This Work…

1. What A Difference Management Makes!Operationalizing High-Performance Human Resource Management Practices 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-082006-2

2. This Work… • Integrates the research and teaching of Susan C. Eaton with the quality improvement work of Quality Partners of Rhode Island and field work and teaching of B&F Consulting

3. Susan C. Eaton

4. About Susan Eaton • PhD from MIT’s Sloan School • Taught graduate courses in human resource management • Researched impact of high performance human resource management practices in nursing homes

5. Susan’s Research from 1997 – 2003 • Pennsylvania's Nursing Homes: Promoting Quality Care and Quality Jobs, Keystone Research Center 1997 • Beyond ‘Unloving Care:’ Linking Human Resource Management and Patient Care Quality in Nursing Homes; June 2000 • Extended Care Career Ladder Initiative (ECCLI), Massachusetts, 2001 • What a difference management makes!, CMS 2002 • Improving Institutional Long-Term Care for Residents and Workers: The Effect of Leadership, Relationships and Work Design, for Better Jobs, Better Care, 2003

6. PA Study links Quality Job and Quality Care Links Pioneer Practices with HR Management Practices Organizational Approach is key factor in success of Career Ladders Management is the Determinant in High and Low Turnover What leadership practices improve QJ & QC? 2000 2001 2002 2003 Susan’s research applied “High Performance Human Resource Management Practices” to Long-Term Care 1997

7. Sphere of Influence • ECCLI • DCWI • Pioneer Network • Direct Care Workers Alliance • Better Jobs, Better Care

8. The Science & Psychology of Change Science of Change: Quality Improvement Practices Root-cause analysis Small pilot-tests Evaluation and Re-evaluation Mid-course adjustments Evidence-based solutions Collaborative Learning, Spread

9. The Science & Psychology of Change Psychology of Change: Relationship-Based Practices Build on Intrinsic Motivation Holistic Approach - Personalize Start where people are Build capacity for change Experiential learning Climate Where Truth is Heard

10. 168 NH Participants 86 NH Participants

12. Five Management Practices Associated with High Retention, Attendance and 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 Concepts Experiential Exercises Practical Examples Homework Drill downs Change Ideas Eaton, 2002

14. Outcomes of INHC – WFR • Results in 9 months from 4 MPQ’s with a total of 55 SNFs • Nursing Department (RN, LPN, CNA) turnover rates: • Relative change = -10% • Annualized = 196 fewer terminations • Annualized direct-cost savings = $490,000

15. INHC - WFR Collaborative • Results from 95 SNFs • Impact on Quality Measures • Comparing Quarter 1 2004 to Quarter 1 2005: • Pain – chronic care population • Dropped from 6.32 to 5.44 • Greatest impact – Physical Restraints • Dropped from 6.51 to 5.94 • 66% of all SNFs had a decline • 4 dropped to 0%

16. Adult Learning Methods • Experiential Learning • Reflection on experiences you bring and on experiences created in the room