A Strategic Operational Approach to Staff Retention

1. A Strategic Operational Approach to Staff Retention Susan Gilster, PhD, FACHCA susang@hcmg.com www.alois.com www.careleadership.com

2. Susan D. Gilster, PhD

3. Turnover in LTC • Most report 40-400% annually in AL/NF • Turnover Adm-43%, DON 38%, RN’s 41%, LPN’s 50%, CNA’s 66% (AHCA 07) • Shortage of other personnel, nurses, dietary, housekeeping, activities… • Fluctuates somewhat with economy but will continue to get worse Susan D. Gilster, PhD

4. Cost of Turnover • Cost $2,000, 5,000, $11,000 per employee and as much as 150% of employees annual total compensation-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 Susan D. Gilster, PhD

5. Real Cost of Staff Turnover • CCRC with 235 resident accommodations • DON @ 150% of $75,000=$112,500 • RN’s 16 (41%) 6.5 leave @ 150% of $43,000=$419,250 • LPN’s 28 (50%) 14 leave @ 150% of $37,000=$777,000 • CNA’s 72 (66%) 47.5 leave@ $5000 =$237,599 • TOTAL=$1,546,349.00 per year Susan D. Gilster, PhD

6. Real Cost of Staff Turnover • NF with 102 room accommodations • DON @150 % $75,000=$112,500 • 6 RN’s 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 Susan D. Gilster, PhD

7. NHA-Staff Turnover-Castle’s • 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 Susan D. Gilster, PhD

8. Staff-Research-what do we know? • You cannot buy quality staff: money comes in 3rd or 4th on most surveys and has done so for the past few decades • Staff satisfaction leads to resident and family satisfaction which leads to a higher census and improved financials Susan D. Gilster, PhD

9. 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 Susan D. Gilster, PhD

10. Organizational/Leadership Frameworks Business and Health Care Susan D. Gilster, PhD

11. Key to Retention is an Organizational Model All leadership models speak to quality-service All address education and learning as an ongoing necessary process Open, honest and routine communication Leaders are only as good as the people they select, prepare, educate, include, respect and value, trust, nurture, support and monitor Organizationally driven, staff take over tasks allowing leaders to lead Susan D. Gilster, PhD Susan D. Gilster, PhD

12. Susan D. Gilster, PhD

13. Susan D. Gilster, PhD

14. Strategic Operational Approach S.E.R.V.I.C.E S ervice (Greenleaf, Blanchard, Kouzes…) E ducation (Deming, Crosby, Teresi…..) R espect (Annison, Longest, Palmer…) V ision (Senge, Kouzes, Buckingham…) I nclusion (Collins, Wheatley, Autry…) C ommunication (Helgesen, Goleman……..) E nrichment (Conger, Bennis, DuPree…) Susan D. Gilster, PhD Susan D. Gilster, PhD

15. Successful Staff Selection • Choose only those whose beliefs are consistent with vision, values • Person vs. experience-I can teach skills, but can’t teach someone to care • Expectation wear “all hats” do whatever it takes • High standards and expectations Susan D. Gilster, PhD

16. Role of Vision • Vision is a dream, mental image of “what” creating • 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 thing and leave • Vision encourages interdepartmental teamwork Susan D. Gilster, PhD

17. Job Preparation and Orientation • Cannot assume that employees know what to do or what you expect • Orientation-mandatory regardless of length of time in field • History, vision, service, departmental roles, performance expectations-working with the best Susan D. Gilster, PhD

18. Ongoing Education and Support • They will not learn all they need to know in orientation • 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-enhances interdepartmental work Susan D. Gilster, PhD

19. RESPECT Lack of respect is repeatedly mentioned in staff satisfaction surveys A lack of respect is often why staff leave Respect for all-staff to residents & families Staff to staff, families to staff Respect does not cost anything simply commitment Susan D. Gilster, PhD Susan D. Gilster, PhD

20. Inclusion-Participation & Ownership • Employees want a voice in the organization • 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 Susan D. Gilster, PhD

21. COMMUNICATION Communication is critical-but often gets the least emphasis and attention How do staff know how to contribute if they do not know what is happening Open, honest, invite critique, differing opinions make organizations stronger Sustainable, routine, all inclusive meetings Susan D. Gilster, PhD Susan D. Gilster, PhD

22. ENRICHMENT Leaders, managers and staff need to seek self-awareness, know what is important to them 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 Susan D. Gilster, PhD Susan D. Gilster, PhD

23. Recognizing and Celebrating Accomplishments • Recognize staff accomplishments-skills, education, kindness, thoughtfulness • Seize every opportunity to recognize exceptional acts and staff in the facility • Local community, state, national–multiple opportunities • Not all facilities take the time to apply Susan D. Gilster, PhD

24. Celebrations cont. • Planned and spontaneous events • Special days, Bengals, Reds, Opening day, 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 something else Susan D. Gilster, PhD

25. SERVICE Model as an Intervention • Two facilities-both CCRC’s-200+accomodations • Facility A-Administrator turnover q 1-2 yrs-new Administrator-inconsistent commitment • Facility B-Administrator in organization in various roles for 13 yrs –consistent commitment and reinforcement Susan D. Gilster, PhD

26. 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, agency utilization, 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 Susan D. Gilster, PhD

27. Respect from supervisor… Susan D. Gilster, PhD

28. Compliments from supervisor… Susan D. Gilster, PhD

29. Respect from my department… Susan D. Gilster, PhD

30. Respect from own shift… Susan D. Gilster, PhD

31. Respect from other departments… Susan D. Gilster, PhD

32. Know making a difference… Susan D. Gilster, PhD

33. Job prep at orientation… Susan D. Gilster, PhD

34. Frequency of ongoing inservice/education… Susan D. Gilster, PhD

35. Feeling part of team… Susan D. Gilster, PhD

36. Frequency of staff meetings… Susan D. Gilster, PhD

37. Availability of Administrators… Susan D. Gilster, PhD

38. Wages/pay received… Susan D. Gilster, PhD

39. Overall satisfaction… Susan D. Gilster, PhD

40. Would advise friend to apply… Susan D. Gilster, PhD

41. I think of changing jobs… Susan D. Gilster, PhD

42. Census and Finances • Facility A-end of the first year • Highest census ever • Decreased turnover, decreased agency use • Increased staff satisfaction-statistically significant at one year • Facility B • Maintained a high census, • Staff satisfaction continued on upward trend, • Cut turnover in half, decreased agency Susan D. Gilster, PhD

43. Facility C • Census has been maintained for years-currently undergoing second expansion • Staff satisfaction remains high-continuous effort (53 item survey, 90% response rate=3.4 average out of 4 “very happy” and 3.6 for overall satisfaction) • Family satisfaction very high (84 item survey,75% response rate=3.8 out of 4 “very happy” and 3.8 for willing to recommend) Susan D. Gilster, PhD

44. 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 projected savings of $1,120,000.00 • Decreased agency use • Facility C • Turnover single digits for years • No agency use Susan D. Gilster, PhD

45. Impact of model on staff turnover • Facility A • Saved $688,000.00 in staff turnover in one year • Decreased agency by tens of thousands dollars • 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 Susan D. Gilster, PhD

46. Lessons learned • Organizational operational approach addresses staff desires enhances satisfaction & retention • Millions of dollars are lost each year in staff turnover and related costs • Sustainability is key-do not start and stop programs Susan D. Gilster, PhD

47. Conclusion (cont) • MOST IMPORTANT • Impact on the people we serve, their quality of life and happiness • Impact on the families, they are secure in knowing that their family members are cared by consistent staff, happy and loved • For staff who deserve respect, dignity, a quality place in which to work Susan D. Gilster, PhD