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Outcomes of a Leadership Intervention in Long-Term Care Q-3 Tuesday, October 9, 2007

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

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Susan D. Gilster, PhD

  7. 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

  8. S.E.R.V.I.C.E. Leadership Model Susan D. Gilster, PhD

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. About Your Assigned Work (10) Susan D. Gilster, PhD

  15. About Your Assigned Work (10) Susan D. Gilster, PhD

  16. 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

  17. About Your Work Conditions (8) Susan D. Gilster, PhD

  18. About Your Work Conditions (8) Susan D. Gilster, PhD

  19. About Facility Policies/Procedures (9) Susan D. Gilster, PhD

  20. About Facility Policies/Procedures (9) Susan D. Gilster, PhD

  21. 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

  22. About Your Relationship with Others (15) Susan D. Gilster, PhD

  23. About Your Relationship with Others (15) Susan D. Gilster, PhD

  24. About Your Relationship with Others (15) Susan D. Gilster, PhD

  25. About Your Relationship with Others (15) Susan D. Gilster, PhD

  26. 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

  27. About Your Training/Education (5) Susan D. Gilster, PhD

  28. About Your Training/Education (5) Susan D. Gilster, PhD

  29. 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

  30. Overall Statements (5) Susan D. Gilster, PhD

  31. Overall Statements (5) Susan D. Gilster, PhD

  32. 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

  33. 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

  34. 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

  35. Family Survey • 63% participation (n=116) • Overall, families satisfied • Majority answered in “Agree” category Susan D. Gilster, PhD

  36. 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

  37. 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

  38. 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

  39. 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

  40. 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

  41. Census, Financial, Agency & Staff • Changes in past 12-15 months: • Moderate Increase in census • Small drop in agency utilization Susan D. Gilster, PhD

  42. 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

  43. Changes in 18 months • Turnover in the single digits • Agency utilization-rare • Census-now full • Financials-greatly improved Susan D. Gilster, PhD

  44. 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

  45. 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

  46. 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

  47. Why is This Important?

  48. Susan D. Gilster, PhD

  49. Susan D. Gilster, PhD

  50. Susan D. Gilster, PhD

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