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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 Susang@hcmg.com www.careleadership.com. Our Belief:.
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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 Susang@hcmg.com www.careleadership.com
Our Belief: • Creating a successful workforce takes an organizational approach, thus it is leadership driven • Leadership is key to the success of any organization. It is critical in the recruitment and retention of staff. • Leadership is in the hands of the person who is at the top, the administrator, executive director, CEO, etc. It will not happen without their blessing. Susan D. Gilster, PhD
Leaders in Long-Term Care • The Administrator is the one who leads the organization – license on the line. • Like it or not, they determine what happens in the facility. • While the President or CEO of a corporation might set the agenda, the Administrator puts the plan into operation-OR NOT Susan D. Gilster, PhD
Leadership Model • Qualitative, historical case study • Extensive review of literature-business, no health care leadership literature in LTC • First leadership literature in 2002 • Grounded in business literature • Identified important organizational elements Susan D. Gilster, PhD
Leadership Model • Long-term care administrator research • Popular leadership concepts – Administrator perspectives- 2004 • Knew what they should be doing but did not know HOW • Consistent with research, National Quality Award Criteria and Baldridge Criteria Susan D. Gilster, PhD
Service Oriented Leadership ModelS.E.R.V.I.C.E. • S ervice (Greenleaf, Blanchard, Kouzes…) • E ducation (Deming, Crosby…..) • R espect (Annison, Longest…) • V ision (Senge, Kouzes…) • I nclusion (Collins, Wheatley, Autry…) • C ommunication (Helgesen, Goleman……..) • E nrichment (Conger, Bennis, DuPree, Jawarski…..) Susan D. Gilster, PhD
S.E.R.V.I.C.E. Leadership Model Susan D. Gilster, PhD
Research • Consulting in Continuing Care Community • Facility in trouble • Administrator turnover – 1-2 years • Attractive building and good location (1987) • Census – up and down • High staff turnover • High utilization of agency staff Susan D. Gilster, PhD
Research Method • Involved in Administrator selection prior to study • Identified an Administrator with SERVICE orientation • Administrator familiar with SERVICE model but was not given instruction on how or what to implement Susan D. Gilster, PhD
Research Method • Staff and family satisfaction surveys conducted prior to announcement of the hiring of new administrator • Staff surveys were conducted at baseline, 3 & 6 months, and at 1 year • Staff surveys – anonymous, placed in sealed box • Staff listed department only-no names • Family surveys at baseline-to PO Box Susan D. Gilster, PhD
Staff Survey Instrument • Consistent survey each session • Consisted of: • Assigned work (10) • Work conditions (8) • Facility policies & procedures (9) • Relationships with others (16) • Training and education (5) • Overall satisfaction and referral (5) • Open ended questions (6) Susan D. Gilster, PhD
Results • Return/Participation Rates: • Staff – All departments • 77% (n=118) at baseline (5 days) • 78% (n=119) at 3 months (2 days) • 70% (n=116) at 6 months (2 days) • 75% (n=119) at 1 year (2 days) • Families – 63% (n=116) at baseline Susan D. Gilster, PhD
About Your Assigned Work (10) Susan D. Gilster, PhD
About Your Assigned Work (10) Susan D. Gilster, PhD
Assigned Work Comments • Baseline Comments: • Themes - Lack of respect and communication • “I’m just a clerk” • “We are not heard a lot of the time” • 12 Month Comments: • Themes – Responsibilities and communication • “I feel as if I am given room to do my job” • “It’s a big improvement since last year” Susan D. Gilster, PhD
About Your Work Conditions (8) Susan D. Gilster, PhD
About Your Work Conditions (8) Susan D. Gilster, PhD
About Facility Policies/Procedures (9) Susan D. Gilster, PhD
About Facility Policies/Procedures (9) Susan D. Gilster, PhD
Policy/Procedure Comments • Baseline Comments: • “HR is too one-sided when you disagree with mg” • Applies to a select few, all rules are not for everyone.” • “Wondering everyday if I will get that phone call – fired with no just cause” • 12 Month Comments: • “Communication is still an issue at time, but I feel attempts are being made to improve things” • “Not unhappy with policy communication but I think we could do better” • “Uncertain with job security – with the loss of long term employees” Susan D. Gilster, PhD
About Your Relationship with Others (15) Susan D. Gilster, PhD
About Your Relationship with Others (15) Susan D. Gilster, PhD
About Your Relationship with Others (15) Susan D. Gilster, PhD
About Your Relationship with Others (15) Susan D. Gilster, PhD
Relationship with Others • Baseline Comments: • “Supervisors don’t listen to aids even though your right…nothing is right but what they say” • “We never got to hear or see the Administrator.” • “I don’t even know who the Administrator is.” • 12 Month Comments: • “The teamwork and communication between staff is very good. Administration is very friendly and supportive and encouraging” • The relationship between all staff is so much better. I don’t feel the stress when coming to work each day. What a change!” Susan D. Gilster, PhD
About Your Training/Education (5) Susan D. Gilster, PhD
About Your Training/Education (5) Susan D. Gilster, PhD
Training/Education Comments • Baseline Comments: • Lack of communication, disorganization when education is offered • “I’m just a clerk” • “Only one good day” • 12 Month Comments: • “Going forward. Much better than a year ago.” • When I started the orientation was almost non-existent. Now the employees get a wonderful orientation.” • The P.I.E. program is great!” Susan D. Gilster, PhD
Overall Statements (5) Susan D. Gilster, PhD
Overall Statements (5) Susan D. Gilster, PhD
What I want most from my job… • Baseline and 12 month themes: • Respect, appreciation, fairness, serving others, education, communication, pay, health benefits, teamwork, a voice, support when someone dies. Susan D. Gilster, PhD
Additional Comments • Most started with a positive comment • “There is a wonderful feeling here…a great ‘vibe’.” • “I feel ___ have come along some but we’re not there yet” • “I believe that many positive changes and strides have been made within the company.” • “I would like to hear results” • “It is great to do research if it effects change” Susan D. Gilster, PhD
If I could do anything in the world I would… • Over 50% would stay in healthcare, but perhaps in a different role/capacity. • Cruise director, talk show host • Open a business • Write a book • Fashion designer • Professional bass fisherman Susan D. Gilster, PhD
Family Survey • 63% participation (n=116) • Overall, families satisfied • Majority answered in “Agree” category Susan D. Gilster, PhD
Interventions • Administrator had no instruction or advice from researchers – complete freedom. • Interventions were recorded by the administrator over the 12 month period. Susan D. Gilster, PhD
Specific Interventions Service, Vision/Mission, Education, Communication, Inclusion, Respect Resident Centered Culture-top/model • Stopped smoking at front entrance • Grievance Committees • Satisfaction surveys • More selective dining for residents • Dept Mg/Nursing offices in resident areas • Routine staff meetings-eventually all shifts • Multiple mechanisms to communicate Susan D. Gilster, PhD
One step forward, TEN steps back? • At month 10 of intervention, “corporate” wants involved… • Employee complaints • Long-term employee resigned • Manager resigned but told to leave, not necessary to work out 30 day notice • Corporate Director wants to interview staff • Want to view staff surveys and results Susan D. Gilster, PhD
One step forward, TEN steps back? • Meeting held with Administrator, Research, and Corporate Team • Don’t undo all progress to date • Don’t undermine Administrator • Integrity of research, promise of confidentiality • If you always do what you have always done you will always get what you always got Susan D. Gilster, PhD
MAKE OR BREAKMoment • Huge turning point in future of facility • Prevent history from repeating itself • 12 month results are proof that success in around the corner if we stay the course Susan D. Gilster, PhD
Census, Financial, Agency & Staff • Changes in past 12-15 months: • Moderate Increase in census • Small drop in agency utilization Susan D. Gilster, PhD
Census, Financial, Agency & Staff • Baseline - Most critical was the hiring/turnover • Hiring 8-24/month, average of 16 per month • Terminating 10-19/month, average 14 per month • $5,000 per employee = $853,000 per year • 12 Months • Hiring decreased, average 13/month from a high average of 24/month • Terminations decreased, average 12/month from a high average of 17/month Susan D. Gilster, PhD
Changes in 18 months • Turnover in the single digits • Agency utilization-rare • Census-now full • Financials-greatly improved Susan D. Gilster, PhD
Conclusions In desire to transform the long-term care industry, leadership cannot be overlooked • Leaders need to be facilitators - or get out of the way • Transformation and culture change require an organizational approach • Answer is not found in a single program or department Susan D. Gilster, PhD
Conclusion It takes time - culture transformation will not happen overnight • Culture change is about people change - not items or physical environment alone • We don’t have a culture crisis - we have a leadership crisis Susan D. Gilster, PhD
Recommendations • Area for further study/research • Research on the impact that leadership plays in long-term care • Education and training for long-term care administrators and managers in leadership and organizational development Susan D. Gilster, PhD