From the winter 2005 edition of Frontline Care
"It's just Mike!"
When faced with an employee turnover rate that exceeded 100 percent some months, one Philadelphia nursing home tried some radical solutions. Birthday cards and baby pictures, frequent “thank yous” and open doors.
Oh, and the diamond necklace probably didn’t hurt.
Did it work?
At the end of November, the turnover-rate average for 2004 year-to-date was less than 44 percent. That's I6 points below the state, according to a study funded by the state Department of Aging.
"That's not subjective," said Lisa Sofia. chief operating officer and administrator for Deer Meadows Retirement Community. "You can actually see the progress we're making."
Deer Meadows has been struggling with the same increasingly problematic trend facing most retirement and nursing homes in recent decades. Their turnover rate reflected those struggles. In 200I the average rate of turnover for all departments for the year was about 8.8 percent. That had fallen only four points by the end of 2002 but the next year saw a I7-point improvement and today, 23 more.
What happened?
The facility began life as the Baptist Home of Philadelphia in 1869 and is today a not-for-profit home with beds for nearly 500 residents in skilled nursing, personal care and independent living sections. It employs about 250 nursing personnel.
Sofia, who's worked at Deer Meadows for 25 years and moved through the ranks, points to November 2002 as the turning point. That's when Mike Jacobs became executive director. He brought a new way of managing with him, implementing an aggressive recognition program. Past management styles, Sofia says, were outdated.
"There were a lot of wounds to heal and a lot of trust to build," she says. Departments didn’t work together and people were suspicious of one another. "Some days you had to just put the armor on and come to work and try to do your job."
"I walked through the door and saw myriad opportunities," Jacobs insists. "I saw potential for changing the environment." He began with seemingly small things.
Many members of management asked him how he preferred to be addressed. "It's Mike," he told them. "Just Mike." Soon, that sentiment had trickled down and staff all over the facility was whispering to each other in incredulous tones, "It's just Mike."
He sends a birthday card to each employee with a gift certificate for the pizza place across the street. He stops and talks to workers in the hallways and listens to what they say, says Sofia.
"It was a cultural transformation," Jacobs says. "I saw people coming from an older school of management. But that way isn't my way." He directed his management team to keep an open door policy — closed doors are barriers, they shut people out, he says.
Also, the basic rules your momma taught you as a child still apply in the workplace. Say thank you and please and well done. And say it often.
With input from his staff, he started implementing ways to say thank you officially and publicly. He tapped Margi Johnston, director of community education, to form a team whose sole purpose would be to make Deer Meadows a better place to work. She gathered members from each of the departments to form a fully representative committee and the SWAT Team — Staff Working All Together — got to work about a year ago. At first they had to tell people who they were and what they were doing but they kept at it.
They came up with the Star program. "Residents and family members will often write letters or notes, thanking an individual or team for the job they do or a special kindness they have shown," said Sofia. The Star program makes certain those letters are shared in general staff meetings and encourages staff members to write letters when they see their co-workers excel.
When Johnston told Jacobs about the idea, he loved it but said, "I have to have some way to break the rule." He laughs, then becomes serious. "What if somebody does something really cool but no one writes a letter or nobody sees it but me? So I created the Director's Star. I can give it to anyone anytime I see fit."
The first was awarded to a nurse who simply began putting soft silken blankets on residents who'd reached a terminal stage of their lives. She put a card on the chart so that staff could note something special about the person for their families.
"Nobody saw her do that," Jacobs said. "She just did it. It's about caring for one another and she did that."
When a letter is received, no matter from whom, the staff member highlighted receives a star … each star is bigger than the last and when a person receives four stars, they receive a gift certificate for dinner or the movies. Five more stars and it's a day off with pay.
"We want everyone to know what has been done, what's been said," says Jennifer Kreutzer, director of nursing. "The day-to-day recognition from management has made a big difference. It's nice to have the public recognition but also that immediate pat on the back, right then and there — that's even more important.” People are proud of the level of care they give and when they get such recognition, she says, they know it makes a difference. It encourages everyone to try to be better and to watch for others' accomplishments.
The SWAT Team also runs a monthly contest. They were given a budget of $100 a month and nearly free reign. Working on the idea that people love to win prizes, they started with simple contests, like "guess the number of jelly beans in the jar." The prize was a $100 Easter basket.
Then she had the managers bring in baby pictures — why management? Because she felt more people would know the managers, where they often didn't know people in other departments. The pictures were posted by the time clock where everyone would see them and the staff were asked to guess who the babies grew up to be.
They displayed the female management in May (Mothers' Day) for the women to guess and the male management in June (Fathers' Day) for the guys to take their chances. The men were going for tickets to a Phillies game and coupons for the concession stands … the women? A $300 diamond necklace bought on sale for $99.99.
"Those ballot boxes were stuffed," Johnston recalls. "Just stuffed!" She believes that contest was the turning point for the staff. "They started to see the managers as real people," she says. "I think that broke it. In the beginning they were leery [of the changes] but after that they could start to see the managers were really trying."
"I've never met more quality people," Jacobs says: "These are heroes. It s a real team effort. They know how to do this better than .think I know how. I’m wise enough to know I better not make I a change in an area without talking to the people who work in that area."
Jacobs is echoing the findings of a study paid for by the PA Department of Aging that looked at the problems facing the commonwealth's long-term care facilities. Conducted by the Polisher Research Institute at the Philadelphia Geriatric Center in February 2001, the study found recruitment and retention to be significant challenges in the care of the state's elderly, with turnover rates ranging regularly from 65 to more than 100 percent across the state.
Contrary to popularly held beliefs, meaningful staff involvement and empowerment were strong elements of the workplaces where the lowest turnover rates exist. Something Kreutzer agrees with.
"Our salaries haven't increased significantly," she says. "Base hasn't changed. The difference is in the environment."
Low wages, poor benefits and poor training were assumed at the start to be some of the reasons turnover was so high. What the study found, however, was that higher wages and more benefits have only a limited impact. Training appeared to help somewhat but it was what they called the cultural change that seemed to make the most difference. When frontline workers were involved in care planning, work scheduling and where their workloads were more balanced and teamwork was emphasized, staff members stayed in their jobs longer and showed up for work more consistently.
The Employment Policy Foundation, a Washington, D.C.-based research group, estimates that replacing a worker costs an average of a quarter of that person's salary. This includes recruiting, selection, training and lost productivity expenses. Turnover, then, becomes a significant bottom-line issue as well as one of quality care.
"When you talk about community, we are the definition of community," Sofia claims emphatically. "It is so alive here. There are no barriers. We started talking to the people and listening to them," she adds. "I think what I've learned is, our employees have real life problems and we can be a resource, not just a place to come to work. They may not have a good support system at home. They may not know what resources are available to them. We try to help."
Attendance and tardiness used to be a problem at Deer Meadows, adds Kreutzer. A veteran of the facility for many years, she began as a charge nurse. There were many shifts when she couldn't get her own work done because so many nurses had called off.
With the new environment of open communication and problem solving, however, some common reasons for the attendance problems were identified: public transportation issues, school and child care schedules, and cultural diversity.
"We educated them to how important it is to show up for their shifts and be there on time," Sofia says. At the same time, she adds, management found ways to make the workplace work for the staff. "We listened and then asked what can we do to help you? We have flex hours now; we're trying to work with our people. Everybody wins."
The effect of different cultures in the population has really been felt in the healthcare industry, according to the Bureau of Labor. Many immigrants find employment there, creating occasional misunderstandings in places such as Deer Meadows.
Kreutzer brings her staff together regularly to talk about conflict management. Combined with the recognition the staff now receives, she sees tremendous change just in the fact that the facility has not had to rely on agencies for staffing over the past year and a half.
"I tell my staff that I'm not the great Magic 8-Ball," Kreutzer says with a laugh. "You can't shake me and have all the answers. I have a lot of staff with a lot of experience. I need that input. I bring the whole team in. I don't want them to be accusatory. I want them to come to an understanding. You're validating their feelings if you listen to them. Often, that's all they want. Before we didn't have any way to help people come together like that."
Johnston's team turned ethnic differences into celebration with the Cultural Diversity Day. Staffers were encouraged to create a display highlighting their national heritage. On the big day, staff, residents and families toured through the conference room to sample the sight, sound and taste of the cultures represented.
“Everybody was nice,” says Johnston. "We had people from the Ukraine, India, Ireland, and Germany. The place was packed." Two team members stood by the ballot boxes at the doors and made sure everyone voted for their favorite display.
The girls from India won the contest, but everybody was a: winner that day because everyone learned more about one another.
And that’s all part of what Jacobs was trying to accomplish when he took the helm two years ago. "People know they can make a difference and they enjoy working at Deer Meadows. That follows through to the care residents receive."
"Respect people," he says. "Pay people market rate, make sure the benefits are reasonable and make sure everyone knows they're part of the big picture. We've raised the bar and everyone's expectations. I tell them, ‘Your hands are truly gifts from God.' I've been in love with my job every day since I started. It's all about caring for people. Now I’m passionate about caring for seniors. Now I'm I in a position to make a difference in their lives. I don’t always get it right but I try."
