a strategic operational approach to staff retention

7/29/2019 A Strategic Operational Approach to Staff Retention

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A Strategic Operational Approachto Staff Retention

Susan Gilster, PhD, [email protected]

www.alois.com

www.careleadership.com
mailto:[email protected]://www.alois.com/http://www.alois.com/mailto:[email protected]


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Susan D. Gilster, PhD


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Turnover in LTC

Most report 40-400% annually in AL/NF

Turnover Adm-43%, DON 38%, RNs41%, LPNs 50%, CNAs 66% (AHCA 07)

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

Fluctuates somewhat with economy butwill continue to get worse


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Cost of Turnover

Cost $2,000, 5,000, $11,000 per employee andas much as 150% of employees annual totalcompensation-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


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Real Cost of Staff Turnover

CCRC with 235 resident accommodations

DON @ 150% of $75,000=$112,500

RNs 16 (41%) 6.5 leave @ 150% of$43,000=$419,250

LPNs 28 (50%) 14 leave @ 150% of$37,000=$777,000

CNAs 72 (66%) 47.5 leave@ $5000 =$237,599 TOTAL=$1,546,349.00 per year


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Real Cost of Staff Turnover

NF with 102 room accommodations

DON @150 % $75,000=$112,500

6 RNs 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


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NHA-Staff Turnover-Castles

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


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Staff-Research-what do we know?

You cannot buy quality staff: moneycomes in 3rd or 4th on most surveys andhas done so for the past few decades

Staff satisfaction leads to resident andfamily satisfaction which leads to a highercensus and improved financials


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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


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Organizational/Leadership FrameworksBusiness 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


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Susan D. Gilster, PhDSusan D. Gilster, PhD

Key to Retention is anOrganizational Model

All leadership models speak to quality-service

All address education and learning as anongoing necessary process

Open, honest and routine communication Leaders are only as good as the people they

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

Organizationally driven, staff take over tasksallowing leaders to lead


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Strategic Operational ApproachS.E.R.V.I.C.E

Service (Greenleaf, Blanchard, Kouzes)

Education (Deming, Crosby, Teresi..)

Respect (Annison, Longest, Palmer)

Vision (Senge, Kouzes, Buckingham)

Inclusion (Collins, Wheatley, Autry)

Communication (Helgesen, Goleman..)

Enrichment (Conger, Bennis, DuPree)


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Successful Staff Selection

Choose only those whose beliefs areconsistent with vision, values

Person vs. experience-I can teach skills,but cant teach someone to care

Expectation wear all hats do whatever ittakes

High standards and expectations


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Role of Vision

Vision is a dream, mental image of whatcreating

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 thingand leave

Vision encourages interdepartmental teamwork


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Job Preparation and Orientation

Cannot assume that employees knowwhat to do or what you expect

Orientation-mandatory regardless oflength of time in field

History, vision, service, departmentalroles, performance expectations-workingwith the best


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Ongoing Education and Support

They will not learn all they need to know inorientation

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-enhancesinterdepartmental work


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RESPECT

Lack of respect is repeatedly mentioned instaff satisfaction surveys

A lack of respect is often why staff leave

Respect for all-staff to residents & familiesStaff to staff, families to staff

Respect does not cost anything simplycommitment


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Inclusion-Participation & Ownership

Employees want a voice in theorganization

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


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COMMUNICATION

Communication is critical-but often getsthe least emphasis and attention

How do staff know how to contribute ifthey do not know what is happening

Open, honest, invite critique, differingopinions make organizations stronger

Sustainable, routine, all inclusive meetings


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ENRICHMENT

Leaders, managers and staff need to seekself-awareness, know what is important tothem 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


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Recognizing and CelebratingAccomplishments

Recognize staff accomplishments-skills,education, kindness, thoughtfulness

Seize every opportunity to recognizeexceptional acts and staff in the facility

Local community, state, nationalmultiple

opportunities Not all facilities take the time to apply


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Celebrations cont.

Planned and spontaneous events

Special days, Bengals, Reds, Openingday, 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 somethingelse


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SERVICE Model as an Intervention

Two facilities-both CCRCs-200+accomodations

Facility A-Administrator turnover q 1-2 yrs-

new Administrator-inconsistentcommitment

Facility B-Administrator in organization in

various roles for 13 yrsconsistentcommitment and reinforcement


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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, agencyutilization, 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


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Respect from supervisor

2.7

2.8

2.9

3

3.13.2

3.3

3.4

3.5

Baseline 3

months

6

months

9

months

1 year

AB

C


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Compliments from supervisor

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

Baseline 3

months

6

months

9

months

1 year

AB

C


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Respect from my department

2.9

3

3.1

3.2

3.3

3.4

Baseline 3

months

6

months

9

months

1 year

AB

c


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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

A

B

C


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Respect from other departments

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3


A

B

C


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Know making a difference

3.3

3.4

3.5

3.6

3.7

3.8


A

B

C


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Job prep at orientation

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5


A

B

C


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Frequency of ongoinginservice/education

2.5

2.6

2.7

2.8

2.9

33.1

3.2

3.3

3.4

3.5


A

B

C


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Feeling part of team

2.7

2.8

2.9

3

3.13.2

3.3

3.4

3.5


A

B

C


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Frequency of staff meetings

2.4

2.52.6

2.7

2.82.9

33.1

3.2

3.3

3.4

3.5


A

B

C


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Availability of Administrators

2.4

2.52.6

2.7

2.82.9

33.1

3.2

3.3

3.4

3.5


A

B

C


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Wages/pay received

2

2.1

2.2

2.3

2.4

2.52.6

2.7

2.8

2.9

3


A

B

C


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Overall satisfaction

2.7

2.8

2.9

3

3.1

3.23.3

3.4

3.5

3.6

3.7


AB

C


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Would advise friend to apply

2.5

2.6

2.7

2.8

2.9

33.1

3.2

3.3

3.4

3.5


AB

C


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I think of changing jobs

1.71.81.9

22.12.22.32.42.5

2.62.72.82.9

3


AB

C


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Census and Finances

Facility A-end of the first year

Highest census ever

Decreased turnover, decreased agency use

Increased staff satisfaction-statistically significant atone year

Facility B

Maintained a high census,

Staff satisfaction continued on upward trend,

Cut turnover in half, decreased agency


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Facility C

Census has been maintained for years-currentlyundergoing second expansion

Staff satisfaction remains high-continuous effort

(53 item survey, 90% response rate=3.4average out of 4 very happy and 3.6 for overallsatisfaction)

Family satisfaction very high (84 item

survey,75% response rate=3.8 out of 4 veryhappy and 3.8 for willing to recommend)


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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 projectedsavings of $1,120,000.00

Decreased agency use

Facility C

Turnover single digits for years No agency use


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Impact of model on staff turnover

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

year

Decreased agency by tens of thousandsdollars

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


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Lessons learned

Organizational operational approachaddresses staff desires enhancessatisfaction & retention

Millions of dollars are lost each year instaff turnover and related costs

Sustainability is key-do not start and stop

programs


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Conclusion (cont)

MOST IMPORTANT

Impact on the people we serve, theirquality of life and happiness

Impact on the families, they are secure inknowing that their family members arecared by consistent staff, happy and loved

For staff who deserve respect, dignity, aquality place in which to work

a strategic operational approach to staff retention

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