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What Does a Leader L ook Like?. Leadership S tyle and Methodology within a Skilled Nursing Facility. What is an INTJ?.
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What Does a Leader Look Like? Leadership Style and Methodology within a Skilled Nursing Facility
What is an INTJ? • The Jung Personality test helps determine whether a person is more of an introvert or an extrovert, more intuitive or sensing, more of a thinker or a feeler, and more judgmental or perceptive. • According to the test, I am an INTJ 11% more introverted than extroverted 33% more Intuitive than Sensing 25% more thinking than feeling 45% more Judging than Perceiving Human-Metrics, 2012
Characteristics of an INTJ • Very self-confident, definite, and strong-willed. • Before making decisions, INTJs have to do a lot of research and exhaust all available resources and data before embracing an idea. • They believe that complex operations involve many steps or stages, and INTJ’s are naturally able to grasp how each one leads to the next, and to prepare alternatives for difficulties that are likely to arise any step of the way (Keirsey, 1998) • INTJs believe that thoughts, feelings, responses and behaviors consciously operate in line with some rules, principles or norms Human-Metrics-Basics, 2012
So…how would an INTJ design the most important presentation of the semester? Graphs & Charts? Storyboard? Excel? PowerPoint? Video? Podcast?
The most organized and logical option was PowerPoint! Please enjoy the following presentation as you learn About my current leadership experience
Leadership Potential • Like most INTJs, I possess the ability to be a great system builder and to see and seize those opportunities which often go unnoticed. • I am also a problem solver and am able to find complex solutions to even the most difficult of problems. • I offer positive criticism rather than negative/hurtful criticism because I enjoy encouraging staff based on their good qualities rather than tearing them down and focusing on the bad. • My personality type works very hard to create an efficient work environment and will quickly remove or change anything that causes inefficiency. • I appreciate and respect rules, procedures, and most traditional authority. • I am dedicated to my goals and I like a career that requires me to solve problems and find solutions. Keirsey, 1998
Where are my leadership skills being formed and transformed? A Skilled Nursing and Long-Term Care Facility with 40 skilled and 20 long-term beds. Received the Gold Medal Award for State Survey (zero deficiencies) in 2012 and 2013. A Five-Star nursing facility according to U.S. News.
Our Patients • Stroke and neurological conditions • Orthopedic surgeries including knee and hip joint replacement • Fractures including hip and femur • Injuries related to falls • Cardiac-related problems including heart failure • Pulmonary impairment including pneumonia and COPD • Post-surgery recovery • Wound care • Tracheostomy (uncuffed) • Professional medical teams are capable of also providing these services for specific patients: • Intravenous Administrations • Total Parenteral Nutrition • PCA Pumps • Wound vacs • PICC (peripherally inserted central catheter) • Exclusive LifeWorks Rehab program Bayside Health and Rehab, 2013
What is LifeWorks Rehab? • Well-rounded • Compassionate • Outcome-driven • Based on proven clinical pathways • Individualized treatment, therapies, services, and recovery tools • Carefully planned and supervised by medical professionals • Most modern technology available • Supportive staff • Therapy is offered seven days per week to speed recovery Bayside Health and Rehab, 2013
Our Team • Nurses: • Talented and caring group of men and women. Some of the nurses are new graduates and others have twenty years of experience • Ratio: One nurse (RN or LPN) to 20 patients during the day and evening shift; one nurse (RN or LPN) to 30 patients on night shift • CNAs • A group of men and women who are friendly, compassionate, and focused on customer service. Some are newly certified, others have been with the facility for 15 years. • Ratio: One CNA to 12 patients during the day and evening shift and one CNA to 20 patients at night.
Our Team • Administrator • Human Resources Director • Dietary staff and management • Housekeeping staff and management • Maintenance Director • Activities Director • Admissions Director • Finance Director • Dietician • Discharge Planner • Receptionist • Therapy staff (manager, Speech, Occupational, Physical, assistants) • Director of Nursing • Associate Director of Nursing and Unit Manager (two roles, one person) • Two shift supervisors and two weekend supervisors • Staff Development Coordinator & Infection Control Nurse (two roles, one person) • Minimum Data Set Coordinator
What role do I play at Bayside? Staff Development Coordinator and Infection Control Nurse Most of my duties revolve around education, in-services, orientation, antibiotic monitoring, isolation precautions, and training.
Common to most nursing facilities, there are many ethical and legal considerations at Bayside…
Ethical Considerations • Respect for persons (autonomy and self-determination) • Beneficence (doing good) • Non-maleficence (avoiding harm) • Justice (fairness, equitability, truthfulness) • Veracity (telling the truth) • Fidelity (remaining faithful to one’s commitment) • Sometimes the nurses, CNAs, managers, and doctors have a difficult time making ethical decisions. At all times, they attempt to be respectful, fair, truthful, faithful, and harmless to the patients. Everyone tries to respect the wishes of the patient and family. Arch Intern Med, 1996
Legal Considerations • Advance directives • Competence and decision-making capacity • Decisions about life-sustaining treatment • Resident abuse • Restraints • Psychotropic medications • Risk management • Participation in research All patients are encouraged to have an advanced directive, living will, or POA so that the medical personel are not overwhelmed by the ethical or legal situations which may occur while the patient is residing at the facility. Arch Intern Med, 1996
What sets Bayside apart from other Nursing and Rehab Facilities? • Person-directed setting: resident-directed care and activities • An example of this is “Resident Council” which is held bi-weekly and it enables the residents who attend the meeting to make important decisions about activities and allows them to share thoughts, opinions, and complaints • Another example is care plan meeting. During this meeting, the patient can make changes to their care and can voice compliments, complaints, and opinions. They can also ask questions and receive education when necessary • Home-like environment for long-term care residents • Staff tries to build relationships with the family, resident and community. Staff Empowerment; all staff are encouraged to answer call-lights. Staff Meetings and Opinion surveys. • Collaborative and decentralized decision-making. Ex.) Morning meeting, Staff meetings, QA meeting quarterly. • Systematic processes that are comprehensive and measurement-based, and that are utilized for continuous quality improvement • The Culture is one of customer service. This attitude is directed towards residents, family, co-workers, management, doctors, transportation services, phlebotomy services, other departments, and anyone else who steps in to the building.
Bayside Philosophy • “We believe that giving the best care requires more than just treating patients…it requires knowing them as people. It’s more than just caring for people–it’s caring about them.” • “People who not only care for you but care about you and take the time to get to know you personally–makes all the difference in the world. That’s the cornerstone of our philosophy.” • “Our unique, inclusive approach creates the perfect environment for healing, and translates to better outcomes and a more personal, rewarding experience for our patients.” Bayside Health and Rehab, 2013
Coaching and motivating is an ongoing process at Bayside. Staff is encouraged to perform at their best at all times and in all circumstances!
Coaching and Mentoring • Trust is developed by encouraging open, two-way communications • Leaders share personal experiences and offer guidance • Each team member is respected and appreciated for his/her individuality. All judgments and opinions are suspended. Good leaders see and appreciate different perspectives • Leaders display patience with new employees because they have a learning curve to overcome. Long-standing employees do not receive as much grace when they make a mistake because they are expected to “know better.” • Leaders must demonstrate good listening/follow-up skills and provide constructive feedback and advice. • Mentors must have great listening skills. Their focus should be completely on the mentee, his/her words, non-verbals, and agenda. • Good mentors ask powerful questions. These questions are short in length, open-ended, deep, and encourage the employee towards a goal. • Leaders also challenge the mentee to become better and to advance in his/her skills and knowledge. • The mentee is held accountable for his/her actions. • Mentees receive encouragement, support, and acknowledgement • Good mentors do not ignore their intuition. They realize that their “gut” feeling is usually trustworthy. ASHA, 2013
How do I coach as the Staff Development Coordinator? • By conducting orientation for all new nursing staff • By providing training and skills fairs so that staff can learn new skills or refresh their knowledge of a rarely used skill • Through utilization of the skills validation checklist, which helps me to assure that the new employee has learned about all important aspects of their job and has hands-on experience with each skill • By having an open-door policy and encouraging staff to discuss their concerns and questions with me at any time. • Through accountability and follow-up with each employee • By correcting errors in a positive and encouraging manner • By listening to staff and trying to meet their needs in the best way possible
Regulatory Agencies • Center for Medicare and Medicaid Services (CMS) • Congress has legislated minimal standards such as Prospective Payment System for facilities using Medicare. • The standards created by Congress “govern minimum participation requirements and an inspection process to review a facility’s compliance” (Markenson, 2004) • CMS has established the Medicare Statutory Operational, Statutory Reimbursement, Regulatory Operational, and Regulatory Reimbursement Requirements as well as the Medicaid Statutory Operational Requirements. • These requirements are closely assessed during the facility’s annual survey. • Virginia Health Department (VDH) • Coordinates with CMS to develop State Statutory Operational Requirements, along with State Medicaid and Medicare Statutory and Regulatory Reimbursement Requirements. • The VDH has also developed regulations about physical environment, administrative services, resident services, and support services as they relate to Skilled Nursing Facilities
What is State Survey? • Nursing facility surveys are not announced to the facility. • States conduct standard surveys and complete them on consecutive workdays, whenever possible. • They may be conducted at any time including weekends, 24 hours a day. Random inspections occur at times as a result from a complaint against the facility. • Bayside has a survey window of 5 months, so management is prepared every day until the surveyors finally arrive • All nursing facilities are subject to inspection or survey by virtue of their certification to participate in Medicare &Medicaid, and/or their licensure by the state in which they conduct their services. • State licensure standards usually follow Federal guidelines. Most surveys are conducted by state personnel who simultaneously assess compliance with both licensure and certification requirements.
What is State Survey? • The standards set by CMS are reviewed during the facility’s annual survey • When a facility is surveyed and found to not be in compliance with one or many of the standards, a deficiency or deficiencies will be given to the facility • Any deficiency cited against the facility will result in regulatory and/or monetary penalties to the facility. It will also become a part of the public record about the facility. • Thankfully, Bayside has not received any deficiencies over the past two years
How do you feel about State Survey? I have to admit…it is VERY stressful!
How does Bayside prepare for Survey? Infection control precautions Locking of supply doors and medication/treatment carts Equipment only on one side of the hall Completion of crash cart logs Verbal orders Pain assessment Error corrections Initialing and signing of orders Informed consent Advanced directives and DNR form completion Approved abbreviations Documentation of timely and consistent care Customer service • Continuous education about: • Control & security of medications • Expiration of medications and labeling of boxes • Labeling of multi-dose vials • High alert medications • Use of at least two patient identifiers • Proper documentation of medication administration • Bedside medications • Hand washing guidelines • Eating/drinking at the nurses’ station • Storage of sterile/non-sterile items • Patient/staff food storage • Mock Surveys • Daily chart and order audits • Infection control rounds • Employee file auditing • Skills fairs for CNAs and Nurses • The Joint Commission, 2013
Quality and Safety • Regulations help to assure that the healthcare environment is constantly improving in quality and safety • The survey process helps the leaders to know the areas in which the healthcare facility needs to make improvements or the areas in which the facility is striving. The agencies provide clear guidelines and initiatives based on evidence & research which guide leaders as they seek to provide the safest and highest quality care for the patients. • Safety is ensured through provision of leadership, recognizing human limits in process design, promoting effective time functioning, anticipating the unexpected, and creating a learning environment • Quality occurs when there is: • adequate staffing • a positive collaborative environment • a supportive nursing culture • resources that encourage ongoing learning • The quality of healthcare is improving as a result of evidence-based practice, electronic medical records, dashboards, increased nurse staffing, reduction in medication errors, and peer review Sullivan, 2012
Accrediting Agency • Bayside Health and Rehab is not accredited. The Administrator does not think it is necessary to become accredited by the Better Business Bureau or the Joint Commission. According to the Administrator, the state survey accounts for the facility’s accreditation. • The management is not pursuing accreditation because Bayside has a great reputation and is well respected by the state and Center for Medicare & Medicaid Services.
Leadership Theory • Most of the leaders within the facility are participative or transformational theorists: • The leaders at Bayside value the thoughts and opinions of others. They encourage participation and contributions from group members and help group members feel more relevant and committed to the decision-making process. • The transformational leaders appreciate the connections formed between leaders and followers. These leaders motivate and inspire people by helping group members see the importance of their work and tasks and encouraging them to fulfill their potential. • I have high ethical and moral standards, so I tend to lead in a transformational style. I try to provide direction for each employee in a way that is most beneficial and understandable to them. Each employee learns differently, so I try my best to be cognizant of their individuality and learning style. • The Administrator of Bayside utilizes the transactional leadership theory style. He focuses on the role of supervision, organization and group performance. When employees are successful, they are rewarded. If they fail, they are reprimanded or punished. Sullivan, 2012
Forcasting What is the five-year outlook for Bayside Health and Rehab?
“Healthcare forecasting is a prediction about the future of healthcare. The purpose of a successful forecast is “to identify the key variables that underlie demand for healthcare services within a particular service area and to understand how and why these variables might change over time.” Finarelli & Johnson, 2004
ObamaCare • Currently, the only worries for Bayside Health and Rehab are the potential changes that may result from ObamaCare. • The fear is that the facility may eventually have to drop-out of Medicare practice because reimbursement will be greatly reduced, administrative costs will be higher, and the rules and reporting requirements will become increasingly complex. • According to a report from the Congressional Budget Office (CBO), “Obamacare will reduce Medicare reimbursements by $716 billion over 10 years.” • These cuts will greatly affect the majority of skilled nursing facilities. Bayside Health and Rehab will more than likely be amongst the majority of nursing facilities that are negatively affected by Obamacare. Moffit& Sneger, 2013
A brighter forecast? • Apart from Obamacare, the outlook for Bayside is positive. • More staff is being hired so that there will be minimal staff shortages (this will increase employee and resident satisfaction) • Many of the nursing employees are furthering their education so that the facility will have a greater number of RNs and Bachelors level nurses. The forecast looks bright for Bayside!
Marketing Plan • Create a list of what Bayside has to offer and then compare to the competition. What makes Bayside the best option for the customer? • Anticipate customer needs. • Assure reliability, quality, and safety place to live. • Staff must be friendly, compassionate, and encouraging • Provide many exciting and variable patient activities • The environment should be home-like and comfortable • Match customer needs with Bayside’s services and benefits. • Markey Bayside’s special awards, qualified staff, unique extracurricular activities, and successful LifeWorks therapy program. • Develop advertisements for the target population (ex. television commercials, newspaper ads, one-page handouts and flyers). The website for Bayside includes success stories from family members and clients who have come to Bayside for skilled nursing or therapy services. • Word of mouth is still one of the most effective forms of drawing clientele. • The Admissions Director markets Bayside to hospitals, surgeons, and other doctors offices. Many of the patients choose Bayside because of its good reputation and because the facility has been recommended to them by a doctor, nurse, or friend.
Methods to increase employee satisfaction & retention • Demonstrate leadership commitment and accountability • Create a work environment in which employees want to establish careers rather than just jobs. • Ensure that employees from all backgrounds feel accepted, respected, and fairly treated • Provide on a fair and equal basis the support and opportunities its employees need to reach maximum potential • Conduct employee opinion surveys and 360 degree evaluations. • Offer a competitive benefits package that fits your employees’ needs. Providing health insurance, life insurance and a retirement-savings plan is essential in retaining employees. • Provide some small perks: free bagels on Monday and dress-down (jeans) Fridays. • Use contests and incentives to help keep workers motivated and feeling rewarded. • Conduct “stay” interviews. In addition to performing exit interviews to learn why employees are leaving, consider asking longer-tenured employees why they stay. • Promote from within whenever possible. And give employees a clear path of advancement. • Foster employee development. This could be training to learn a new job skill or tuition reimbursement to help further your employee’s education. • Create open communication between employees and management. Hold regular meetings in which employees can offer ideas and ask questions. Have an open-door policy that encourages employees to speak frankly with their managers without fear of repercussion. • Get managers involved. Require your managers to spend time coaching employees, helping good performers move to new positions and minimizing poor performance. • Offer financial rewards. Consider offering stock options or other financial awards for employees who meet performance goals and stay for a predetermined time period, say, three or five years. Also, provide meaningful annual raises. • Make sure employees know what you expect of them. If they don’t know exactly what their jobs entail and what you need from them, they can’t perform up to standard, and morale can begin to dip. U.S. EEOC, 2013
How does Bayside retain employees? • Dress-down Fridays • Monthly staff meetings and Skip-Levels (both meetings allow staff to voice their concerns and opinions in a non-threatening group setting • Employee satisfaction surveys and employee evaluations. This helps management to assess the climate of the workplace and make changes to increase employee satisfaction. • Competitive benefits packages • Staff Development Contests: the team that wins the contest and finishes their monthly education on time wins a small party • Employee development and tuition reimbursement • Regular, monthly meetings are held and employees are encouraged to share opinions and ask questions. • My open-door policy and a lot of the employees come to me before going to the Associate Director of Nursing or the Director of Nursing because they know that I will offer advice and guidance without repercussion. • Weekly in-services to correct errors and help fix problems before they become commonplace or habit. This prevents employees from receiving warnings or suspensions for making the same mistakes repeatedly
How does Bayside retain employees? • At Bayside, leadership is encouraged and rewarded. Those CNAs and nurses who perform their duties to the best of their abilities are given the option to be a star CNA or a nurse preceptor. Continual education is mandatory and encouraged. • CNAs are encouraged to become nurses, LPNs are encouraged to become RNs and RNs are encouraged to earn their BSN or MSN. Other team members such as therapists, social workers, and human resource managers are encouraged to further their schooling as well. • The company offers financial assistance for those who desire to further their education. Not only does MFA offer reimbursement up to $1,500, but they also offer 20 scholarships of $1,000 or more to those employees who are eligible and who apply for the scholarship. • Bayside encourages leadership by helping their employees to find other job opportunities within MFA if/when an employee is looking for a manager/leader role. For example, if an RN is interested in becoming an MDS, Bayside provides the RN with a list of facilities that are seeking an MDS. As long as employees stay within MFA, Bayside Health and Rehab is very supportive of employees wanting to transition into a leadership position.
Human Resources • The nurse managers meet with HR on a daily basis if there is a nursing staffing need. When they meet, they discuss applications, phone screening, upcoming interviews and opinions about the applicant. More importantly, they discuss the type of applicant that the nurse managers desire so that HR can more easily sift through the applications. • The nurse managers are responsible for the in-person Interview and HR is responsible for recruiting, phone screening, and making the job offer after the department head has made a decision. • The nurse managers rely on HR to choose the best locations at which to do mock-interviews (job fairs, colleges, tech schools, etc.). • The nurse managers rely on HR to find and attract the widest and most diverse applicant pool. Recruitment policies and practices are regularly reviewed to assure that they are finding the best applicants. • Human Resources is encouraged to observe the exit interviews and look for patterns of discontent so that she can report it to the department heads and they can make changes where necessary.
Organizational Chart President & CEO of Medical Facilities of America Regional Director Administrator Director of Nursing Minimum Data Set Coordinator Staff Development Coordinator Assistant Director of Nursing Nurses CNAs
Accountability • I am accountable to the Director of Nursing, Assistant Director of Nursing and Administrator • We all meet on a daily basis and talk about the issues within the facility that are most important. • The Director of Nursing looks through my documentation, educational in-services, orientation data, and infection control records to make sure that I am not doing something wrong. • The Administrator comes to me on occasion to discuss in-services and infection patterns. He shares his opinions about what he sees and what he thinks I should do in the upcoming week (s). • The Assistant Director of Nursing keeps me aware of problems amongst the nursing staff, either as individuals or as a group. She is also a great resource whenever I have a question about skills or job duties.
