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A Strategic Operational Approach to Staff Retention
Susan Gilster, PhD, FACHCAsusang@hcmg.com
www.alois.comwww.careleadership.com
Susan D. Gilster, PhD
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
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• 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
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
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
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
Kotter General Leadership (Kouzes &
Posner)
Baldridge Criteria for
Performance Excellence –
Concepts
S.E.R.V.I.C.E. Model (Gilster)
Core Principles (Senge)
Technical (Stewardship)
A Sense of Urgency Never let up
Challenging the Process
Customer Driven Excellence
Focus on results, value
Service Personal Vision
Vision Vision Inspiring a Shared Vision
Visionary Leadership, valuing
employees/partners
Vision Shared Vision
Change (Commitment to Growth)
Empowerment Enabling Others to Act Organizational & Personal Learning
Agility & Management for innovation and by
fact
Education/Inclusion Team Learning
Visible Presence (empathy, awareness,
healing)
Guiding Team Encouraging the Heart Social Responsibility 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, PhDSusan D. Gilster, PhDSusan 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, PhDSusan D. Gilster, PhDSusan 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
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
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, PhDSusan D. Gilster, PhDSusan 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
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, PhDSusan D. Gilster, PhDSusan 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, PhDSusan D. Gilster, PhDSusan 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
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
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 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
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…
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
Baseline 3months
6months
9months
1 year
ABC
Susan D. Gilster, PhD
Compliments from supervisor…
2.62.72.82.9
33.13.23.33.43.5
Baseline 3months
6months
9months
1 year
ABC
Susan D. Gilster, PhD
Respect from my department…
2.9
3
3.1
3.2
3.3
3.4
Baseline 3months
6months
9months
1 year
ABc
Susan D. Gilster, PhD
Respect from own shift…
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Respect from other departments…
2.6
2.7
2.8
2.9
3
3.1
3.2
3.3
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Know making a difference…
3.3
3.4
3.5
3.6
3.7
3.8
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Job prep at orientation…
2.6
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Frequency of ongoing inservice/education…
2.52.62.72.82.9
33.13.23.33.43.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Feeling part of team…
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Frequency of staff meetings…
2.42.52.62.72.82.9
33.13.23.33.43.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Availability of Administrators…
2.42.52.62.72.82.9
33.13.23.33.43.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Wages/pay received…
22.12.22.32.42.52.62.72.82.9
3
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Overall satisfaction…
2.72.82.9
33.13.23.33.43.53.63.7
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
Would advise friend to apply…
2.52.62.72.82.9
33.13.23.33.43.5
Baseline 3 months 6 months 9 months 1 year
ABC
Susan D. Gilster, PhD
I think of changing jobs…
1.71.81.9
22.12.22.32.42.52.62.72.82.9
3
Baseline 3 months 6 months 9 months 1 year
ABC
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
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