Improving Retention & Competency: Career ladders and practical …€¦ · •Lack of stress...

Improving Retention & Competency: Career ladders and practical approaches

Amy Lee, RN, MSN, CRRN, QCPPresident/CEO

Coretactics Healthcare Consulting, Inc.

September 26, 2019

• Discuss a variety of strategic approaches & review useful tools to improve retention.

• Demonstrate insight into evidence-based resources and tools to assist in the development of clinical competencies.

• Identify various satisfaction survey methods & data collection tools to assist with monitoring retention.

• Recognize how your QAPI program can be used to monitor & sustain facility retention efforts.

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Turnover Facts

• Costs $3,500-%5,000 / employee

• Compromise QOC

• Decrease staff & resident/family satisfaction

• CMS will soon report on NHC

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2018 Data

Nurses 17.4%CNA 27.7%

2018 National Health Care Retention & RN Staffing Report

Common Causes for Turnover

• Good economy = more opportunities

• Poor onboarding process

• Lack of career growth

• Lack of stress management

• Poor pay

• Poor relationships with their supervisor

• High physical & emotional demands

• Lack of management respect

• Aggressive /combative resident behaviors

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Strategy Development

Strategic planning is a management tool that helps an organization establish shared goals and adjust the organization’s direction in response to a changing environment. In short, it produces fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it – with a focus on the future.

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Purpose of Strategic Planning

• Ever changing environment – assess and adjust org direction

• Creates Direction – set priorities

• Focus energy and resources

• Strengthen operations

• Ensure stakeholders are working toward common goals

• Proactive vs. reactive

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Process Check• What systems do you have in place

for staff to grow and advance professionally?

• How are you working to prevent burnout?

• Are you an employee-centered culture?

• What processes are in place for employees to communicate with leadership?

Focusing on employees allows employees to focus on consumers, a win-win!

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Key Strategies1. Know what your employees

want!

2. Recognize the critical role education plays

3. Review/Implement structured Orientation / Preceptor programs

4. Career Ladders Programs

5. Employee Recognition Programs

6. Competency & skills development

7. Utilize data to guide your strategy

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Education

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• Focus on learning or you will lose!

• 93% of employees would stay longer if there was investment in their careers (2018 Workforce Learning Report; LinkedIn)

KEY!

• Bring education to the staff

• Condense and stay on point = increased productivity

• Learning platforms

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Paid Feeding Assistants –NYS Part 415 Title 10

• State-approved feeding assistant training program (FATP) – 15 hours

• FA must work under a RN or LPN; not assigned other tasks

• Can assist only uncomplicated residents in congregate dining areas only

• Difficulty swallowing, recurrent aspiration, etc.

• DOES NOT apply to family &/or volunteers who provide the resident with assistance

• Can use existing staff (i.e., administrative, clerical, housekeeping, dietary, activities aides, etc.)

• Training can only be conducted by nursing homes

• Maintain record of training

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Paid Feeding Assistants –Course Content

❑Resident Rights

❑Infection Control

❑Safety & emergency Procedures (including Heimlich Maneuver)

❑Communications & Interpersonal Skills

❑Changes in Resident Condition

❑Appropriate Response to Resident Behavior

❑Assistance with Eating & Hydration

❑Feeding Techniques

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A preceptor is…

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An experienced staff member who provides support and learning

experiences to a new staff member (“preceptee”) while

continuing to perform some or all the responsibilities of their

position.

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Develop Your Process

• Who will oversee the program?

• Develop preceptor requirements.

• Interpersonal skills, attendance, motivation, employment longevity, disciplinary actions, self-motivated, etc.

• How many are needed for each shift?

• “Preceptor Nomination Notification”

• Who will choose the preceptor?

• Create a Preceptor Checklist.

• How will Preceptors establish competency & how often.

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• Determine how often the overseer will communicate with the preceptor & preceptee

• Determine average duration of program

• Annual preceptor evaluation / consequences

• Consider preceptor recognition (i.e., pay increase, custom ID badge, colored uniform, etc.)

• Create a preceptee program evaluation

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Determine Skills

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Outline Responsibilities

Preceptor:✓Assist new staff members to learn

✓Include preceptee in social activities (ex. Coffee break, lunch, etc.)

✓Provide support

✓Be a role model

✓Be competent in their duties

✓Assess and re-assess the preceptee’s learning needs, knowledge, skills and motivation

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Outline Responsibilities

Preceptor (continued):✓Give constructive feedback

✓Assist preceptee in identifying their learning needs

✓Let the preceptee know how they are doing

✓Communicate with the Staff Development Coordinator on preceptee’s performance and progress

✓Assist in evaluating the preceptee at the end of their program

✓Evaluate own effectiveness as a preceptor

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Outline Responsibilities

Staff Development Coordinator:

✓ Reinforce a positive approach and acknowledge the effort of the preceptors

✓ Select appropriate preceptors and provide feedback to them

✓ Continually monitor progress of preceptee throughout their program

✓Monitor and evaluate the preceptor program

✓ Assist the preceptor & preceptee to stay focused on goals

✓ Ensure the staffing schedule is correct and that all preceptees continue through their program with the “same” preceptor

✓Maintain program records of participants, the success of preceptors and trainees and retention data

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How to provide feedback – “IMPROVE”

I = Identify the issue

M = Make a feedback-friendly environment

P = Prioritize areas needing improvement

R = Respond to preceptee’s self-assessment

O = Objective work on only specific areas

V = Validate what is done well

E = Establish a plan for changes

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Program Benefits

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▪ Prevent new employee frustration

▪ Identify training & development opportunities for new employees

▪ Improve staff satisfaction

▪ Improve resident/family satisfaction

▪ Builds skills and confidence

▪ Make new employees feel welcome and confident in their new role

▪ Promotes teamwork

▪ Improves retention!!!!

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Guiding Principles

• Avoid temptation - Don’t rush it!

• Ensure Staff Development staff & Preceptors are competent

• Make an effort to use 1 consistent preceptor throughout orientation

• Communicate frequently

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Geriatric Nursing Assistant Career Development Program (GNACD)

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GNACD Outline

1. Safety First • Infection Control• Fire & Emergency Procedures• Falls Reduction• Safe Transfers

2. Teamwork & Cooperation• Teamwork• Caregiving Role• Learn about the function of other

departments

3. Aging & Illness• Physical/Functional Changes/Disease

Symptoms

4. Communication• Tactics for improving communication

5. Nutrition• Nutrition /Hydration Basics• S/S of Poor Nutrition• Factors that affect eating ability/appetite

6. Spirituality & Dying• Spirituality & Mourning

7. Resident Quality of Life• Empathy/Psychosocial Needs

8. Dementia Care• Behavior Management & Communication

9. The Importance of Family• Managing family concerns

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Advanced Nurse Education

• Certifications

• RAC-CT

• QCP

• CRRN

• WOCN

• Gero Nurse Prep (www.geronurseprep.com)

• Tuition Assistance Programs

• National & State Association training

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Employee Recognition Programs• Plan out the program before

implementation

• program goal

• how will results be measured

• what will the reward be

• eligibility

• who will administer the program

• program promotion

• cost

• funding source

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Definition: Workforce Capability

“Your organization’s ability to accomplish it’s work processes through it’s peoples’ knowledge, skills, abilities and competencies.”

Source: AHCA/NCAL National Quality Award Program

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Competent staff are more likely to engage

residents & families in a knowledgeable, honest

manner!

Staff Competencies

Primary areas:

1. Physical & Cognitive Systems Assessments

2. Technical procedures using evidenced based tools

3. Use of medical equipment/supplies for treatment

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Based on your Facility Assessment

Tie your competencies to your mission

Review current Policies & Procedures

Develop missing Policies & Procedures

Create a competency from the procedures (step-by-step) in your policies

Develop a process for administering initial and ongoing competencies (i.e., upon hire, annually, etc.)

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Reviewing Your Competency Process

• What competencies do you assess?

• Are they core & job specific?

• How often, what methods are used & who assesses?

• How do you document?

• What’s working well and what isn’t?

• How do you promote accountability for competencies?

• Does your process incorporate cultural competency & person centered care?

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Determine Competencies

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Competency Methods

• Self–assessment

• Observation of daily practices

• Outside resources (i.e., hospitals, colleges, You Tube, etc.)

• Peer review

• Return demonstration

• Interactive scenarios or role play

• Competency fair

• Checklists (procedures)

• Pre and Post tests

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Don’t forget agency staff!

Develop Your Competencies

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▪Webinars

▪ Video links (Nursing Schools) / You Tube

▪Hospital Resources

▪ Procedural manuals (Lippincott 7th Edition)

▪ Sim Labs

Look for current evidence

based resources!

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Workforce Capacity

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Definition: Workforce Capacity

Your organization’s ability to ensure sufficient staffing levels to carry out its work processes and successfully deliver health care services to

patients, including the ability to meet seasonal or varying demand levels.

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Source: AHCA/NCAL National Quality Award Program

Staffing

3 Calculations

1. Actual Staffing Hours Per Patient Day (PPD)

2. Expected Staffing Hours PPD

3. Adjusted Staffing Hours PPDCoretactics, Inc.

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CASPER Employee & Census Report

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Actual Staffing Hours PPD

Actual Staffing Hours = PBJ Hours / 90 days / Avg Qtr Census in PBJ

1.RN Hours PPD: DNS (5); RN Admin Duties (6); RN (7)

2.Total Nursing Hours PPD: RN (5, 6, 7) + LPN (8, 9) + Nurse Aides (10,12)

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Expected Hours

Expected Hrs = Sum of nsg time (minutes) connected to each Resident’s RUG /

# of residents included / 60 minutes

• RUG IV score on most recent MDS for each active resident on the last business day of the PBJ quarter• Active = on day data is pulled, do not have a Discharge MDS & most recent MDS

transaction is less than 180 days old)• Utilization of CMS STRIVE Study results for staffing thresholds

• Utilizes percentile ranking compared to nation

• Higher acuity is expected to have higher staffing levels

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STRIVE EstimatesFive-Star Quality Rating System: Technical Users’ Guide

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CMS Five Star Users Manual: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf

Adjusted Staffing Hours PPD

Case Mix Adjusted based on RUG Categories

Adjusted Hours = Hours Reported (PBJ)/Hours Expected (RUGs/Strive) * Hours National Avg

CMS Staffing Data File (calculations updated monthly)

https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html

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Daily Staff Vacancy Tracking

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Resources

AHCA Retention Program

1. Interviewing Outline/Guide

2. Behavioral Based Interview Questions

3. Performance Review (30, 60, 90)

4. Employee Feedback (30, 60, 90)

5. Walkabouts/Rounding on Direct Reports• Feedback Log

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Resources

• LTCTT Data (www.ltctt.ahcancal.org)

• CMS Toolkit: Nursing Home Employee Satisfaction Survey

• Introduction to the Nursing Home Employee Satisfaction Survey (link): https://youtu.be/9WE40dUELpw

• Data Collection and Analytics Tool Tutorial (link): https://youtu.be/wXN3bNJzZ6A

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Staff Surveys

First question in the “What Makes a Great Place to

Work” quiz

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What makes a great

workplace?

Training that helps me grow my skills and knowledge.

Satisfaction Surveys

National Research Corporation

CoreQ (AHCA/NCAL Long Term Care Trend Tracker

Internal Programs

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What is QAPI?

QAPI is the merger of 2 complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI). Both involve using information but differ in key ways:

• QA = meeting quality standards & making sure care reaches an acceptable level (REACTIVE)

• PI = continuous study of processes (PROACTIVE)

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Creating a Culture of Quality Improvement

• Implement the key elements of QAPI

• Leaders assume responsibility for results and see opportunities for improvement (OFIs)

• Understand that problems are primarily the result of poor or weak processes rather than incompetent people

• Employees need to be empowered to improve their work processes = RETENTION

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QAPI Features

• Using data to not only identify your opportunities but to also set priorities for action

• Developing Performance Improvement Project (PIP) teams with specific “charters”

• Performing a Root Cause Analysis to get to the heart of the reason for a problem

• Undertaking systemic change to eliminate problems at the source

• Developing a feedback and monitoring system to sustain continuous improvement

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LTCTT Staff Turnover

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PIP Team Steps:

• What information is needed for the PIP

• Determine a timeline

• Identify supplies/equipment

• Select/create measurement tools

• Prepare & present results

• Use a problem-solving model (i.e., PDCA)

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Systematic Analysis & Systemic Action

Root Cause Analysis

Examples:

• Five Whys

• Flowcharting

• Fishbone Diagram

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QAPI Element 5

Analysis & Action

Opportunities

Are there system changes needed?

• Policies & Procedures

• Staff communication (i.e., huddles, frequent rounds)

• Staff education

• Equipment

• Environment

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PDCA: Just like a Care Plan!

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Sustained Improvement

• Updating P&P

• Clearly defining roles & responsibilities for new actions

• Communicate change & purpose

• Identify barriers to new change

• Integrate new change into orientation / competency

• Ensure adequate funding

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Organizational Benefits

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Organization Benefits

1. Improved resident & employee satisfaction

2. Improved staff recruitment

3. Improved quality of care & quality outcomes

4. Less workplace stress

5. Potential new program development

5. Decreased re-admissions / ED visits

6. Improved communication with community partners (i.e., hospitals, schools of nursing, etc.)

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Thank You for Joining us

Today!Amy Lee, RN, MSN, CRRN, QCP

President/CEO

Coretactics Healthcare Consulting, Inc.

amy.lee@core-tactics.com