts are being made to improve things” ““Not unhappy with policy communication but I think we Not unhappy with policy communication but I think we
could do better”could do better” ““Uncertain with job security – with the loss of long Uncertain with job security – with the loss of long
term employees”term employees”
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Relationship with About Your Relationship with Others (15)Others (15)
About your relationship with About your relationship with others…others…
Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Respect from my departmentRespect from my department 3.063.06
3.19*3.19*
Respect from other Respect from other departments…departments… 3.05*3.05*
2.972.97
Respect from my shift…Respect from my shift… 3.093.09
3.16*3.16*
Other staff listen…Other staff listen… 2.862.86
2.96*2.96*
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Relationship with About Your Relationship with Others (15)Others (15)
About your relationship with About your relationship with others…others…
Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Respect from supervisor…Respect from supervisor…
3.10*3.10*2.902.90
Respect from families…Respect from families… 3.423.42
3.33*3.33*
Families listen…Families listen… 3.353.35
3.26*3.26*
Compliments from supervisor…Compliments from supervisor…
3.02*3.02*2.732.73
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Relationship with About Your Relationship with Others (15)Others (15)
About your relationship with About your relationship with others…others…
Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Relationship with residents…Relationship with residents… 3.713.71
3.59*3.59*
Feeling part of team…Feeling part of team…
3.13*3.13*2.972.97
Feeling others care…Feeling others care…
3.05*3.05*2.912.91
Emotional support…Emotional support… 2.822.82
2.99*2.99*
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Relationship with About Your Relationship with Others (15)Others (15)
About your relationship with About your relationship with others…others…
Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Availability of administrators…Availability of administrators… 2.602.60
2.95*2.95*
Availability of department Availability of department heads…heads…
2.642.64
2.95*2.95*
Administrator openness…Administrator openness… 2.422.42
2.87*2.87*
Susan D. Gilster, PhDSusan D. Gilster, PhD
Relationship with OthersRelationship with Others
Baseline Comments:Baseline Comments: ““Supervisors don’t listen to aids even though your right…Supervisors don’t listen to aids even though your right…
nothing is right but what they say”nothing is right but what they say” ““We never got to hear or see the Administrator.”We never got to hear or see the Administrator.” ““I don’t even know who the Administrator is.”I don’t even know who the Administrator is.”
12 Month Comments:12 Month Comments: ““The teamwork and communication between staff is very The teamwork and communication between staff is very
good. Administration is very friendly and supportive and good. Administration is very friendly and supportive and encouraging”encouraging”
The relationship between all staff is so much better. I The relationship between all staff is so much better. I don’t feel the stress when coming to work each day. don’t feel the stress when coming to work each day. What a change!”What a change!”
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Training/Education About Your Training/Education (5)(5)
About your training/education…About your training/education… Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Job preparation/orientation…Job preparation/orientation… 2.762.76
2.83*2.83*
Regular staff meetings…Regular staff meetings… 2.672.67
2.78*2.78*
Chance to learn from others…Chance to learn from others…
3.00*3.00*2.872.87
Susan D. Gilster, PhDSusan D. Gilster, PhD
About Your Training/Education About Your Training/Education (5)(5)
About your training/education…About your training/education… Very Very HappyHappy
HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy
Inservices/ongoing training…Inservices/ongoing training… 2.772.77
2.89*2.89*
Chance to learn new things…Chance to learn new things… 2.782.78
2.97*2.97*
Susan D. Gilster, PhDSusan D. Gilster, PhD
Training/Education Training/Education CommentsComments
Baseline Comments:Baseline Comments: Lack of communication, disorganization when education Lack of communication, disorganization when education
is offeredis offered ““I’m just a clerk”I’m just a clerk” ““Only one good day”Only one good day”
12 Month Comments:12 Month Comments: ““Going forward. Much better than a year ago.”Going forward. Much better than a year ago.” When I started the orientation was almost non-When I started the orientation was almost non-
existent. Now the employees get a wonderful existent. Now the employees get a wonderful orientationorientation.”.”
The P.I.E. program is great!”The P.I.E. program is great!”
Susan D. Gilster, PhDSusan D. Gilster, PhD
Overall Statements (5)Overall Statements (5)
StatementStatement Strongly Strongly AgreeAgree
AgreeAgree DisagreeDisagree Strongly Strongly DisagreeDisagree
Satisfied with my job…Satisfied with my job…
3.09*3.09*2.972.97
Proud of work…Proud of work… 3.633.63
3.57*3.57*
Making a difference…Making a difference… 3.553.55
3.55*3.55*
Susan D. Gilster, PhDSusan D. Gilster, PhD
Overall Statements (5)Overall Statements (5)
StatementStatement Strongly Strongly AgreeAgree
AgreeAgree DisagreeDisagree Strongly Strongly DisagreeDisagree
Would advise a friend to Would advise a friend to apply…apply…
2.892.89
2.99*2.99*
Think of changing jobs…Think of changing jobs… 2.462.46
2.26*2.26*
Susan D. Gilster, PhDSusan D. Gilster, PhD
What I want most from my What I want most from my job…job…
Baseline and 12 month themes: Baseline and 12 month themes: Respect, appreciation, fairness, Respect, appreciation, fairness,
serving others, education, serving others, education, communication, pay, health benefits, communication, pay, health benefits, teamwork, a voice, support when teamwork, a voice, support when someone dies.someone dies.
Susan D. Gilster, PhDSusan D. Gilster, PhD
Additional CommentsAdditional Comments
Most started with a positive commentMost started with a positive comment ““There is a wonderful feeling here…a great ‘vibe’.”There is a wonderful feeling here…a great ‘vibe’.” ““I feel ___ have come along some but we’re not I feel ___ have come along some but we’re not
there yet”there yet” ““I believe that many positive changes and strides I believe that many positive changes and strides
have been made within the company.”have been made within the company.”
““I would like to hear results”I would like to hear results”
““It is great to do research if it effects change”It is great to do research if it effects change”
Susan D. Gilster, PhDSusan D. Gilster, PhD
If I could do anything in the If I could do anything in the world I would…world I would…
Over 50% would stay in healthcare, but Over 50% would stay in healthcare, but perhaps in a different role/capacity.perhaps in a different role/capacity.
Cruise director, talk show hostCruise director, talk show host Open a businessOpen a business Write a bookWrite a book Fashion designerFashion designer Professional bass fishermanProfessional bass fisherman
Susan D. Gilster, PhDSusan D. Gilster, PhD
Family SurveyFamily Survey
63% participation (n=116)63% participation (n=116)
Overall, families satisfiedOverall, families satisfied
Majority answered in “Agree” Majority answered in “Agree” categorycategory
Susan D. Gilster, PhDSusan D. Gilster, PhD
InterventionsInterventions
Administrator had no instruction or Administrator had no instruction or advice from researchers – complete advice from researchers – complete freedom.freedom.
Interventions were recorded by the Interventions were recorded by the administrator over the 12 month administrator over the 12 month period.period.
Susan D. Gilster, PhDSusan D. Gilster, PhD
Specific InterventionsSpecific Interventions
Service, Vision/Mission, Education, Service, Vision/Mission, Education, Communication, Inclusion, RespectCommunication, Inclusion, Respect
Resident Centered Culture-top/modelResident Centered Culture-top/model Stopped smoking at front entranceStopped smoking at front entrance Grievance CommitteesGrievance Committees Satisfaction surveysSatisfaction surveys More selective dining for residentsMore selective dining for residents Dept Mg/Nursing offices in resident areasDept Mg/Nursing offices in resident areas Routine staff meetings-eventually all shiftsRoutine staff meetings-eventually all shifts Multiple mechanisms to communicateMultiple mechanisms to communicate
Susan D. Gilster, PhDSusan D. Gilster, PhD
One step forward, TEN steps One step forward, TEN steps back?back?
At month 10 of intervention, At month 10 of intervention, “corporate” wants involved…“corporate” wants involved… Employee complaintsEmployee complaints Long-term employee resignedLong-term employee resigned Manager resigned but told to leave, not Manager resigned but told to leave, not
necessary to work out 30 day noticenecessary to work out 30 day notice Corporate Director wants to interview staffCorporate Director wants to interview staff Want to view staff surveys and resultsWant to view staff surveys and results
Susan D. Gilster, PhDSusan D. Gilster, PhD
One step forward, TEN steps One step forward, TEN steps back?back?
Meeting held with Administrator, Meeting held with Administrator, Research, and Corporate TeamResearch, and Corporate Team Don’t undo all progress to dateDon’t undo all progress to date Don’t undermine AdministratorDon’t undermine Administrator Integrity of research, promise of Integrity of research, promise of
confidentialityconfidentiality If you always do what you have always If you always do what you have always
done you will always get what you always done you will always get what you always gotgot
Susan D. Gilster, PhDSusan D. Gilster, PhD
MAKE OR BREAKMAKE OR BREAKMomentMoment
Huge turning point in future of facilityHuge turning point in future of facility
Prevent history from repeating itselfPrevent history from repeating itself
12 month results are proof that 12 month results are proof that success in around the corner if we success in around the corner if we stay the coursestay the course
Susan D. Gilster, PhDSusan D. Gilster, PhD
Census, Financial, Agency & Census, Financial, Agency & StaffStaff
Changes in past 12-15 months:Changes in past 12-15 months:
Moderate Increase in censusModerate Increase in census
Small drop in agency utilizationSmall drop in agency utilization
Susan D. Gilster, PhDSusan D. Gilster, PhD
Census, Financial, Agency & Census, Financial, Agency & StaffStaff
Baseline - Most critical was the hiring/turnoverBaseline - Most critical was the hiring/turnover Hiring 8-24/month, average of 16 per monthHiring 8-24/month, average of 16 per month Terminating 10-19/month, average 14 per monthTerminating 10-19/month, average 14 per month $5,000 per employee = $853,000 per year$5,000 per employee = $853,000 per year
12 Months12 Months Hiring decreased, average 13/month from a high Hiring decreased, average 13/month from a high
average of 24/monthaverage of 24/month Terminations decreased, average 12/month from a Terminations decreased, average 12/month from a
high average of 17/monthhigh average of 17/month
Susan D. Gilster, PhDSusan D. Gilster, PhD
Changes in 18 monthsChanges in 18 months
Turnover in the Turnover in the single digitssingle digits
Agency utilization-rareAgency utilization-rare
Census-now fullCensus-now full
Financials-greatly improvedFinancials-greatly improved
Susan D. Gilster, PhDSusan D. Gilster, PhD
ConclusionsConclusions
In desire to transform the long-term care In desire to transform the long-term care industry, leadership cannot be overlookedindustry, leadership cannot be overlooked
Leaders need to be facilitators - or get out Leaders need to be facilitators - or get out
of the wayof the way Transformation and culture change require Transformation and culture change require
an organizational approachan organizational approach Answer is not found in a single program or Answer is not found in a single program or
departmentdepartment
Susan D. Gilster, PhDSusan D. Gilster, PhD
ConclusionConclusion
It takes time - culture transformation It takes time - culture transformation will not happen overnightwill not happen overnight
Culture change is about people Culture change is about people change - not items or physical change - not items or physical environment aloneenvironment alone
We don’t have a culture crisis - we We don’t have a culture crisis - we have a leadership crisishave a leadership crisis
Susan D. Gilster, PhDSusan D. Gilster, PhD
RecommendationsRecommendations
Area for further study/researchArea for further study/research Research on the impact that Research on the impact that
leadership plays in long-term careleadership plays in long-term care Education and training for long-term Education and training for long-term
care administrators and managers in care administrators and managers in leadership and organizational leadership and organizational developmentdevelopment