Tip of the week: Invest in people by making changes to your leadership

The pilot program created a model for change in these areas with training sessions, conference calls, and homework assignments (see “Retention homework assignment” below). The use of these tools led to several improvements, including the following:

Lead by example

The main thrust of the change came from modifications to leadership styles, Brady says. “Be visible, be out there, be a model.”

Do things the way you want them done. For example, if you walk by the nurses’ station and hear the call bell, don’t ignore it. Tend to the resident’s need instead.

The same goes for spills on the floor. Don’t just walk by them; clean what you can, and if more attention is needed, notify the facility’s maintenance crew that it needs to clean it up.

Good teamwork comes from those at the upper levels of management modeling teamwork. When you walk by a call bell or spill and tell someone else to take care of it, you’re modeling the ethic that “it’s not my job.”

Walking around is a great way to manage and get a pulse on what’s happening in the units, Brady says. But do it naturally by building it into your everyday routine. “There’s a big difference between walking around with a clipboard and walking around with a cup of coffee,” she says.

If you walk around with a clipboard on a mission to find errors, you will cause your staff stress and make them feel as though you are looking over their shoulder and that they are not capable of doing their jobs.

This may lead them to make errors or feel uncomfortable coming to you when there is a problem.

Tear down the hierarchy

To become a coffee-cup manager as opposed to a clipboard boss, create a system of teamwork rather than a chain of command, Frank says. “A lot of nursing homes still use an out-of-date leadership hierarchy to manage,” she says.

Teamwork will bring out the best in your staff. It will also give each member of your team a sense of ownership in the company’s success.

For example, one nursing home with which Frank worked was in danger of losing its licensure because of too many medical errors and related survey deficiencies. Instead of bringing the nurses together, pointing fingers at everyone, and demanding zero errors in the future, the managers brought the team together to talk out the problem.

The administration asked what the staff needed to reduce errors and which factors contributed to the errors.

This prompted a discussion about distractions that led to errors, Frank says. Staff shared that when managers—including the administrator—came to them with questions while they were passing medications, they lost their focus and made mistakes.

The managers concluded that they would not interrupt staff during med cart rotations.

Nurses made it a routine to meet with their staff before and after the medication pass to check in on staff needs. And, in cases in which staff needed immediate help, nurse managers who were not involved in the med pass served as back-up.

Bring out the leader in others

Everyone on your staff has useful answers when you are working together to achieve a common goal, Frank says. This may not be as obvious in every employee, but there are small ways in which you can help those late-bloomers come out of their shells. Good leaders bring out leadership abilities in those around them through people development.

For example, one facility with which the consultants worked had certain staff who went to administrators for direction on everything.

“Don’t get frustrated with people who do that; it’s very natural. We’ve been trained to want direction from our supervisors,” Frank says.

In this particular facility’s case, when the staff member asked her boss what to do about a situation, the boss asked the employee what she thought her options were. The two brainstormed possible solutions and decided together what to do.

The next time, the employee came to the boss with a problem and possible solutions that she had already thought of on her own, and with the boss’s encouragement, she identified the solution.

The following time, the employee came to the manager with the problem and what solution she chose and why, just to keep the supervisor in the loop.

A pat on the back goes a long way

Try not to be robotic or simply go through the motions of including these techniques in your culture change. Appreciate your staff’s efforts along the way, Frank and Brady say.

“We spend so much of our time caring for our residents that we forget to take care of each other, too,” Frank says.

Praise and encouragement are always appreciated by people. Even if they know that they are doing well, it’s inspiring to hear that their boss also notices.

One participant in the pilot program said in the final debriefing of the study that he was preparing to spend a lot of money on consulting to solve his retention problems. However, the program taught him that an important thing that kept people coming to work was simply relating to them and treating them with respect. Sincere thank yous and letting people know that you value them are key components to staff retention.

Calculate turnover costs

Ever wonder what turnover actually costs your facility? Fill out the sample turnover replacement costs form on p. 4 of the PDF of this issue or on www.hcpro.com/content/62931.cfm to get automatic calculations to see how far back turnover financially sets your facility.

Retention homework assignment

Step out of your administrator shoes for a few minutes and learn what it’s like to be an employee at your facility. “Improving Nursing Home Culture Pilot Study,” a project sponsored by CMS, gave participants homework assignments to learn more about their employees.

Ask your staff on every shift the following questions to gain a better understanding of their pressures and needs on the job:

In addition to talking with staff, take time to see the day through their eyes. For example, sit in the break room and see whether you’d like to eat lunch there, says Barbara Frank, cofounder of B&F Consulting, who worked as a partner on the CMS initiative.