1. Employee Satisfaction: What do we do with the data? Mary Tellis-Nayak, RN, MSN, MPH VP Quality Initiatives My InnerView mary@myinnerview.com Mary Tellis-Nayak, RN, MSN, MPH VP Quality Initiatives My InnerView mary@myinnerview.com

2. Objectives The participant will be able to: —Identify three issues which staff say cause them to recommend a nursing home as a good place to work —Describe the relationship between the quality of the workplace and 3 other measures —Discuss what must be done with employee satisfaction results —List 2 things a leader can do with the results of staff satisfaction surveys The participant will be able to: —Identify three issues which staff say cause them to recommend a nursing home as a good place to work —Describe the relationship between the quality of the workplace and 3 other measures —Discuss what must be done with employee satisfaction results —List 2 things a leader can do with the results of staff satisfaction surveys

3. Our Mission To provide long-term care leaders evidence-based management tools to better achieve their organization’s goals

4. My InnerView Nationwide » 5,600+ providers in all 50 states and District of Columbia use our tools » Largest satisfaction benchmark database in long-term care » Recommended by: —3 national associations —32 state associations » 5,600+ providers in all 50 states and District of Columbia use our tools » Largest satisfaction benchmark database in long-term care » Recommended by: —3 national associations —32 state associations

5. Providers will commit to focus on at least 3 of 8 measurable goals

6. CLINICAL GOALS: 1.Reducing high risk pressure ulcers 2.Reducing use of daily physical restraints 3.Improving pain management for longer term nursing home residents 4.Improving pain management for short stay, post-acute nursing home residents CLINICAL GOALS: 1.Reducing high risk pressure ulcers 2.Reducing use of daily physical restraints 3.Improving pain management for longer term nursing home residents 4.Improving pain management for short stay, post-acute nursing home residents OPERATIONAL/ PROCESS GOALS: 1.Establishing individual targets for improving quality 2.Assessing resident and family satisfaction with the quality of care 3.Increasing staff retention 4.Improving consistent assignment of nursing home staff, so that residents regularly receive care from the same caregivers OPERATIONAL/ PROCESS GOALS: 1.Establishing individual targets for improving quality 2.Assessing resident and family satisfaction with the quality of care 3.Increasing staff retention 4.Improving consistent assignment of nursing home staff, so that residents regularly receive care from the same caregivers

7. Looking at National Results

8. National Employee Satisfaction Survey Results 2006 Nearly 107,000 responses

9. » First nationwide report » 1,933 nursing homes in 49 states and D.C. participated in 2006 NOTE: Alaska not included

10. Employee’s age FIGURE 2a

11. Employee’s job category FIGURE 2b

12. Length of employment FIGURE 2d

13. SATISFIED NURSING HOME WORKERS BY CATEGORY SATISFIED NURSING HOME WORKERS BY CATEGORY Based on the percent of total weighted respondents who rated their overall satisfaction as “excellent” or “good” in each job category FIGURE 1

15. An Exercise: What Matters Most?

17. Survey items: 1Quality of orientation 2Quality of in-service education 3Quality of resident-related training 4Quality of family-related training 5Comparison of pay 6Care (concern) of supervisor 7Appreciation of supervisor 8Communication by supervisor 9Attentiveness of management 10Care (concern) of management 11Safety of workplace 12Adequacy of equipment/supplies 13Sense of accomplishment 14Quality of teamwork 15Fairness of evaluations 16Respectfulness of staff 17Assistance with job stress 18Staff-to-staff communication

19. Ranked correlations (p < 05) between employee workplace recommendation and employee satisfaction items FACTORS THAT DRIVE WORKFORCE RECOMMENDATION

20. Ranked correlations (p < 05) between employee workplace recommendation and employee satisfaction items FACTORS THAT DRIVE WORKFORCE RECOMMENDATION (continued) TABLE 5

22. Ranked by average scores and correlations with workplace recommendation PRIORITY ITEMS FOR NURSING STAFF TABLE 6

23. Recommendation for care FIGURE 3

24. Recommendation for job FIGURE 3 Does not total 100% due to rounding

25. Overall satisfaction FIGURE 3

26. TRAINING May not total 100% due to rounding TABLE 1

27. WORK ENVIRONMENT May not total 100% due to rounding TABLE 2

28. SUPERVISION May not total 100% due to rounding TABLE 3

29. MANAGEMENT May not total 100% due to rounding TABLE 4

30. What does research tell us about satisfaction survey data?

31. What about employee data? What do we know today?

32. higher family satisfaction higher family satisfaction lower nursing assistant turnover lower nursing assistant turnover higher employee satisfaction higher employee satisfaction higher family satisfaction higher family satisfaction Key Performance Drivers

33. higher satisfaction among families and employees higher satisfaction among families and employees higher occupancy rates higher occupancy rates Key Performance Drivers

34. higher satisfaction among families and employees higher satisfaction among families and employees better clinical outcomes related to falls, pressure ulcers and catheters better clinical outcomes related to falls, pressure ulcers and catheters Key Performance Drivers

35. SUMMARY OF RELATIONSHIPS Staff Satisfaction Staff Satisfaction Resident/Family Satisfaction Resident/Family Satisfaction HR Decrease nurse absenteeism Decrease nurse turnover Decrease CNA turnover HR Decrease nurse absenteeism Decrease nurse turnover Decrease CNA turnover Improve care outcomes Improve relationships Improve care outcomes Improve relationships Financial Increase occupancy

36. Facilities with higher family satisfaction have better work environments < 54%54% to 58%58% to 64%> 64% Mean = 68.0 EMPLOYEE ENVIRONMENT SCORE (%) FAMILY SATISFACTION

37. Facilities with higher family satisfaction have better employee training Mean = 57.1 EMPLOYEE TRAINING SCORE (%) FAMILY SATISFACTION < 54%54% to 58%58% to 64%> 64%

38. Facilities with higher family satisfaction have better supervision Mean = 72.2 EMPLOYEE SUPERVISION SCORE (%) FAMILY SATISFACTION < 54%54% to 58%58% to 64%> 64%

39. Facilities with higher family satisfaction have better management Mean = 66.5 EMPLOYEE MANAGEMENT SCORE (%) FAMILY SATISFACTION < 54%54% to 58%58% to 64%> 64%

40. » More residents without falls » More residents without pressure ulcers » More residents without acquired catheters » Less nurse turnover » More nurse stability » Less CNA absenteeism » Less nurse absenteeism » Higher occupancy » More residents without falls » More residents without pressure ulcers » More residents without acquired catheters » Less nurse turnover » More nurse stability » Less CNA absenteeism » Less nurse absenteeism » Higher occupancy Facilities with higher employee satisfaction have:

41. CNAs speak up! A 2004 study 156 nursing facilities in the Southeast 3,579 CNAs, 6,502 families surveyed November 2004 Quality of leadership and quality of the workplace: The interface Quality of leadership and quality of the workplace: The interface

42. Indicators of quality of workplace 1.Pay compared to other nursing homes 2.Safety of workplace 3.Adequate equipment and supplies to do your job well 4.Work allows you to make a difference in people's lives 5.Co-workers work as a team 6.Fair performance evaluations 7.Staff are respectful of residents 8.Helps you get to deal with job stress 9.Communication between shifts

43. Quality of leaders produce a quality workplace Rating by 6,305 CNAs in 156 Nursing Facilities: 4 percentile ranked groups, 2004

44. A quality workplace earns staff recommendation

45. A quality workplace earns family recommendation

46. A quality workplace creates QoL for resident

47. As Staff are Treated So will the elders be treated.

48. A quality workplace creates QoCare for resident

49. A quality workplace creates QoService for resident

50. A quality workplace results in better state surveys

51. A quality workplace makes business sense

52. We did the best we could, with what we knew, And when we knew better, we did better We did the best we could, with what we knew, And when we knew better, we did better Maya Angelou

53. Now you know better so … … what do you do?

54. If you do not plan to use the results of your employee satisfaction survey to improve the work environment, it is far better that you not conduct the survey at all.

55. Using Satisfaction Data » One member of the leadership team must be responsible and held accountable for managing this initiative —Human Resources —Department Manager(s) —Administrator/Assistant Administrator —Staff Development » One member of the leadership team must be responsible and held accountable for managing this initiative —Human Resources —Department Manager(s) —Administrator/Assistant Administrator —Staff Development

56. Using Satisfaction Data » Use current structures or create new ones —QA&A committee —Staff meetings —Neighborhood/unit meetings —Interdepartmental teams —Focus groups » Use current structures or create new ones —QA&A committee —Staff meetings —Neighborhood/unit meetings —Interdepartmental teams —Focus groups

57. Communicating results » Determine what you want to communicate initially and to whom —Depends on your current facility structure (e.g. neighborhoods vs. units; universal workers vs. departments) » Consider the current culture of your community when considering how to proceed —Use a bulletin board to post results —Pull together an employee group to obtain feedback —Publish results in a newsletter format —Have unit/team meetings to present the results —Have an all staff meeting on each shift —Initially present the results to department heads » Determine what you want to communicate initially and to whom —Depends on your current facility structure (e.g. neighborhoods vs. units; universal workers vs. departments) » Consider the current culture of your community when considering how to proceed —Use a bulletin board to post results —Pull together an employee group to obtain feedback —Publish results in a newsletter format —Have unit/team meetings to present the results —Have an all staff meeting on each shift —Initially present the results to department heads

58. Where do we start? » Choose the issues —Start with “low hanging fruit” —Choose an area where you know you can show staff that you are listening to them —Choose an area which is important to the staff even if you may not have scored too badly —Choose an area where you know you can achieve results quickly —Choose an area which is no surprise because you’ve “heard it before” » Choose the issues —Start with “low hanging fruit” —Choose an area where you know you can show staff that you are listening to them —Choose an area which is important to the staff even if you may not have scored too badly —Choose an area where you know you can achieve results quickly —Choose an area which is no surprise because you’ve “heard it before”

59. My InnerView’s reports help you to choose the topic(s) which are most important to your staff.

60. 1.How residents, families and staff rate your care and services Your average score on each item: 1 – 4: “Poor” ”Fair” ”Good” ”Excellent” Rank order all items by their average score: 1 – 100: lowest to highest ranking score 2. How much each item influences residents, families and staff to recommend the facility to others. Correlate each item with “Recommendation” 0 - 1: no correlation to strongest correlation Rank order all items by their correlational strength: 1 – 100: lowest to highest ranking correlation Quadrant analysis: Two key concepts

61. The Quality Quadrant and Action Priorities 1 ---------- Lowest to highest ranking correlation --------  100 Recom- mendation Item score Successes You have little control over customer expectations You can meet customer expectations C. Secondary opportunties D. Primary opportunities B. Primary strength A. Secondary strength Challenges 1 --- Lowest to highest ranking score  100 Goal

62. Just ask why! My work is stressful — I gave Mrs. J her supplement and she threw up — No one told me she had been sick all morning — My work is stressful — I gave Mrs. J her supplement and she threw up — No one told me she had been sick all morning —

63. There is no communication between the morning and evening shifts of CNAs —

64. Take Home Tips » Just ask until there are no more ‘whys’ to ask » Focus on systems and processes » LISTEN » OBSERVE » Don’t BLAME » Involve the team » Just ask until there are no more ‘whys’ to ask » Focus on systems and processes » LISTEN » OBSERVE » Don’t BLAME » Involve the team

65. Turn Information Into Knowledge Study current process Gather more information Evaluate process Identify contributing factors Determine root cause(s)

66. Develop Drill Down Questions Issue – Orientation Drill down suggested questions: » New CNAs are oriented specifically to their unit » New CNAs are oriented specifically to their shift » New employees are taught the proper use of equipment which they will be using » New employees are shown the location of the supplies and equipment they need to do their job » New employees are assigned to a mentor or a buddy system » New employees are not given a full a workload initially, but in gradual steps » New employees are introduced individually to the residents assigned to them Issue – Orientation Drill down suggested questions: » New CNAs are oriented specifically to their unit » New CNAs are oriented specifically to their shift » New employees are taught the proper use of equipment which they will be using » New employees are shown the location of the supplies and equipment they need to do their job » New employees are assigned to a mentor or a buddy system » New employees are not given a full a workload initially, but in gradual steps » New employees are introduced individually to the residents assigned to them

67. Use the Workplace Scale as Starting Point » Pay compared to other nursing homes » Safety of workplace » Adequate equipment and supplies to do your job well » Work allows you to make a difference in people's lives » Co-workers work as a team » Fair performance evaluations » Staff are respectful of residents » Helps you get to deal with job stress » Communication between shifts » Pay compared to other nursing homes » Safety of workplace » Adequate equipment and supplies to do your job well » Work allows you to make a difference in people's lives » Co-workers work as a team » Fair performance evaluations » Staff are respectful of residents » Helps you get to deal with job stress » Communication between shifts

68. A Valuable Resource » “Better Jobs Better Care: Issue Paper” —No. 7/April 2007 —“Respectful Relationships: The Heart of Better Jobs Better Care” » Link to this paper —http://www.bjbc.org/Page.asp?PgID=27http://www.bjbc.org/Page.asp?PgID=27 » This paper addresses the key issue of the long-term care workforce — RESPECT » “Better Jobs Better Care: Issue Paper” —No. 7/April 2007 —“Respectful Relationships: The Heart of Better Jobs Better Care” » Link to this paper —http://www.bjbc.org/Page.asp?PgID=27http://www.bjbc.org/Page.asp?PgID=27 » This paper addresses the key issue of the long-term care workforce — RESPECT

69. Whether individuals feel respect 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.

70. Studies suggest that the quality of these relationships has a defining impact on workers’ decisions to stay on the job or leave to pursue opportunities elsewhere.

71. Lessons Learned Practical Suggestions » Take a “relationships inventory” » Listen to what workers say about respect » Identify changes necessary to “operationalize” respect » Think in terms of maximizing human potential » Understand the needs of new immigrants and non-English speakers » Commit to making continuous improvement » Take a “relationships inventory” » Listen to what workers say about respect » Identify changes necessary to “operationalize” respect » Think in terms of maximizing human potential » Understand the needs of new immigrants and non-English speakers » Commit to making continuous improvement

72. Take a “relationships inventory” » Do managers at all levels of your organization have positive and professional relationships with the people they supervise? » Does the disciplinary action make up a large portion of interaction between frontline staff and managers? » Do direct care staff see managers as mentors they feel comfortable going to for advice and problem solving? Without a foundation of healthy relationships among frontline workers and between direct care workers and their supervisors, other initiative to create a more respectful work environment are unlikely to be successful. » Do managers at all levels of your organization have positive and professional relationships with the people they supervise? » Does the disciplinary action make up a large portion of interaction between frontline staff and managers? » Do direct care staff see managers as mentors they feel comfortable going to for advice and problem solving? Without a foundation of healthy relationships among frontline workers and between direct care workers and their supervisors, other initiative to create a more respectful work environment are unlikely to be successful.

73. Listen to what workers say about respect » When workers say they feel a lack of respect, it often reflects their sense that no one is listening to them. » Everyone knows how to listen but knowing how to listen to information that is emotionally charged is difficult. » Responding without blaming or being judgemental requires training and practice. » When workers say they feel a lack of respect, it often reflects their sense that no one is listening to them. » Everyone knows how to listen but knowing how to listen to information that is emotionally charged is difficult. » Responding without blaming or being judgemental requires training and practice.

74. Identify changes necessary to “operationalize” respect » Review existing P&Ps to understand what changes, big or small, will make workers feel more respected, valued and heard. » Do you have a process in place to provide emotional support to workers who are caring for consumers or encountering family members who are verbally or physically abusive? » How does your organization support workers who feel they are being discriminated against? » Review existing P&Ps to understand what changes, big or small, will make workers feel more respected, valued and heard. » Do you have a process in place to provide emotional support to workers who are caring for consumers or encountering family members who are verbally or physically abusive? » How does your organization support workers who feel they are being discriminated against?

75. Think in terms of maximizing human potential. » When workers have the opportunity to improve themselves, personally or professionally, they feel better about themselves and have a more positive attitude about their workplace. » Do you have a career track for direct care workers? » Do you offer educational opportunities through scholarships or on-site distance learning? » When workers have the opportunity to improve themselves, personally or professionally, they feel better about themselves and have a more positive attitude about their workplace. » Do you have a career track for direct care workers? » Do you offer educational opportunities through scholarships or on-site distance learning?

76. Understand the needs of new immigrants and non-English speakers » Does your workforce include immigrants or those with limited English skills? » How well do you understand their customs? » What are you doing to help them operate in their new language and cultural environment? » Does your workforce include immigrants or those with limited English skills? » How well do you understand their customs? » What are you doing to help them operate in their new language and cultural environment?

77. Commit to making continuous improvement » There is no “one-time fix” for creating a respectful work environment » To be successful, the work must be an ongoing process, fully supported by all levels of people within the organization and owned by more than one person » One innovation to create a more respectful work environment is likely to lead to another as workers feel more empowered to articulate their needs and interests. » There is no “one-time fix” for creating a respectful work environment » To be successful, the work must be an ongoing process, fully supported by all levels of people within the organization and owned by more than one person » One innovation to create a more respectful work environment is likely to lead to another as workers feel more empowered to articulate their needs and interests.

78. “A resident’s satisfaction with his/her relationship to nursing staff was found to be significantly related to the proportion of CNAs on the resident’s unit who said they intended to stay in the job, and to the proportion of CNAs who had positive relationships with their supervisors.” - Bishop, October 2006

79. Using employee satisfaction surveys will help leaders to improve the tenure of staff by addressing those issues most important to them.

80. Don’t miss this valuable opportunity to improve quality of life for your residents by improving quality of life for your employees

81. QUESTIONS? Contact: Mary Tellis-Nayak mary@myinnerview.com 773-942-7525 mary@myinnerview.com 773-942-7525