Creating a Culture of Retention: Getting to the Roots

of the Workforce ShortageMarch 18, 2019 American College of Health Care Administrators

Disclosure of Commercial Interests

Consultant for PHI, “Paraprofessional Healthcare Institute”

Title: Vice President of Workforce Innovations

PHI is a national nonprofit organization based in the Bronx that aims to improve quality of care for older people and individuals with disabilities by improving jobs for those that provide that care.

We believe that caring, committed relationships between direct care workers and their clients are at the heart of quality care, and our work serves to strengthen those relationships.

Our Strategy

Learn what works – and what doesn’t.

Share lessons and implement best practices through hands-on coaching, training and consulting.

Support employers, policymakers and advocates to craft evidence-based policies and practices.

© PHI 2019

© PHI 2019

Understanding The Workforce Crisis

Raise Your Hand…

• If you are having trouble finding qualified staff

• If you’ve lost at least one DON due to unstable staffing

• If you have had to turn away new admissions due to staffing shortages

© PHI 2019

Source: PHI. 2018. U.S. Home Care Workers: Key Facts. Bronx, NY: PHI. https://phinational.org/wp-content/uploads/2018/08/U.S.-Home-Care-Workers-2018-PHI.pdf.

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

2016 2026Home Care: PCAs Home Care: HHAs and CNAs Nursing Homes

1.4 million new jobs

Direct care job growth: 2016 to 2026

© PHI 2019

© PHI 2019

$11.00

$12.00

$11.50

$15.00

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Recruit the Right Staff

Get everyone involved!

1Create mission-driven materials that reflect your unique brand

2Identify a range of potential new applicants

3Use targeted outreach strategies

4

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© PHI 2019

Give all staff recruiting business cards that they can put their name on

If you hire someone who brings in a staff member’s business card, that employee gets a bonus or gift card

Form a cross functional team to lead new strategies

Consider the message

X© PHI 2019

Mission Driven Materials that Reflect your Unique Brand

“Imagine the Stories You Can be Part of…”

“Imagine the Lives you can Touch”Following the Disney Example

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© PHI 2019

• Highlight direct care skills and competencies

• Recruit family caregivers

• Integrate training and job opportunities

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Recruiting men to the caregiving workforce

Men comprise 53% of the labor force and 40% of family caregivers, but just 14% of the paid direct care workforce

• Recruit through schools and colleges

• Promote direct care as career entry point

• Integrate training and job opportunities

© PHI 2019

Recruiting younger workers to the caregiving workforce

51% of younger people in the labor force are also enrolled in education.

• Promote direct care as an encore career

• Capitalize on older workers’ skills

• Integrate ongoing learning opportunities

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Recruiting older workers to the caregiving workforce79% of workers plan to get a job after retirement

Schools

WIBs

Social Media

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Between 2016 and 2017:• The number of new applicants

increased by 33%• The number of hires increased by 46%• The number of vacant positions

decreased by 45%

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Digital Campaign Case Study

The Power of Employee Voices

Improve Hiring, Welcome, and Onboarding

When interviewing candidates…

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Ask values-based questions

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“Tell me about a meaningful relationship you’ve had with an older person or someone with a disability. How has that relationship impacted you?”

The key to retention is to treat our employees the same way we ask them to treat the residents!

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Have a Person-Centered Welcome

1. Send a welcome letter2. Include a small gift with the letter3. Include an invitation to a meal

with residents4. Personal phone call from peer

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The First Week + Increase human contact

Decrease videos

Never eat alone

Ease into full

assignment

Immerse in

company culture

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Engage Peer Mentors • Support new hires as they transition into

direct care roles

• Offer experienced workers a career advancement opportunity

• Encourage an organizational culture of collaboration, learning, and problem-solving

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Provide free or low cost meals

1purchase diapers and formula at reduced cost

2

Create an employee pantry/share center

3

Provide free or discounted uniforms

4

Get creative with transportation

5

Include Value Added Benefits

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Develop Advancement Opportunities

Ensure Effective Supervision

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Turnover timeline

First week• Mismatched

expectations• Ineffective

supervisor

First 30 days• Disciplinary

action due to inadequate preparation

• Work schedule/ workload

• Ineffective supervisor

First 90 days• Lack of strong

relationships• Unmet

training/ resource needs

• Ineffective supervisor

First 6 months• No recognition or

feedback• Inadequate

communication/ engagement

• Ineffective supervisor

Source: Crescendo Strategies. 2018. “Why People Leave” Timeline. https://www.crescendostrategies.com/wp-content/uploads/2019/01/2018-Why-Employees-Leave.pdf.

© PHI 2019

First week• Mismatched

expectations• Ineffective

supervisor

First 30 days• Disciplinary

action due to inadequate preparation

• Work schedule/ workload

• Ineffective supervisor

First 90 days• Lack of strong

relationships• Unmet

training/ resource needs

• Ineffective supervisor

First 6 months• No recognition or

feedback• Inadequate

communication/ engagement

• Ineffective supervisor

Source: Crescendo Strategies. 2018. “Why People Leave” Timeline. https://www.crescendostrategies.com/wp-content/uploads/2019/01/2018-Why-Employees-Leave.pdf.

Turnover timeline

© PHI 2019

© PHI 2019

PHI Coaching Supervision®

A relational approach to managing and supporting employees and teams that helps them develop their interpersonal, critical thinking, and problem-solving skills.

© PHI 2019

Traditional Supervisors…• Raise a performance concern;

• Describe the rules and explain the consequences of breaking them;

• Offer or mandate solutions to the problem;

• Require compliance, and penalize non-compliance.

© PHI 2019

Traditional Supervisors…• Raise a performance concern;

• Describe the rules and explain the consequences of breaking them;

• Offer or mandate solutions to the problem;

• Require compliance, and penalize non-compliance.

• Establish a trusting and respectful relationship with employee;

• Raise a performance concern;

• Gather information from employee’s perspective;

• Engage employee in generating solutions;

• Help employee commit to action steps.

Coaching Supervisors…

Coaching SkillsActive Listening: Body language, paraphrasing, open curious questions

Self Awareness and Self Management: Being conscious of judgments and assumptions, controlling emotional reactivity and listening blocks

Clear Communication: Using language free of blame and judgment

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© PHI 2019

Supervisors improved their ability to listen and respond objectively,

without making assumptions

and judgments

Supervisors established

better relationships with CNAs,

residents, and family

members

Supervisors were able to

better resolve performance related issues

without disciplinary

actions

Improvement in retention

State Based Initiatives

© PHI 2019

• Create a Pathway to a Living Wage

• Support a Culture of Retention

• Establish a CNA Scholarship Program

© PHI 2019

© PHI 2019

Bold, Creative Ideas Will Guide our path to a future with care for all who need it, and good jobs for all who provide it

Sue MisiorskiVice President of Workforce Innovations

smisiorski@phinational.org

© PHI 2018

400 East Fordham Road, 11th Floor • Bronx, New York 10458 • www.PHInational.org