A Strategic Operational Approach to Staff Retention

Susan Gilster, PhD, FACHCA

susang@hcmg.com www.alois.com www.careleadership.com

Susan D. Gilster, PhD

Turnover in LTC
Most report 40-400% annually in AL/NF Turnover Adm-43%, DON 38%, RNs 41%, LPNs 50%, CNAs 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

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

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
Susan D. Gilster, PhD

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

Susan D. Gilster, PhD

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

Susan D. Gilster, PhD

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

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

Organizational/Leadership Frameworks Business and Health Care

Greenleaf Servant Leadership Model
Technical (Stewardship)

Kotter

General Leadership (Kouzes & Posner)

Challenging the Process

Baldridge Criteria for Performance Excellence Concepts

Customer Driven Excellence Focus on results, value Visionary Leadership, valuing employees/partners

S.E.R.V.I.C.E. Model (Gilster)

Core Principles (Senge)

A Sense of Urgency Never let up

Service

Personal Vision

Vision

Vision

Inspiring a Shared Vision

Vision

Shared Vision

Change (Commitment to Growth)

Empowerment

Enabling Others to Act

Organizational & Personal Learning Agility & Management for innovation and by fact Social Responsibility

Education/Inclusion

Team Learning

Visible Presence (empathy, awareness, healing)

Guiding Team

Encouraging the Heart

Respect

Mental Models

Communication (Listening)

Communication Short-term wins

Modeling the Way

Systems Perspective Focus on the future

Communication & Enrichment

Personal Mastery

Susan D. Gilster, PhD

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

Susan D. Gilster, PhD

Susan D. Gilster, PhD

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

Successful Staff Selection

Choose only those whose beliefs are consistent with vision, values Person vs. experience-I can teach skills, but cant teach someone to care Expectation wear all hats do whatever it takes High standards and expectations
Susan D. Gilster, PhD

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

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

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

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

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

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

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

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, nationalmultiple opportunities Not all facilities take the time to apply
Susan D. Gilster, PhD

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

SERVICE Model as an Intervention

Two facilities-both CCRCs200+accomodations Facility A-Administrator turnover q 1-2 yrsnew Administrator-inconsistent commitment Facility B-Administrator in organization in various roles for 13 yrs consistent commitment and reinforcement
Susan D. Gilster, PhD

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

Respect from supervisor

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 Baseline 3 months 6 months 9 months 1 year A B C

Susan D. Gilster, PhD

Compliments from supervisor

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

Respect from my department

3.4 3.3 3.2 3.1 3 2.9 Baseline 3 months 6 months 9 months 1 year A B c

Susan D. Gilster, PhD

Respect from own shift

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 Baseline 3 months 6 months 9 months 1 year A B C

Susan D. Gilster, PhD

Respect from other departments

3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 Baseline 3 months 6 months 9 months 1 year A B C

Susan D. Gilster, PhD

Know making a difference

3.8 3.7 3.6 3.5 3.4 3.3 Baseline 3 months 6 months 9 months 1 year A B C

Susan D. Gilster, PhD

Job prep at orientation

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 Baseline 3 months 6 months 9 months 1 year A B C

Susan D. Gilster, PhD

Frequency of ongoing inservice/education

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 2.5 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

Feeling part of team

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 Baseline 3 months 6 months 9 months 1 year A B C

Susan D. Gilster, PhD

Frequency of staff meetings

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 2.5 2.4 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

Availability of Administrators
3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 2.5 2.4 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

Wages/pay received
3 2.9 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 2 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

Overall satisfaction
3.7 3.6 3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

Would advise friend to apply

3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6 2.5 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

I think of changing jobs

3 2.9 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 2 1.9 1.8 1.7 Baseline 3 months 6 months 9 months 1 year

A B C

Susan D. Gilster, PhD

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

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

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

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

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

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