Creating a Positive Chain of Leadership

1. Creating a Positive Chain of Leadership David Farrell, MSW, NHA

2. What Matters the Most? • Systems • Equipment • People

3. High Performing Nursing Homes Three Common Elements - Culture – person-centered care Workforce commitment Leadership practices All three are interdependent Grant, L. 2008

4. Results are Interrelated Implement principles of culture change Enhanced leadership practices Employee satisfaction Workforce stability Low turnover, high retention, low absenteeism Consumer satisfaction Clinical outcomes Regulatory compliance Occupancy rate and mix Grant, L. 2008

5. A Consumer Perspective on Quality Care: The Residents’ Point of View NCCNHR 1985

6. Drivers of Consumer Satisfaction • Caring staff • Competent staff • Choices and preferences • Nursing care • Responsive management • Respectfulness of staff MyInnerView, Inc. 2010

7. Path to Improvement People and Systems Development © B&F Consulting Inc. 2011 www.BandFConsultingInc.com

8. Drivers of Staff Engagement • Management cares about employees • Management listens to employees • Help with job stress MyInnerView, Inc. 2010

9. Building Trust and Making a Statement • Presence • “You go into the rooms?” • Asking and delivering • Listening • Speaking with conviction • Painting the graffiti

10. Leadership Practices Matter Most Person-Centered Performance Improvement Process Improvement Leadership Practices Adapted from Albert Einstein Health Foundation, Philadelphia, PA., 1990

11. The Impact of Leaders Healthcare organizations • Fragile ecosystems • Leader’s actions influence: • Culture • Relationships • Staff engagement • Clinical outcomes • Quality of life

12. Person-Centered Care Leadership Compassion Performance

13. Relationships and Quality

14. People Paradigm W. Edwards Deming: • Quality, the result, is a function of quality, the process • Essential ingredients of the process: • Leaders and their people • Cannot improve interdependent systems and processes of care until you progressively improve interdependent, interpersonal relationships

15. Theory of Relational Coordination • The effectiveness of care and service is determined by the quality of communication among staff • Which depends on the quality of the underlying relationships • The quality of the relationships reinforce the quality of the communication Gittell, et al, 2008

16. Relational Coordination in Healthcare • Task interdependence • Uncertainty • Time constraints Gittell

17. Healthcare Organizations CNAs CNAs Therapists Nurses Nurses Therapists Physicians Food Service Physicians Food service Within functions Across functions Gittell

18. Trigger Relational Coordination Leadership actions • Increase Communication • Frequency, timeliness • Accurate, transparent, frequent • Model problem solving • Enhance Staff Relationships • Shared goals • Enhance shared knowledge • Model mutual respect

19. Relational Coordination Works • Significantly associated with – • Enhanced resident quality of life • Higher nursing assistant job satisfaction • Evident in SNFs implementing person-centered care Gittell, et al, 2008

20. Quality is All About Relationships • Between co-workers • Across departments • Between supervisors • Frontline and supervisors • Staff and residents • Between residents • Staff and resident’s family members Eaton, S. 2001

21. Thank You Cards Cards are powerful Send them to staff members’ homes Birthday cards Anniversary cards Excellent attendance “I appreciate you” “I am glad you work for us. On behalf of the residents, their families and your co-workers – Thank you.”

22. Relationship Facilitation Strategies • Ample supplies at hand • Resident transfer equipment at hand • Report between shifts • Staffing configurations • Staff composition

23. Relational Coordination in Oakland Key changes – • New name badges • Created efficiencies • Mitigate conflict • “Just in time” compassion • Tragedies in their lives

24. Enhancing Staff Relations • Karaoke • Kids Day • Heritage Days • Senior Prom • Weight Loss Challenge • Safety Huddles

25. Manage Relational Coordination • Our systems and structures of communication create our relationships and our culture

26. Relational Coordination Applied to Staff Assignments HIGH: Consistent Assignments LOW: Rotating Assignments Communication and Relationship Factors © B & F Consulting, Inc. www.BandFConsultingInc.com

27. Relational Coordination Applied to Shift Hand-off HIGH: Structured Person to person discussion with checklist LOW: Tape recorded Communication and Relationship Factors © B&F Consulting Inc. 2011 www.BandFConsultingInc.com

28. Relational Coordination Applied to Interdisciplinary Problem-solving HIGH: Root-cause analysis conducted by PIP team led to successful pilot test and then facility-wide adoption LOW: Conducted by 2 managers and solution rolled out via in-service Communication and Relationship Factors © B & F Consulting, Inc.

29. Enhancing Relational Coordination Follow QAPI systematic process - • Charter Performance Improvement Projects • Learn, teach and utilize • Ice breakers • Root-cause analysis • Brainstorming • Flow chart • Learning circle

30. Cause and Effect Diagram Systems People Environment Equipment/Supplies 30

31. First 2 Hours Checklist • People support what they help create

32. Empowerment • Humility • Listen to others perspectives • Stakeholders – • Who is effected? • Who can help us understand this better? • Involvement = success of changes • Spread • Sustainability

33. Communication Builds Trust

34. Leadership Visibility Rounds to trigger engagement • Engage the heart and minds of staff • What you do and say matters • Meet and greet, linger • Observe – processes of care, handoffs • Praise, build self-esteem • Build trust • Foster teamwork

35. Invisibility “The problem is not motivation. It is theways in which we unintentionally de-motivate employees.” Quint Studer

36. Community Meetings • Performance data • Human resource • Clinical outcomes • Business results • Benchmark and compare • Celebrate positives • Employee and rookie of the month • Raffles • Patient safety chain

37. Communicate Why? How? What?

38. The “Golden Rule” • Christianity • Do unto others, as you would have them do unto you • Islam • No one of you is a believer, until he loves for his brother what he loves for himself • Judaism • What you hate, do not do to anyone • Hinduism • Do nothing to thy neighbor, which thou would not have them do to thee • Buddhism • Hurt not others with that which pains thyself • Confucianism • What you do not want done to thyself, do not do to others

39. Assume the Best To bring out the best - • Self-fulfilling prophecy • Express confidence • Spark optimism • “I’m proud of all of you.” Sutton, R., 2010

40. Bad is Stronger Than Good • Eliminate the negative • Interdependent work = larger negative effect • Grumpiness is contagious Felps, W. 2001

41. Human Beings are Flawed What exposes the flaws? Workload, fatigue Broken systems Lighting, noise, distractions Personal issues Coworkers behaviors Equipment, supplies 41

42. Who are the CNAs? • Total 1.47 million • Deliver 80% of hands-on care • 90% are women • 51% are non-white • Average age is 38 • 50% are near or below the poverty line • 41% rely on public benefits GAO, 2001 National Clearinghouse on the Direct care Workforce, 2006 BLS 2006, FHCEF 2010

43. Common Forms of Feedback • Silence • Negative • Positive • Deliver feedback to individuals and teams: • Timely • Be specific • Be sincere • End on a positive

44. Person-Centered Care Leadership “We missed you yesterday…and the residents did too. I hope your son is feeling better. We are a better place when you are here.” Performance Compassion

45. Small Wins are the Path Steps forward Visible results People Energized

46. David J. Farrell, MSW, LNHA Director of Organizational Development Regional Director of Operations SnF Management dfarrell@snfmgt.com (510) 725-7409 Contact Information