LeadingAge Magazine · March/April 2014 • Volume 04 • Number 02

The Leaders Within: Providers Make the Most of Talent Already in the Fold

March 12, 2014 | by Debra Wood, R.N.

Finding new talent to work in aging services is an ongoing challenge, but providers are also working to get the most out of the people they already employ. Here are some stories of providers maximizing talent at many levels.

Aging services remains a “people field.” The talented individuals who deliver care and the visionaries who lead those efforts create successful organizations that understand the value in continuously investing in developing their people’s skills and recognizing their accomplishments.

Happy, engaged employees, ready to accept challenges and lead, ultimately enhance resident care and satisfaction.

“Residents need to feel safe and secure and continuity of care helps with both,” says Cynthia Holaday, vice president of human resources at Midwest Geriatrics in Omaha, NE.

Employee turnover plagues long-term care, but retention efforts can prove successful, as found at Florence Home Healthcare Center, one of the communities managed by Midwest Geriatrics.

“High turnover is a trend commonly found in long-term care and assisted living communities,” Holaday says. “We don’t like it and are working diligently to rise above it.”

In addition to offering competitive wages and benefits, Florence Home management has established a number of tools to aid with retention, including a mentoring program, a recognition program and an employee morale committee, which holds picnics and other events for staff. Recently, the organization also created retention committees on their campuses.

“I Caught You Caring,” part of the community’s recognition program, offers employees an opportunity to recognize colleagues who have gone above and beyond the call of duty. Recipients’ names are added to a plaque in the lobby on each campus. Those employees also become eligible for a monthly drawing for a gift card. The chief executive officer adds a personal note to each nomination form, and copies are posted in each nominee’s work area and sent to the employee’s home.

New employee orientation focuses on mission, teamwork, communication, resident sensitivity, conflict resolution and customer service. Mentors train new employees, help them acclimate to their new positions and the organization, and after orientation, continue to befriend the new person to answer questions and resolve concerns. Florence Home provides mentor training for caregivers, medication aides and nurses, which helps develop their communication and leadership skills.

“The program benefits not only the mentors and mentees, it truly enhances the care we provide,” Holaday reports. “Feedback from the individuals we serve has confirmed the importance of the program.”

Additionally, the nurse manages mentor charge nurses. Each nurse manager spends time with an assigned charge nurses and runs through problem-solving scenarios with the newly hired nurse. Holaday has found that while nurses come out of nursing school clinically able to care for patients, few are prepared for supervisory responsibilities. At Florence Home, all nurses work in a charge role.

“We are helping them become good supervisors, to provide leadership for their team and, at the same time, provide quality resident care,” Holaday says.

Florence Home often involves employees in hiring decisions. Human resources conducts an initial screen on the phone and performs a background check. The supervisor follows up with an in-person interview and may invite the candidate to shadow a current employee in the same role and then solicit feedback from the current staff members. When a new manager is hired, the same process may be followed in addition to a team interview with the top candidates.

“By following this model, we are facilitating team ownership in the hiring decision, initiating a mentoring relationship and encouraging a greater likelihood of success for the new hire, all with the intent of reducing and/or eliminating the trend of turnover seen in our [field],” Holaday says.

In 2009, Mather LifeWays, Evanston, IL, adopted a new operating philosophy, “Eliminating My Impossibilities.” One of its key principles is the need to draw out what is unique—the best—in each individual. In keeping with that emphasis, Mather LifeWays is rolling out a new leadership development program, “Ways to Lead Well,” designed to provide employees the opportunity to significantly develop their leadership “brand” and boost their competencies.

 

“Our program objectives are to prepare future leaders for organizational growth at Mather LifeWays, and to develop them in their roles,” says Mary Sullivan, vice president, human resources.

The Ways to Lead Well program is designed for salaried employees, and Sullivan anticipates a group of eight to 12 people will be chosen for the first class, to be launched this spring. (About 125 staff are eligible.) The program has four main components:

  • Personal Transformation (Leading Self)
  • Team Effectiveness (Leading Others)
  • Organizational Effectiveness (Leading Across Functions)
  • Organizational Transformation (Leading the Field)

“Our methodology will be 10% formal learning—classroom work, homework assignments, listening to lectures,” says Sullivan. “Twenty percent will be learning from others: bringing in speakers or having staff travel to sites to see other organizations. Seventy percent will be experiential. They will take on assignments, be in charge of a project or initiative across departments in Mather LifeWays, or perhaps something out of their comfort zone—take risks to perhaps fail and learn from them.”

Sullivan describes the approach as “intrinsic”: Participants will draw out their own values and leadership styles, and learn from a variety of books and other resources, including those they bring into the program on their own.

“Because [we have] kind of a flat organizational structure, we look at growth from a lattice perspective (not always a ladder) which allows us to provide additional experiences related to employee growth; you’re not always going to get promoted from manager to director to VP,” Sullivan says.

The program will begin in April with the first of six meetings. The first will be a kick-off with Mather LifeWays President and CEO Mary Leary; two-day sessions for each of the four components of the program; and a closing ceremony at the end, complete with “Mather Orange” caps and gowns.

Foulkeways at Gwynedd in Gwynedd, PA, strives to solve a different problem—how to help employees progress in an organization with little turnover. It’s something Mary Knapp R.N., director of health services, attributes to a great work environment and consistent assignments in which staff get to know the residents. An RN and aide work together, providing care for 10 residents in the skilled facility, which follows a resident-centered care model.

Some nursing assistants (CNAs) have spent their entire careers at Foulkeways and are still caring for residents decades later.

“We have CNAs who are working in their 70s,” Knapp says. “People don’t leave.”

Even so, staff members want the opportunity to advance and try new things, so Foulkeways has created opportunities for them. The continuing care retirement community (CCRC) encourages people to pursue additional education and offers tuition assistance. Several CNAs have become licensed practical or registered nurses, with the help of tuition assistance, and assumed new roles in the organization.

Foulkeways developed a Medicare-certified hospice program in 2013 and provided an interested RN with additional education about end-of-life care; that nurse assumed responsibility for the role of the hospice nurse.

“It allows her to have more diversity,” Knapp says. “One day a week, she steps out of her role as a primary nurse and provides hospice care.”

Additionally, a home care nursing assistant can be cross-trained to become a hospice aide. Now a second nurse is training to become the hospice nurse, and the original nurse will return to a primary nurse role.

“We are trying to allow different nurses to get that experience,” Knapp explains.

Foulkeways rethought the second-shift supervisor position, after experiencing some difficulty finding the right nurse for the job. The organization created a clinical nurse support role. Now, any RN working on that shift may step out of the primary care role and serve as the clinical support nurse and help with admissions or a resident with increased care needs. They respond to emergency calls in the independent living section of the campus. They do not have supervisory responsibility, such as conducting annual performance evaluations. That falls to the director of nursing, with staff input. The RNs deal with immediate issues, such as supervising the nursing assistants or tardiness or absenteeism, and report those to the director of nursing.

“It’s been successful, because nurses who do not want a management role are comfortable in the clinical support role,” Knapp says. “It gives them some diversity. They respond to needs across the CCRC.”

Additionally, Foulkeways offered two LPNs the opportunity to receive additional education and become co-managers of personal care. One day a week, they deal with regulatory compliance, documentation and problem solving. The nurse practitioner, who formerly handled those responsibilities, has become a hospital liaison, meeting with the medical team and discussing care requirements for when a person returns to the CCRC.

“What we try to do is give people opportunities in clinical practice and optimize their talents,” Knapp says. “The things we have done are not costly, yet give people the chance to grow.”

Elder Care Alliance in Alameda, CA, offering the full continuum of services at multiple sites, has created a “learning culture,” in which everyone from front-line staff to executive directors are encouraged to assess situations and use their critical thinking skills to come up with solutions. The board deemed learning an organizational core value.

“Learning is core to who we are,” says Jesse Jantzen, president and CEO of Elder Care Alliance. “We want to empower employees, and it makes good business sense. We don’t want people who are robots and can only act in pre-described scenarios.”

That requires that leaders accept errors or failures when someone tries something new.

“If mistakes are made, we use that mistake as an opportunity to learn from,” Jantzen says. “We do a good job of holding people accountable to get better results and at the same time do it in a learning environment, where people are not afraid to experiment, learn and get better.”

Elder Care Alliance aims to hire the right people and give them the tools to succeed. Current leaders keep an eye out for employees who have the potential to advance and then help make that happen.

The organization encourages each employee to craft with their manager a professional development plan, which outlines steps to help them achieve their personal goals as well as the organization’s objectives. Funds are available to support additional education.

“We will create a unique program to help them move up,” says Cheryl MacGregor, vice president of human resources at Elder Care Alliance.

Additionally, employees can excel in their current position or suggest ways to enhance the care they are giving. One caregiver began teaching memory care residents Spanish and more about Hispanic culture. Other care staff members have shared different ethnic holiday traditions and developed reading materials for memory care residents on the subject.

“There are ways we support people’s growth and development that may not result in a change in position,” says Adriene Iverson, vice president of operations at Elder Care Alliance.

The organization encourages employees to continually strive to do better, while holding people accountable.

“Status quo is never good enough,” says Kathleen Quinlan, director of professional development at Elder Care Alliance, a position to help employees grow. “We expect people to step into their fullest capacity. People who want to engage in that way become fully committed.”

Leadership development is key. Department directors and above are expected not only to shepherd their departments but also serve as part of an extended leadership team and provide perspectives and help craft decisions the organization makes.

Elder Care Alliance created a manager cohort to help develop leadership skills. New and experienced managers meet monthly for one year. The curriculum focuses on leadership and living the organization’s values. Participants tackle a variety of projects and learning objectives to hone their critical thinking skills. Sharing allows the employees to learn from each other.

“They are asked to use their intellectual skills to make the best decisions, make the best hires and the best financial decisions and [resolve] customer service situations,” MacGregor explains.

In addition to developing leaders within the organization, Elder Care Alliance hopes to develop people who can positively influence the field of aging, Jantzen says.

“Employees’ lives are changed,” Jantzen adds. “There are huge returns on investment. It continues to fuel our energy.”

Why should domestic violence be a high-priority issue for long-term care? At The Hebrew Home at Riverdale, the answer is all about maintaining a safe and secure workplace with a productive and focused staff. One in four women in the United States is or has been a victim of domestic violence, and research demonstrates that this has a significant impact on a victim’s job performance. At a long-term care community, this involves care and support for older adults, many of whom are medically fragile. The organizational consequences of failing to respond appropriately to employees living with domestic violence can be dire.

 

In order to properly support and protect its staff, The Hebrew Home has developed a comprehensive domestic violence prevention and intervention initiative. The program, “It’s Your Call,” is a commitment to employees that victims of domestic violence will be offered several forms of assistance. The first is education. The Hebrew Home provides every staff member with mandatory comprehensive domestic violence training. After gaining an understanding of the subject matter, employees learn about the components of the It’s Your Call program. These include: referrals to counseling and legal services organizations, the assistance of the facility’s security team, and the possibility of work accommodations.

Employees can access the program via colleagues who serve as “Lighthouses,” meaning they are available to all staff for private discussions about domestic violence related incidents. Individuals from Hebrew Home management and staff are encouraged to volunteer to serve as Lighthouses; supervisors can recommend appropriate candidates for the program. These Lighthouses are drawn from across departments and supervisory structures, and receive additional training about listening and responding to domestic violence related disclosures. The training focuses on the role of the Lighthouse, which is to serve as a source of support and a conduit to access the Hebrew Home’s resources, rather than an advocate providing substantive advice. The program also creates a multi-department safety response team, a small group of experts that evaluates all disclosures and creates a response plan. This team is also available to assist Lighthouses as needed.

It’s Your Call can be easily adapted to a variety of health care settings, and the Hebrew Home is eager to share its curriculum, resources and strategic advice with other interested organizations, with the hope that such programs will soon be commonplace in long-term care facilities.

Written by Joy Solomon, the creator of the “It’s Your Call” program and director and managing attorney for The Weinberg Center for Elder Abuse Prevention. Contact her at Joy.solomon@hebrewhome.org.

When a yearly employee satisfaction survey found that staff members wanted more education to improve their performance and move up in the company, Tim Conroy, executive director of Capitol Lakes in Madison, WI, created a leadership academy with help from the Madison Area Technical College (MATC), which developed a course specific to Capitol Lakes’ needs.

MATC Account Manager Kristin Polywacz met with Conroy and Steve Mellstrom, Capitol Lakes’ human resource director, to learn about Capitol Lakes’ values and she conducted focus groups to learn about needs. MATC then crafted a curriculum. As the program progressed, the instructor met with Conroy and further tailored the curriculum to meet the CCRC’s goals.

“To make an impact, it needs to be relevant material to them,” says Polywacz, who explains the college also offers businesses consulting services. She reports community and technical colleges often offer such services to companies in their communities.

Thirty supervisor-level and higher employees attended the eight-month program, learning about their leadership styles, interpersonal communications and how to use their strengths to become better leaders. The course included role playing and handling difficult conversations. Participants shared their experiences and learned from each other. The organization separated direct reports. Everyone received a certificate of completion.

“Many people were new at being a supervisor, and it helped them,” Conroy adds. Those who attended encouraged the CCRC to offer the program again, and Conroy considers the investment well worth it. Capitol Lakes paid the college and compensated employees to attend the classes.

“I see improvements in their leadership style,” Conroy says. “It is really satisfying. It was money well spent.”

Capitol Lakes is considering a coaching program, again with the college, to continue the good work started with the Leadership Academy.

“Our goal is to be the provider and employer of choice in Madison,” Conroy says. “We want people to enjoy working here. If they have a good boss, they are happy, and that benefits our residents.”