Leadership Seminar - NYSHFA - 63014 - Copy (2) · Good leaders are made, not born ... – Self-study –Education – Training – Experience ... • Do I see progress as a result

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www.nationalresearch.com

NYSHFAJune 30, 20149-10:30 AM

Leadership Seminar: What I can do to improve my skills


Mary Tellis-NayakVP of Quality Initiatives - MyInnerView

[email protected]

773-942-7525


Leadership is essential in transforming our

homes to a culture ofquality, not a culture

of compliance

And here is why …www.nationalresearch.com

Administrator and DON: The architects of excellence

W. EDWARDS DEMING

An organizationexcels or fails

with its managers “80% of all quality problems are the fault of managers”

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The manager maintains

The manager has a short-range view

The manager focuses on systems and structure

The manager asks how and when

The manager accepts the status quo

The manager does things right

The leader develops

The leader has a long-range perspective

The leader focuses on people

The leader asks what and why

The leader challenges it (the status quo)

The leader does the right thing

MANAGER LEADERVS


Put More Simply


Quality of care: QI Index

Survey results

Family satisfaction

Staff satisfaction

Staff turnover

Administrator turnover

Census

Liability

Finances

Other

The NHA/DON turnover is by far the best predictor of a quality collapse

Every quality-related outcome turns direction and heads south

Administrators and DONs are the KEY to quality


0 1 2+

DON turnover in 2 years

0 1 2+

NHA turnover in 2 years

Quality of care: QI Index

Survey results

Family satisfaction

Staff satisfaction

Staff turnover

Administrator turnover

Census

Liability

Finances

Other

When NHAs/DONs exit: The outcomes

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0 1 2+0 1 2+

DON turnover in 2 years NHA turnover in 2 years

Families “Very satisfied”Staff “Very satisfied”



Deficiency-free surveysScope and severity of G and G+


0 1 2+0 1 2+


CNA turnoverRegistry use


What isLeadership?

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Think of someonein your life

who

has beenan effective leader

What qualities did he/she have?www.nationalresearch.com

Share a story about the best or most influential leader that you have encountered.

Identify their leadership characteristics : What was it that made this person such an effective leader?

Exercise


• Honest• Trusted me• Allowed me to do my job• Great communicator• Listened and showed concern• Strategic • Fair• Willing to pitch in

Characteristics of the BEST BOSS


• Although your position as a manager, supervisor, lead, etc. gives you the authority to accomplish certain tasks and objectives in the organization, this power does not make you a leader...

it simply makes you the boss

Authority and leadership

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• A boss tells people to accomplish a task or objective

• A leader makes people want to achieve high goals and objectives


Striving ToBe An

Effective Leader


• Trait Theory

• Great Events Theory

• Transformational Leadership Theory

How people become leaders


Trait Theory

• Some personality traits may lead people naturally into leadership roles

• We have all met a few people like this, such as high school coach, scout leader, teacher or a good boss

• There are very few people who have natural talent for leading others

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Great Events Theory

• A crisis or important event may cause a person to rise to the occasion

• This can bring out extraordinary leadership qualities in an ordinary person


Transformational Leadership Theory

• People can choose to become leaders• People can learn leadership skills

This is most widely accepted theory today


Good leaders are made, not born

• Must have the desire and willpower • Good leaders develop through

never-ending process of:– Self-study – Education – Training – Experience

• Best leaders are continually working and studying to improve their leadership skills


Focus on these 3 things!

• What you are (“BE”)

• What you KNOW

• What you DO

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What you are (“BE”)

A professional– Seek responsibility and take responsibility

for your actions– Search for ways to guide your organization

to new heights– When things go wrong (they will

eventually), do not blame others– Analyze the situation, take corrective

action and move on to next challengewww.nationalresearch.com

What you KNOW

• The four factors of leadership – Follower: Different people require different

styles of leadership – Leader: To be successful you have to

convince your followers, not yourself or your superiors, that you are worthy of being followed


What you KNOW

• The four factors of leadership – Communication: You lead through two-way

communication; much of it is nonverbal • You must not ask them to perform anything that

you would not be willing to do

– Situation: What you do in one leadership situation will not always work in another situation


What you KNOW

• Yourself– You need to understand your own attributes– Seek self-improvement to strengthen

your attributes

• Human nature – Know human nature and the importance

of sincerely caring for your workers

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EXERCISELooking at your personality

and what it can tell you about your leadership


What you KNOW

• Your job– A leader must know the job – Have solid familiarity with your employees' jobs – Train your people as a team

• Your organization – Use full capabilities of your organization


What you DO — Implement

• Develop sense of responsibility in your team • Ensure that tasks are:

– Understood– Supervised– Accomplished

• Communication is the key to this responsibility


What you DO — Motivate

• Set the example• Be a good role model for you employees

– They must not only hear what they are expected to do, but also see

• Know your team and look out for their well being

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Indicators of motivation

Engagement

Commitment

Satisfaction

Intention toQuit


Employee Engagement

• Employee engagement is a characteristic of the relationship between an organization and its employees.

• An "engaged employee" is one who is fully absorbed by and enthusiastic about their work

• An “engaged employee” takes positive action to further the organization's reputation and interests.

• An organization with 'high' employee engagement will be expected to outperform those with 'low' employee engagement, all else being equal.


Employee Satisfaction

• An employees feelings about the job• How content an individual is with his or her job• Affective job satisfaction is the extent of

pleasurable emotional feelings individuals have about their jobs overall, it is different from…

• Cognitive job satisfaction which is the extent of individuals’ satisfaction with particular facets of their jobs, such as pay, pension arrangements, working hours, and numerous other aspects of their jobs.

If a pretty picture and a cute saying are all it takes to motivate you, You probably have a very easy job.

The kind robots will be doing soon

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• Motivation is what makes a person behave in a particular way

• Motivation is the underlying energy that compels action in a particular direction

What is motivation?


INTRINSIC /EXTRINSIC MOTIVATION

WHAT IS IT?


Extrinsic Motivators

• Money• Benefits

These are no longer enough to compel workers to act.

MyInnerView data demonstrates this very clearly

EMPLOYEE - 2013

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Those forces within an individual that cause the person to act (i.e. religion, experiences, altruism)

Intrinsic Motivation

Religion

Experiences

Altruism


Leaders need to understand the intrinsic motivators that drive employee performance– They need to reinforce

these by their leadership actions

Intrinsic Motivation


Intrinsic MotivationWhen an employee is intrinsically motivated to do what needs to be done, the leader’s presence is of secondary importance.


Economic rewards worked pretty well for buying compliance

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Gaining commitment is a far different matter

External motivators (such as money and benefits) are no longer enough to compel workers to act.


Factors that people find intrinsically motivating

Thomas, K.W. 2000. Intrinsic Motivation at Work: Building Energy and commitment. San Francisco: Berrett-Koehler

•Meaningful work•Choices in carrying out that work•A sense of competence•The ability to make progress toward desired outcomes•The presence of health relationships


Leadership Strategies Based on the Fulfillment of Intrinsic Motivators

Cheerlead for progress

Inspire & focus employees on the meaningfulness of

work

Create choices in the workplace

Coach for development and

competence

Build and encourage

healthy interpersonal relationships


Leadership Strategies Based on the Fulfillment of Intrinsic Motivators

Cheerlead for progress

Inspire & focus employees on the meaningfulness of

work

Create choices in the workplace

Coach for development and

competence

Build and encourage

healthy interpersonal relationships

PROGRESS• Do I see progress as a result of my

efforts?• Are my outcomes generally positive?• Do I seem to be dealing with the same

problems year after year?• Is the progress I make recognized,

even when it is small?

Meaningful Work• Is my work meaningful?• Am I living up to my values?• How much of my work is important?• How much of my work feels trivial and

distracts me from my real work?

Choices

• Do I have the level of authority I need to carry out my work?

• Is my level of authority on important projects and responsibilities clear?

• Is the environment supportive of innovation and creativity?

Competence• Do I experience continual growth at

work?• How often do I learn new skills?• Does the environment support learning?• Do I report to someone I can learn from?• Do I have opportunities for further

development?

Relationships• How healthy and positive are my relationships

with other employees and managers?• Are there high levels of trust, respect, support,

and open communication?• Are any of my important relationships toxic or

unhealthy?

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Self-Assessment of Current Job in Terms of Intrinsic Motivators

Where am I?

My relationships are toxic

My work is meaningless

Opportunities are scarce

Choices are limited

Progress is minimal

Work is painful & difficult

My relationships are healthy

My work is meaningful

Opportunities are plentiful

Choices are extensive

Progress is frequent & apparent

Experiencing joy at work is common

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6


Leaders createother leaders,not followers


How do organizations encourage leadership

development?


How do organizations encourageleadership development?

• Encourage employees to personalize organization’s vision and determine how they can contribute to achieving it

• Empowering employees creates environment where people are more likely to participate in trying to achieve organization’s goals

• Teamwork where employees pools their resources and rely on each other to achieve common goals

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Indicators of motivation

Engagement

Commitment

Satisfaction

Intention toQuit


EMPLOYEE COMMITMENT


Employee Commitment

• Whatever it is that makes a person engage or continue when difficulties or positive alternatives influence the person to leave.

• It predicts– turnover,– organizational behavior,– job performance.


Types of Organizational Commitment

• Continuance• Affective• Normative

Understanding these different types of commitment enables leaders to have greater influence on the level of commitment experienced by employees.

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Continuance Commitment:A Cognitive Process

The balance between sacrifices and rewards must tip in the directions of rewards for an employee to stay

401k, Sick days accrued, established respectThe threat of loss binds the employee

Employees committed for financial reasons are less likely to feel committed to the organizational values

It costs too much to leave


Affective Commitment

• The emotional bond• Lower rates of turnover when there are

strong emotional ties• A sense of community within the

workplace• Turnover costs more than money-it

ruptures relationships



• Studies have shown that a person’s experiences during the initial months of employment are the most crucial in developing affective commitment


Peer relationship are important but so is the relationship between the individual and the organization’s leader.


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• The group’s attitude toward the organization

• The organization’s dependability and trust

• The individual’s perception of his or her importance

Experiences found to impact affective commitment are:

Normative CommitmentA Moral Commitment

EmployeesBeliefs

OrganizationsBeliefs and Actions


• They want to (affective commitment)

• They need to (continuance commitment)

• They feel they ought to (normative commitment)

People stay with an organization because

AffectiveCommitment

NormativeCommitment

Positive

I.e. lower absenteesim

Positive Organizational

OutcomesI.e. lower absenteesim

ContinuanceCommitment

GreaterInflexibility

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EmployeesWalk with their feetPhysically leave job

EmployeesWalk with their heartsEmotionally leave job Shared Values

Deep-seated standards that influence various aspects of our lives

Common MissionOur reason for existence (what we do and for whom)

Shared VisionOur preferred future state

(what we believe we can attainThat is better than our current reality)

Building NormativeCommitment


• What are VALUES?– Deep-seated standards

• Impact every aspect of life

– They represent beliefs– They determine what a

person deems to be worthwhile

• Leader’s values are– Clear– Communicated– Spoken from the heart

Shared Values

Organization and Personal Values

Linked to Engagementwww.nationalresearch.com

Common Mission – What is it?

Defines:• Purpose• Direction • Focus

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Sharing your personal mission statement is a powerful way of making connection with those you lead

Organizational Personal

SUCCESSTo laugh often and much;to win the respect of intelligent people and affection of children;to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty, to find the best in others;to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to know even one life has breathed easier because you have lived. This is to have succeeded.


There are those who look at things the way they are, and ask why...

I dream of things that never were, and ask why not?

Shared Vision


1. Define and describe the vision

2. Engage in dialogue about the vision

3. Create a structure for the vision

Developing a vision

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“I have a dream that one day this nation will rise up and live out the true meaning of this creed-we hold these truths to be self-evident that all men are created equal.”

This was a tremendous stretch in

MLK had a “dream”….

Leaders are doers, not just dreamers.


• Compliance is not commitment

• Commitment cannot be forced

• Decision made on information

• Small commitments beget ever-increasing commitments.

Common Pitfalls in Establishing Commitment

Shared ValuesDeep-seated standards that influence various aspects of our lives

Common MissionOur reason for existence (what we do and for whom)

Shared VisionOur preferred future state

(what we believe we can attainThat is better than our current reality)

Building NormativeCommitment


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How do organizations encourageleadership development?

• Providing training, support and constructive feedback as employees carry out their responsibilities (coaching)

• Delegating responsibilities to team members and expecting them to handle the details …“Do what you do best and give away the rest to someone else”


• Every interaction with team members is a coaching occasion

• “To coach” comes from the root meaning “to bring a person from where they are to where they want to be”

• Coaching begins with creating an environment where people want to be part of a winning team

Coaching


• Super Stars– 10% of staff or if REALLY lucky, up to 30%

• Middle Stars– About 50% of the team are inconsistent performers– They may be new or just not have the motivation

to be super stars• Falling Stars

– The rest– They consistently fail to carry their share of the load– They probably are preventing the top performers

from doing their jobs as well

Performance groupings


EXERCISE1. Write down the names of people on your team whom

you would place in the:• Super Star category• Middle Star category• Falling Star category

2. Are their significant differences in the behavioral traits of the 3 groups?

1. Write down the names of people on your team whom you would place in the:

• Super Star category• Middle Star category• Falling Star category

2. Are their significant differences in the behavioral traits of the 3 groups?

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• Pull out their performance reviews –do they reflect your current thinking?

• Is there a noticeable difference among the 3 categories?

• If there are few differences, it will be difficult for you to effectively coach your Super, Middle and Falling Stars

When you get back to work…


• Don’t abuse them by giving them more work• Coaching the Super Stars:

– Get them involved– Delegate extensively– Encourage them to teach– Provide training– Have them to fill in for you– Stretch them– Celebrate their successes– Tell them how proud you are to have them on the team– Spend time with them– Promote them

Raising the bottom, not lowering the top


• Build their confidence by increasing their responsibilities

• Give frequent and accurate performance feedback• Create a resource library• Teach them how to set goals• Catch them doing good things• Hook them up with a super star• Create rewards that appeal to THEIR

personal values

Coaching the Middle Stars


Coaching Falling Stars

• Helping them improve• Replacing them with more productive people

This represents the area with the greatest opportunity for enhancing the overall performance of your work group

They can have a very detrimental impact on your team —the top performers will pick up more work

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The manager’s most important job is

• Getting the right people in the right places• Doing the right things• For the right reasons

• Recruiting and keeping the best talent is arguably the single most important skill for a manger.


First Break All the Rules

• What the world’s greatest managers do differently.

• Distinctive marks.

• Gallup study of employees and managers.

• A triumph of common sense.


Talented employees may join a company because of its charismatic leaders, its generous benefits, its training programs.

Talented employees stay because of their relationship with their immediate supervisor.


Employees leave managersnot organizations.

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If employees answer these 6 questions

they in fact offer a grade report on management

If your grade is positive in all 6 areas

Then they have placed you in the privileged company

of the nation’s premier manager-leaders

The 6 core elements of a rich and positive workplace the employee perspective


1. Do I know what is expected of me?

2. Do I have materials and info needed to do my job right?

3. Do I have the opportunity to do what I can do best?

4. Have I received recognition or praise in the last 7 days?

5. Does my superior care about me as a person?

6. Does any one at work encourage my development?

The 6 core elements of a rich and positive workplace


competenceor

talent?

What does a great leader look for ?


We only talk about “competence” “skills”

How come we hardly talk about “talent?”

Managers are concerned with competence, skills, orientation, inservices, training and CEUs

Leaders focus on talent

SkillsCompetence

Talent

What’s the difference?

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Hiring at Disney

• Is this person happy?• Is this person smart?

If you are smart, we can teach you anything.If you are happy, I know you will make the

customers happy.Even in a prestigious Disney restaurant,

experience and skill were secondary to talent. www.nationalresearch.com

The cradle of quality

=

The nurse-resident interface

For a leader that is

Ground Zero

The Heart of Quality

To nurture talent, know how quality is born


WHAT TALENTS ARE NEEDED TO CARE FOR OUR ELDERS?

Voice of Residents

NATIONWIDE

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TOP DRIVERS FORRECOMMENDATION TO OTHERS

ADULT DAYPARTICIPANTSSufficiency of

personal assistance 0.6

Competency of staff 0.6

Ability-focused activities 0.6

Safety of center 0.6

Pleasantness of environment 0.5

INDEPENDENT LIVINGRESIDENTS

Home-like atmosphere 0.6

Commitment toindependence 0.6

Responsivenessof management 0.6

Care (concern) of staff 0.6

Sufficiency of personal assistance 0.6

ASSISTED LIVINGRESIDENTS


Resident-to-stafffriendships 0.6

Respectfulness of staff 0.6

Resident-to-residentfriendships 0.6

Choices/preferences 0.6HOME HEALTH

CLIENTSCare (concern) of staff 0.8


Sufficiency of services 0.8


NURSING HOMERESIDENTS




Choices/preferences 0.6

SHORT STAYRESIDENTS




Responsivenessof management 0.7 www.nationalresearch.com

2013 - RESIDENTS


NATION’S SKILLED NURSING HOME RESIDENTS SAY:

2013

Competencyof staff Choices/

preferences

Responsivenessto management

Safety of facilityAttention to resident grooming

Respectfulness of staffCommitment to family updates

CNA/NA care

Care (concern)of staff

RN/LVN/LPN care


Items Ranked byPercent

“Excellent”

RESIDENT- 2013

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Voice of Families

NATIONWIDE TOP DRIVERS FORRECOMMENDATION TO OTHERS

ADULT DAY FAMILIESRespectfulness of staff 0.8


Responsiveness of management 0.7

Adequate staff to meet needs 0.7

Pleasantness of environment 0.6

HOME HEALTH FAMILIESCare (concern) of staff 0.8


Sufficiency of services 0.8



ASSISTED LIVING FAMILIESCare (concern) of staff 0.9



Responsiveness of staff 0.6


NURSING HOME FAMILIESCare (concern) of staff 0.7


RN/LVN/LPN care 0.7




2013 - FAMILY


NATION’S SKILLED NURSING HOME FAMILIES SAY:

Competencyof staff

Choices/preferences

RN/LVN/LPNcare

Responsiveness of management

Respectfulness of staff

Safety of facilityAdequate staff to meet needsResident‐to‐staff friendships

2013

CNA/NA care

Care (concern)of staff

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Items Ranked byPercent

“Excellent”

FAMILY - 2013


A wonderful sweet elderly resident passed away at the nursing home I work at tonight. A woman who never complained, always had a smile, and said thank you to all us aides for helping her out. She spoke with a very soft voice. She had no visitors ever , which breaks my heart ♥ The other 3 caring aides I worked with tonight all sat on her bed..holding her hand, praying and letting her know she wasn't alone. 9:45pm This wonderful sweet lady is now at peace


The nursing home:

The nursing home:

• lowest status age group

• loss of health, roles, home

• dependent, frail

• powerless to change

• weakest social class

• lowest social status job

• least paid, least autonomy

• powerless to change?How do DON and Administrator generate quality of life?

where two worlds meetwhere two

worlds meet

CNAsResidents


The cradle of quality=

Resident’s world = The CNA

• 90% of personal care• 6 times as an RN• 5 times as an LPN

CNAs significant world =

The Nursing Home • 50% of waking hours • 90% economic support• significant social bonding• self image, self respect

Resident CNA

interaction

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“The executives who ignited the transformations from good to great did not first figure out where to drive the bus and then get people to take it there. No, they first got the right people on the bus (and the wrong people off the bus) and then figured out where to drive”.

“Good to Great” – Jim Collins


• Emphasize character attributes rather than specific experience or education

• Exceptional leaders know that skills and knowledge are teachable whereas– Character traits are ingrained

Determining who the right people are


• Amazon Link to purchase this book

• http://www.amazon.com/Meeting-Leadership-Challenge-Long-term-are/dp/1932529705

• Authors:– David Farrell– Cathie Brady– Barbara Frank

• Publisher – Health Professional

An Excellent Reference


Hiring Right for Staff Stability

• Not just a large pool of candidates– but the right pool of candidates– Target advertising– Targeted Refer a friend

©B&F Consulting 2014www.BandFConsultingInc.com

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Recruitment: Getting the Right Pool of Candidates

• What are your selling points as a place to work?

• Refer a friend bonus – who are your best staff, who are their friends?

• What are good sources of candidates –where do you recruit?

• What’s your reputation in the community as an employer?


Refer-a-friend Bonus

• Word of mouth is best advertisement

• Actively promote refer-a-friend bonus~Personally approach your best employees

• Pay as soon as you hire – it’s up to you then, to have them stay


Recruitment

• Where do (really good) CNA’s come from?• Who do you want to attract and where

are they?• What are the benefits of working at

YOUR nursing home?


Screen before you hire, not after

• Take the time to hire someone who will be value added to your team

• Make hiring process a good screen –have a multi-layer process

“Measure twice – Cut once”

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You get 1 chance to make a 1st impression!

• Applicant is not greeted • Receptionist is not aware of her role • No one knows open positions • Interviews are not conducted for walk-ins

– “Come back Tuesday at 11:00”

– Overall first impression to the applicant is disorganization


Focus on Character Traits

• Maturity – self reflection• Compassionate• Sensitivity to others needs• Self esteem• Ability to communicate, learn• Friendliness - Five smile rule

___ ___ ___ ___ ___


Welcoming Applicants

• Make a good first impression

• Receptionist/person at front door is key –Make sure she has postings, applications, info on benefits, and she’s tuned in to welcoming

• Make it a priority to meet new applicants

• Screen, tour, interview right when they come inwww.nationalresearch.com

Give them a tour

• Facility tour observations– Walk quickly and see how they keep up

– Go up and down stairs if you have them

– Place them next to residents who will engage them – see how they respond

– Monitor interactions with people – afterwards, ask staff what they know about person

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Include others in interview

• Include: co-workers, supervisor, resident and/or family

• Teach interview and hiring skills

• Give training on legal prep on what’s acceptable

• This starts the process of a warm welcome –builds confidence in the new employee and starts the relationship


Interview Tips

• High standards • Ask to see their last performance evaluation• Where have they been trained? (Does it make a

difference?)• Do they have experience?• Do they have realistic expectations about the job?• Ask the right questions

– Open ended– Behavior based; scenario based– Character based


Interview Questions

• Who is the nicest person you know, and why?• What are you most proud of?• Tell me about your prior experiences in

caregiving?• Tell me about a time that you’ve had a

conflict with a co-worker. What did you do?• Tell me the names of three elders you had a

close relationship with in your past job?www.nationalresearch.com

“What do you like to do in your free time?”

“Well…I’m not much of a people person. I tend to stay at home and keep to myself.”

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Possible Resident Questions

• What do you do when you are stressed?• What made you decide to become a CNA?• If a 96 year old resident was going toward

the door to leave and told you that she was waiting for her mother to pick her up, how would you respond?

• If you were going in to care for a resident who was agitated, how would you handle it? www.nationalresearch.com

Providing a Good Welcome

Will Increase the Percentage of Newly Hired Staff Who Stay

126


Manager’s 2nd most important job

• Developing and motivating people so they will have the habits that make for success in their role.

• Managers as coaches– Help people without the talent for some

aspect of their job become motivated.


What’s it like to be new?

• They are new to:• Type of job/skills and responsibilities• Workplace• Co-workers• Residents• Management style• Layout of the community• The way things are done• The way things work• Where things are kept/stored 128

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A Warm Welcome from Management and Co-workers Helps New Staff Stay

• Leadership– Administrator personally tune in to new

person– Check in at morning stand-up– Follow-up with them:

• every day the first week,• regularly over first month (It takes 3 months to feel comfortable, 6

months to feel competent)


How to ensure people stay

• Supervisor responsibility for welcome– Use shift huddle to intro, support and orient

(to residents, co-workers, routines)– Frequent check-ins

• Co-workers Warm Welcome– Pictures of staff, bio, balloons, pizza party – Invite to lunch and on breaks


Friendships at Work

People stay in places where they have friends

131 www.nationalresearch.com

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Voice of Employees


Skilled Nursing Employee

SURVEY QUESTIONS1 Quality of orientation 10 Care (concern) of management2 Quality of in-service education 11 Safety of workplace3 Quality of resident-related training 12 Adequacy of equipment/supplies4 Quality of family-related training 13 Sense of accomplishment5 Comparison of pay 14 Quality of teamwork6 Care (concern) of supervisor 15 Fairness of evaluations7 Appreciation of supervisor 16 Respectfulness of staff8 Communication by supervisor 17 Assistance with job stress9 Attentiveness of management 18 Staff-to-staff communication


NATION’S SKILLED NURSING HOME EMPLOYEES SAY:

Attentiveness of management Safety of

workplace

Assistance with Job stress

Fairness of evaluation Communication by supervisorAppreciation of supervisor

2013

Care (concern)of management

Care (concern) of supervisorAdequacy of equipment/suppliesQuality of resident‐related training


EMPLOYEE

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EMPLOYEE

Safety of workplaceCare (concern) of supervisorCommunication by supervisorAppreciation of supervisor

Resident-related trainingEquipment/supplies

Care (concern) of managementAttentiveness of managementAssistance with job stress



1 Quality of orientation

2 Support of career

3 Quality of skill training

4 Comparison of benefits

5 Comparison of pay

6 Care (concern) of supervisor

7 Appreciation of supervisor

8 Communication by supervisor

9 Clear expectations of management

10 Care (concern) of management

11 Attentiveness of management

12 Adequacy of equipment/supplies

13 Sense of accomplishment

14 Quality of teamwork

15 Staff-to-staff communication

16 Respectfulness of staff

17 Assistance with job stress

18 Fairness of evaluations

Survey items

ASSISTED LIVING EMPLOYEE


Care (concern) of management

Attentiveness of management

Assistance with job stress

Clear expectations of management

Fairness of evaluationsSupport of careerQuality of skill training

Appreciation of supervisorCare (concern) of supervisorCommunication by supervisor

Nation’s Employees say:WHAT MATTERS MOST IN ASSISTED

LIVING COMMUNITIES

Source: Assisted Living Employee Satisfaction Surveys collected in 2013

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EMPLOYEE


EMPLOYEE B

D

Care (concern) of supervisor

Appreciation of supervisor

Clear expectations by manager

Fairness of evaluations

Quality of skill trainingSupport of career

Care (concern) of managementAttentiveness of managementAssistance with job stress


“EXCELLENT,”“GOOD,” “FAIR”OR “POOR” RANKED BY PERCENT “EXCELLENT”

EMPLOYEETOP DRIVERS FOR

RECOMMENDATION FOR JOBADULT DAY

EMPLOYEESAssistance with

job stress 0.7

Attentivenessof management 0.6

Care (concern)of management 0.6

Comparison of pay 0.6

Clear performanceexpectations 0.6

INDEPENDENT LIVINGEMPLOYEESCare (concern)

of management 0.6

Assistance with job stress 0.6

Attentiveness of management 0.6

Clear expectationsby management 0.6

Support of career 0.6

HOME HEALTH CLIENTS

Care (concern) of management 0.7



Clear performanceexpectations 0.6

Fairness of evaluations 0.6ASSISTED LIVING EMPLOYEESCare (concern) of management 0.7



Clear expectations by management 0.6

F i f l ti

NURSING HOME RESIDENTSCare (concern) of management 0.7



Safety of workplace 0.6

F i f l ti

6/11/2014

37

EMPLOYEE: ASSISTANCE WITH JOB STRESS

13%

15%

16%

15%

15%

33%

40%

42%

39%

40%

31%

28%

30%

33%

28%

23%

17%

12%

12%

16%

Nursing home

Assisted living

Independent living

Adult day

Home health

EXCELLENT GOOD FAIR POOR

Based on 2010 satisfaction surveys conducted nationwide by My InnerView

EMPLOYEE: ATTENTIVENESS OF MANAGEMENT

17%

25%

28%

24%

29%

35%

36%

40%

39%

37%

29%

26%

23%

27%

20%

19%

13%

10%

10%

13%

Nursing home

Assisted living

Independent living

Adult day

Home health


Based on 2010 satisfaction surveys conducted nationwide by My InnerView

EMPLOYEE: CARE (CONCERN) OF MANAGEMENT

19%

27%

30%

27%

34%

36%

39%

43%

42%

36%

29%

23%

21%

24%

20%

16%

11%

7%

7%

10%

Nursing home

Assisted living

Independent living

Adult day

Home health


Based on 2010 satisfaction surveys conducted nationwide by My InnerView www.nationalresearch.com

Great managers are not judged but what they can do but by what their

teams can do without them

6/11/2014

38


Determining YourLeadership Style


Think about your daily interaction with the people who you lead. Generally speaking, determine the actual behaviors that define

that interaction. Using the list of behaviors on your paper (Reality Check), determine the amount of time (in percentages)

that you generally spend on each behavior. Do not fill in the “Ideally” column now.

REALITY CHECK


REALITY CHECK


Blake MoutonManagerial

GridBALANCING TASK-

AND PEOPLE-ORIENTED LEADERSHIP

6/11/2014

39


• Some leaders are very task-oriented; they simply want to get things done

• If you prefer to lead by setting and enforcing tight schedules,you tend to be more production-oriented (or task-oriented)

Task oriented


• Some leaders are very people-oriented; they want people to be happy

• If you make people your priority and try to accommodate employee needs, you are more people-oriented

People oriented


Concern for people – This is the degree to which a leader considers the needs of team members, their interests, and areas of personal development when deciding how best to accomplish a task

Concern for production – This is the degree to which a leader emphasizes concrete objectives, organizational efficiency and high productivity when deciding how best to accomplish a task

MANAGERIAL GRID:BASED ON TWO BEHAVIORAL DIMENSIONS


Concern for Production

Low High

High

ConcernForPeople

6/11/2014

40

www.nationalresearch.com www.nationalresearch.com

COUNTRY CLUB LEADERSHIP: HIGH PEOPLE/LOW PRODUCTION

• This style of leader is most concerned about the needs and feelings of members of his/her team

• These people operate under the assumption that as long as team members are happy and secure then they will work hard

• What tends to result is a work environment that is very relaxed and fun but where production suffers due to lack of direction and control


PRODUCE OR PERISH LEADERSHIP: HIGHPRODUCTION/LOW PEOPLE

• Also known as Authoritarian or Compliance Leaders,people in this category believe that employees are simply means to an end

• Employee needs are always secondary to need for efficient and productive workplaces

• This type of leader is very autocratic, has strict work rules, policies and procedures, and views punishment as the most effective means to motivate employees

6/11/2014

41


IMPOVERISHED LEADERSHIP: LOW PRODUCTION/LOW PEOPLE

• This leader is mostly ineffective• He/she has neither a high regard for:

– Creating systems – Getting the job done – Nor for creating work environment that is satisfying

and motivating• The result is place of disorganization, dissatisfaction

and disharmony


MIDDLE-OF-THE-ROAD LEADERSHIP: MEDIUM PRODUCTION/MEDIUM PEOPLE

• This style seems to be balance of the two competing concerns

• May at first appear to be an ideal compromise • Therein lies the problem, though:

– When you compromise, you necessarily give away a bit of each concern so that neither production nor people needs are fully met

• Leaders who use this style settle for average performance and often believe that this is the most anyone can expect

6/11/2014

42


TEAM LEADERSHIP: HIGH PRODUCTION/HIGH PEOPLE

• This is pinnacle of managerial style• These leaders stress production needs and needs

of people equally highly• Premise here is that employees are involved in

understanding organizational purpose and determining production needs – When employees are committed to and have stake in

organization’s success, their needs and production needs coincide

– This creates team environment based on trust and respect, which leads to high satisfaction and motivation and, as a result, high production


Identify areas of improvement and develop your leadership skills

• Look at your current leadership method and critically analyze its effectiveness

• Look at ways you can improve – Are you settling for ‘middle of the road’ because it is easier than reaching for more?

6/11/2014

43



• Identify ways to get skills you need to reach team leadership position

– It may mean involving others in problem solving

– Improving how you communicate with them, if you feel you are too task-oriented

– It may mean becoming clearer about scheduling or monitoring project progress if you tend to focus too much on people



• Continually monitor your performance and watch for situations when you slip back into old habits


REALITY CHECKComplete the “Reality Check” sheet and

fill in the second column, determine what you feel would be ideal distribution of time (in percentages)


REALITY CHECK

6/11/2014

44


• Is there a gap between how you should spend your energy and how you actually spend it?

• Are there some behaviors that are taking up too much of your leadership time? Why?

• Are there some strategies that you can employ that would move you closer to your ideal distribution of behavior?

• What are some behaviors that may not be on this list that are required to promote life-giving environments.

Reality check


PUT THE GRID IN CONTEXT

• The Team Leadership style isn’t always most effective approach in every situation

• While benefits of democratic and participative management are universally accepted, there are times that call for more attention in one area than another


PUT THE GRID IN CONTEXT

• If your company is in midst of merger or some other significant change, it is often acceptable to place a higher emphasis on people than on production

• Likewise, when faced with an economic hardship or physical risk, people concerns may be placed on the back burner, for short-term at least, to achieve high productivity and efficiency


LeadershipBest Practices

What can I do to make my home successful?

6/11/2014

45


Employeesspeak out about

leadership


Listen to your employees

• The truths of leadership you need to know:1. We are watching everything you do

• If you show up late for a meeting you are telling us you don’t value OUR time

• If you lose your cool over small issues, we wonder how you will react with big ones

• You are ALWAYS leading, you can’t NOT lead

2. Everything you do counts• Sharing juicy gossip and remove yourself from your

leadership role? NO TIME OUTS• What you say to us outside the office COUNTS


Listen to your employees

3. We have expectations of you• Hire great people – this is one of the most important things you do

• Don’t just hire any “warm body” just to fill a position• You can be the best manager in the world but if we have people

on the team who are not talented we will not be successful• “De-hire” those on the team who are NOT contributing

to the mission• They are more detrimental than any of our competitors• If we get lucky, our competitor will hire them

• Treat us with respect• You need us just as much as we need you…sometimes

even morewww.nationalresearch.com

Let’s talkabout

communication

6/11/2014

46


• Employees are frustrated by perceived lack of communication with their managers

• Most managers feel they are outstanding communicatorsA recent study discovered that 90%of the managers rated their communication skills in the top 10% of all managers

A paradox


“Sixty percent of all management problems are the result of poor or faulty communication.”

PETER DRUCKER


• Communication may not be the problem• Communicating more may not be the solution• Most of the information employees receive:

– Doesn’t get read– That which is read is often not understood– That which is understood is usually

not remembered• Communication being delivered is not the same as the

message being received

Another paradox


• We pay more attention to the HOW we’re going to communicate than to the WHAT

• Proliferation of communication methods

• Pagers• Memos• Video• Intranets• Newsletters • Text message

Communication as an outcome –not an activity

• E-mail• Voice mail• Meetings• Conference calls• Cell phones

6/11/2014

47


• Understanding does not mean agreement• Goals

– To build support and acceptance– To have receivers internalize the message– To move them to action

• Understanding is intellectual• Support and acceptance are emotional

Understanding communication


Communicate in a way… 1. the team understands what is being said2. the team makes a decision to accept and support

the message1. This is the simple part2. This is the tough partYou don’t need to do MORE of itYou need to do it BETTER

Manager’s role


How do you show you care about your

employees?


The biggest investment is TIME

1. Schedule time to focus on employee development

6. Remember birthdays and service anniversaries

2. Ask about interests outside of work 7. Support employees in times of crisis

3. Treat everyone with respect and dignity

8. Be available when people need you

4. Say “thank you” 9. Help co-workers become more effective

5. Get employees involved and ask for their opinion

10. Surround good people with other good people

6/11/2014

48


Whether individuals feelrespect in the workplace

is largely a function of how they are treated

by their supervisors,their clients and family members

or advocates and,many times, their peers,

particularly for new workers.www.nationalresearch.com

A Studyon Turnover


The study

• Paired facilities• Same geographical location• Several different states• High and low turnover facilities


General observationsin low turnover facilities

• Less odor or urine • Residents wearing fresh unstained clothing• Clean and well groomed• Few behavioral problems• Few people wandering aimlessly or sitting lined

up in wheelchairs by nurses’ stations• Residents were attuned to particular staff members• Residents were likely to speak to visitors showing

they felt safe and not frightened

6/11/2014

49


General observationsin high turnover facilities

• Desperate and chaotic air• Staff were rushing around or hard to find• Residents were calling out, crying and screaming• Call lights were typically buzzing, flashing or

ringing with no one appearing to pay attention

• Few smiles in evidence• Entire parts of the home seemed to be abandoned

by staff• Break rooms were gloomy, dark and dingy www.nationalresearch.com

In general, if a visitorwalked blindfolded into

the selected pair of facilitiesin each community and

sat in the lobby or dining roomfor less than one hour,he or she could haveaccurately predicted

which was the high turnover workplace


Five areas stand out as

distinguishing facilities with low

nursing staff turnover


What a difference management makes!

Five management practices associated with

low turnover, high attendance and high performance:

High quality leadership at all levels

of the organization

Valuing staff day-to-day in

policy and practice, word

and deed

High performance,

high commitment HR policies

Work systems aligned with and serving

organizational goals

Sufficiency of staff and resources

to care humanely

Eaton, 2002

6/11/2014

50


High quality leadershipand management

• Tenure of administration• The best leaders have clear sense of

mission and philosophy that connected residents and workers

• “I spend as much time as I can on the floors. I am a soldier, not a general…We should spend our money on staff, not agency or corporate offices or furnishings”

1


Who is good leader or manager?

• Someone with a strong vision or mission and sense of goal

• Someone who sets standards and keeps others accountable

• Someone who listens to others and spends time on floors

• Someone who values the contributions and work of others while demanding commitment and high performance

• Someone who tries to create a chain of positive supervision all the way to the front line while being


Respect for nursing caregivers

• Demonstrated in many ways:– Bulletin boards recognizing long service– Photos of new staff with information containing

things others should know about him or her– New residents also had bulletin board

• Attending to needs of the job:– Supplies and education– Assistance both on and off the job

• Flexible scheduling• Emergency loans

2


Respect for nursing caregivers

2Hardly anyone had left the staff in last year because they were unhappy in the homes where they felt respected!

6/11/2014

51


Valuing relationships

• Between workers themselves

• Between residents• Between workers

and residents• With families

This quality was noticeably absent in high-turnover facilities


Positive Human Resource policies

• Compensations was NOT key factor distinguishing facilities from one another

• Wages were often comparable between high and low turnover facilities

• “People who do this work want to care for people. It’s their calling. They still have to be able to enjoy their co-workers.”

3


Policies which matter!

• Recruitment process — greater selection in hiring is imperative

• Orientation times ranged from one shift or less at high turnover facilities to 10 days or more at low-turnover facilities

• “I didn’t get orientation because the lady that does it was on sick leave”

• Mentoring• Evaluations, feedback, rewards• Managerial training for supervisory personnel www.nationalresearch.com

Effective work organization

• Consistent assignments between residents and CNAs

• Sufficient staffing• Careful attention to emotional and religious

passages in life• Organizing eating and bathing in ways

that rarely caused conflict and distress for residents or caregivers alike

4

6/11/2014

52


Effective work organization

• Involvement of aides in care planning meetings

• Seeking their input into the decisions about care for residents they know well

• Celebrations

4


In general,positive caregiving

practiceswere more likely linked

to decentralizeddecision-making and

an absence of arbitrarychanges without

involvement of or explanation


Adequate staffing ratios

• In workplaces where people stayed longer over time, aides had 5, 6 or 7 residents to care for on a typical day shift

• In high-turnover facilities, their assignments were more typically 8, 9, 10 or even 12

• The issue of having enough staff was described as basic

• Staff often leave because of “working short”

5


We did the best we could,

with what we knew,

And when we knew better,

we did better.

MAYA ANGELOU

6/11/2014

53


The importance of follow-up:Leadership Calendar

• Mark 8 different days on your calendar spread out over 8 months

• After the end of that day, write down some leadership behavior that you exercised during the previous period (or that day)

• Ask yourself:– How did I feel about my action or behavior?– How does this action or behavior jive with what I

know about leadership best practices?


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April 2014 May 2014


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July 2014SUN MON TUE WED THU FRI SAT

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June 2014



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August 2014 September 2014


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November 2014SUN MON TUE WED THU FRI SAT

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October 2014

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23


QUESTIONS?

[email protected]

[email protected]

Thank you!

6/11/2014

54


National Research Corporationis listed as #1 among the largest patient-satisfaction firms in the U.S. according to Modern Healthcare.

Improving Your Leadership

Skills

HANDOUTS AND EXERCISES

My InnerView by

TRAITS OF AN EFFECTIVE LEADER

My InnerView by

DRAW A PIG

My InnerView by

LEADERSHIP SITUATIONS

Describe something you have done or witnessed that demonstrates e ective (or ine ective) leadership in the following situations:

A PLEASANT SURPRISE:

A CLEVER IMPROVISATION:

A CONFLICT RESOLVED:

A REALLY TOUGH SITUATION:

A MOVING OR EMOTIONAL SITUATION:

My InnerView by

How do you motivate those who report to you?

How do you keep those who report to you meaningfully informed?

How do you maintain your team’s focus on speci�c goals?

How do you set, clarify and hold those who report to youaccountable to your expectations?

How do you recognize successful work?

My InnerView by

How do you encourage leadership development in your home?

How do you promote the development of a team spirit within your home?

My InnerView by

List 3 Super Stars

List 3 Middle Stars

List 3 Falling Stars

My InnerView by

REALITY CHECK

BEHAVIOR % OF TIME SPENT ON BEHAVIOR IDEALLY THE % OF TIME YOU

WOULD DEVOTE TO BEHAVIOR

Informing

Directing

Clarifying or Justifying

Persuading

Collaborating

Brainstorming or Envisioning

Reflecting (quiet time for thinking)

Observing

Disciplining

Resolving

Praising and/or Encouraging

My InnerView by

Concern for Production

Low High

High

ConcernForPeople

List 10 (or more) important pieces of data that are essential to YOU to be successful in leading your LTC organization

Which of these are important to share with staff in order for them to be successful in their work? Which staff and why?

My InnerView by


MON TUE WED THU FRI SAT SUN

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4 5 6 7 8 9 10

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July 2014

23

August 2014

September 2014 October 2014


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29 30


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1

2 3 4 5 6 7 8

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16 17 18 19 20 21 22

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February 2015

November 2014 December 2014

January 2015


1 2

3 4 5 6 7 8 9

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8 9 10 11 12 13 14

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9/11/09, My InnerView — Adapted from: Encouraging the Heart: A Leader’s Guide to Rewarding and Recognizing Others. Kouzes, J.M. and Posner, B.Z. Jossey-Bass Publishers, San Francisco. 1999

Encouraging the heart

EXPECT THE BEST 1. People tend to act consistently with your expectations of them. Expect them to succeed and be great. 2. Practice smiling. This is not a joke. Smiling and laughing release naturally occurring chemicals in our bodies that

uplift mood, and mood is contagious. 3. Ask yourself this question: “Do I honestly believe everyone on my team can achieve the values and goals of the

organization?” If the answer is “yes,” make sure you communicate this to them verbally and nonverbally. If your answer is “no,” figure out what you can do to change your answer to “yes.” What changes have to be made, in you and in them, for that to happen? Make them. You can do it.

4. Next time you talk to an employee about a difficulty she is having, make sure that sometime during the conversation you say, “I know you can do it.” Or words to that effect. And you better mean it. The next time someone is struggling to succeed, find a way to walk beside him for the most difficult part of the work, telling him, “Come on, I know you can do it. You’re the best.”

PAY ATTENTION 1. Leave your desk for 15 minutes every day, solely for the purpose of learning more about each of your key staff

members. Who are they? What are their needs and aspirations? What do they need to find greater joy in their work? How do they like to be rewarded?

2. When you are out there caring by walking around (CBWA), take along a pocket notebook to record the things people are doing right and the right things people are doing. Make sure to record not only the names but also the details about the setting, people involved, how the act is special and how it fits with the standards you’re trying to reinforce. Use this later when telling you recognition stories.

3. Start a file of recognition ideas and on your computer or in a journal that you carry in your briefcase or notebook. Record ideas that come to you for recognizing and rewarding individual accomplishments. Be on the lookout for contributions and successes.

4. Don’t wait for ceremonies or performance evaluations to recognize someone. If you notice something that deserves recognition, do it now!

5. Walk in another person’s shoes for a while. Volunteer to do their job, jump in and get going. People appreciate your efforts and you can get a better appreciation of their job.

6. Make a short list of those persons who are performing their work over stated performance expectations. Pay particular attention to those who best embody the team’s values and priorities. Then jot down at least three ways to single out, praise and reward them over the next several weeks. Don’t wait too long.

7. Ask your colleagues for feedback about your performance. You can only ask questions for clarification and you can only say “thank you.”

PERSONALIZE RECOGNITION 1. Think back on a time when someone encouraged your heart meaningfully and memorably. What did she do to make it

special for you? How did she personalize it for you? Make note of the lessons you learned and apply them. 2. If you are giving a talk outside of your work area or workplace, finish the talk by saying something like, “My colleagues

from XX couldn’t be with me today. I sure hope I represented them well.” 3. Send a personalized letter to the home of someone who has done something well. Tell them how important they are. 4. Invite a person’s family to any event that recognizes an employee. 5. Every time you plan a recognition gift, ask yourself, “Is this something that this person would appreciate?” 6. At the next staff meeting, make the only agenda item “How people are feeling at the moment about working at your

organization.”

My InnerView by

My InnerView — Adapted from: Encouraging the Heart: A Leader’s Guide to Rewarding and Recognizing Others. Kouzes, J.M. and Posner, B.Z. Jossey-Bass Publishers, San Francisco.

CONTINUED

SET THE EXAMPLE 1. Become more visible. You are supposed to be setting the example so people need to see you are doing what you

are saying. 2. Get involved in as many staff recognition and celebration events as possible. If you don’t attend you are sending the

message that you are not interested or too busy. 3. Write and deliver at least one “thank you” note each day. 4. Look around for someone who is very good at encouraging the heart. Ask for his advice and some feedback. 5. Tell stories about giving recognition and how people respond and react to this positive feedback.

CELEBRATE TOGETHER 1. Celebrations have a dual purpose. One is to offer social support. The other is to honor an individual, group or entire

organization for upholding a standard or value. Make sure to ask yourself about the fundamental principles that are being honored as well as how you’re going to have fun.

2. Buy this book!

Encouraging the heart My InnerView by

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