Four Part CMS Satellite BroadcastFrom Institutional to Individualized Care
This material was designed by Quality Partners, the Medicare Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. Contents do not necessarily represent CMS policy. 8SOW-RI-NHQIOSC-072006
Part 4
The How of Change:
What a difference management makes!
Marguerite M. McLaughlin
Manager of Educational Development,
Quality Partners of Rhode Island
3Quality Partners of Rhode Island
CMS Satellite Broadcast Series: From Institutional to Individualized Care
• Part 1, November 3, 2006: Integrating individualized Care with Quality Improvement
• Part 2, May 4, 2007: Transforming Systems to Achieve Better Clinical Outcomes
• Part 3, May 18, 2007: Clinical Case Studies in Culture Change Case Examples
• Today: The How of Change: What a difference management makes!
Cathie Brady
Co-founder, B&F Consulting
Consultant, Quality Partners of RI
Barbara Frank
Co-founder, B&F ConsultingConsultant, Quality Partners of RI
6Quality Partners of Rhode Island
Thomas Hamilton
Director, Survey & Certification Group
Center For Medicaid and State Operations
Centers For Medicare & Medicaid Services
7Quality Partners of Rhode Island
Goals:
1. Describe a change process
2. Explore the importance of inclusive leadership
3. Identify workplace practices to achieve staff stability
4. Demonstrate why of individualized care is better care
Basic Premise
Good care needs to be individualized
That requires good relationships between residents and staff
9Quality Partners of Rhode Island
Sections
• Section 1: The How of Change
• Section 2: A Positive Chain of Leadership
• Section 3: Achieving Staff Stability
• Section 4: Individualized Care: The Path to OBRA
10Quality Partners of Rhode Island
The How of Change• Personalize
• See how it is for residents and staff
• What’s working – keep it
• Open dialogue to change what’s not working
• Look at the data
• Pilot test
• Mid-course adjustments
• Spread
Build this slide
Bathing Without a Battle
www.bathingwithoutabattle.unc.edu
12Quality Partners of Rhode Island
Ways to personalize the experience
• sit in a shower chair
• wear a chair alarm
• lie in a resident’s bed
• take a shower in the shower room
• eat a meal
13Quality Partners of Rhode Island
Sources
• The Leadership Challenge by Jim Kouzes and Barry Posner
• What a difference management makes! by Susan Eaton
Build
14Quality Partners of Rhode Island
What a difference management makes! Five Management Practices Associated with
Low-Turnover, High Attendance and High Performance:
High quality leadership at all levels of
the organization
Valuing staff day-to-day in
policy and practice, word
and deed
High performance,
high commitment HR policies
Work systems aligned with and serving
organizational goals
Sufficiency of staff and resources
to care humanely
Eaton, 2002
15Quality Partners of Rhode Island
A Positive Chain of Leadership
• Encouragement and Valuing
• Positive Presence
• People Development
• Personal Growth as a Leader
build
16Quality Partners of Rhode Island
Facilities with higher employee satisfaction have:• More residents without falls
• More residents without pressure ulcers
• More residents without acquired catheters
• Less nurse turnover
• Less CNA and nurse absenteeism
• Higher occupancyMy InnerView
2007
17Quality Partners of Rhode Island
Encouragement:
• Set clear standards
• Expect the best
• Pay attention and tune in to people
• Personalized recognition
build
18Quality Partners of Rhode Island
Effective praise is:
• Timely
• Specific
• Sincere
• Proportional
• PositiveOne Minute Manager
Ken Blanchard
19Quality Partners of Rhode Island
Achieving Staff Stability
• Maximizing Financial Resources to Invest in Staff Stability
• Attendance policies
• Hiring practices
• Consistent assignment
build
20Quality Partners of Rhode Island
Snapshot of Current SituationComposition of the current staff
Position Total FT PT PD Baylor
RN - 30 8 4 14 4
LPN - 27 15 0 5 7
CNA - 77 37 8 7 25
21Quality Partners of Rhode Island
Financial Incentives:
Bonus Extra Per Hr. Annual
Baylor (work two 12’s, paid for 30 hours)
RN -- $7
LPN -- $5
CNA -- $3
$268,944
Last minute assignment
RN, LPN --$10
CNA -- $5
$360,000
Perfect attendance $0 $0
22Quality Partners of Rhode Island
Terminations by Length of Service
Position 1 day – 1 mo
1 – 3 mo
3 - 6 mo
6 mo – 1 yr
RN 18% 18% 18% 27%
LPN 7% 13% 33% 27%
CNA 23% 30% 23% 16%
Other 8% 27% 39% 12%
23Quality Partners of Rhode Island
Incentives Bonus Amt Offered Quarter - Annual
Sign-on bonus
Paid after 6 mos.
RN -- $2000
LPN -- $500
CNA -- $250
$12,500 - $50,000
Referral bonus
Paid after 6 mos.
RN, LPN --$1000
CNA -- $500
$6,000
Longevity $0 $0
Raises Average 2% $90,710
24Quality Partners of Rhode Island
Turnover Costs:
Position Per Person Annual Cost
RN $4,899 $53,889
LPN $4,193 $62,895
CNA $3,207 $205,248
Other $2,692 $131,908
Total 2004 $453,940
25Quality Partners of Rhode Island
Instability vs. StabilityLast minute bonus $360,000
Perfect attendance $ 0
Baylors
$268,994
Raises @ 2%
$90,710
Sign-on bonuses
$50,000
Referral bonuses
$6,000
Turnover costs
$453,940
Longevity bonus
$0
Total:
$1,132,934
Total:
$96,710
26Quality Partners of Rhode Island
Stage 2: Staff Stabilization Plan
Goals:
–more full-time positions
–Improve attendance
–Improve percent of new hires who stay
27Quality Partners of Rhode Island
New Wage Package
For Full-time Staff
Old Wage Range
New Wage Range
Raise Amount
CNA $9.25 to $10.50
$11.50 to 12.75
+ $2.25
LPN $15.00 to $16.70
$18.00 to $20.50
+ $3.00 to $3.80
RN $18.00 to $20.50
$23.50 to $26.00
+ $5.50
28Quality Partners of Rhode Island
As a result: Increase in FT Staff
Date # of FT
nursing staff
June 2005 60
Dec 2005 80
Dec 2006 96
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RN LPN LNA
Status 2005Dec. 2006 2005
Dec. 2006 2005
Dec. 2006
Full Time 27% 71% 56% 84% 48% 83%
Part Time 13% 17% 0% 3% 10% 3%
Per Diem 47% 8% 18% 3% 9% 4%
Baylor 13% 4% 26% 9% 32% 10%
Increase in Percent of Nurses and CNAs Working Full-time
30Quality Partners of Rhode Island
Case Study and Tools Available from:
• Better Jobs Better Care – www.bjbc.org
• COVE – Coalition of Vermont Elders – 802-229-4731
• Quality Partners of Rhode Island – www.riqualitypartners.org
31Quality Partners of Rhode Island
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32Quality Partners of Rhode Island
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