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Employee Satisfaction:

What do we do with the


data?
Mary Tellis-Nayak, RN, MSN, MPH
VP Quality Initiatives
My InnerView
mary@myinnerview.com

Objectives
The participant will be able to:
Identify three issues which staff say
cause them to recommend a nursing
home as a good place to work
Describe the relationship between
the quality of the workplace and
3 other measures
Discuss what must be done with
employee satisfaction results
List 2 things a leader can do with the
results of staff satisfaction surveys

Our Mission

To provide long-term care


leaders evidence-based
management tools to
better achieve their
organizations goals

My InnerView Nationwide

5,600+ providers in all 50 states and


District of Columbia use our tools

Largest satisfaction benchmark

database in long-term care

Recommended by:
3 national associations
32 state associations

Providers will
commit to focus on
at least 3 of 8
measurable goals

CLINICAL GOALS:
1. Reducing high risk
pressure ulcers

2. Reducing use of
daily physical
restraints
3.

4.

Improving pain
management for longer
term nursing home
residents
Improving pain
management for short
stay, post-acute nursing
home residents

OPERATIONAL/
PROCESS GOALS:
1. Establishing individual
targets for improving
quality

2. Assessing
resident and family
satisfaction with the
quality of care
3. Increasing staff
retention
4. Improving consistent
assignment of nursing
home staff, so that
residents regularly
receive care from the
same caregivers

Looking
at
National
Results

National Employee
Satisfaction
Survey Results

2006
Nearly 107,000 responses

First
nationwide
report

1,933
nursing
homes in
49 states
and D.C.
participated
in 2006
NOTE: Alaska not included

FIGURE 2a

Employees age

FIGURE 2b

Employees job category

FIGURE 2d

Length of employment

FIGURE 1

SATISFIED NURSING HOME


WORKERS BY CATEGORY
Based on the percent of total weighted respondents who rated their overall satisfaction
as excellent or good in each job category

An Exercise:

What Matters Most?

Survey items:
1

Quality of orientation

11 Safety of workplace

Quality of in-service education

Quality of resident-related training

12 Adequacy of
equipment/supplies

Quality of family-related training

Comparison of pay

Care (concern) of supervisor

Appreciation of supervisor

Communication by supervisor

Attentiveness of management

10 Care (concern) of management

13 Sense of accomplishment

14 Quality of teamwork
15 Fairness of evaluations
16 Respectfulness of staff
17 Assistance with job stress
18 Staff-to-staff
communication

FACTORS THAT DRIVE


WORKFORCE RECOMMENDATION

Ranked correlations (p < 05) between employee workplace recommendation and employee satisfaction items

TABLE 5

FACTORS THAT DRIVE


WORKFORCE RECOMMENDATION (continued)

Ranked correlations (p < 05) between employee workplace recommendation and employee satisfaction items

TABLE 6

PRIORITY ITEMS FOR NURSING STAFF

Ranked by average scores and correlations with workplace recommendation

FIGURE 3

Recommendation for care

FIGURE 3

Does not total 100% due to rounding

Recommendation for job

FIGURE 3

Overall satisfaction

TABLE 1

TRAINING

May not total 100% due to rounding

TABLE 2

WORK ENVIRONMENT

May not total 100% due to rounding

TABLE 3

SUPERVISION

May not total 100% due to rounding

TABLE 4

MANAGEMENT

May not total 100% due to rounding

What does
research tell us
about satisfaction
survey data?

What about employee data?

What do we know today?

Key Performance Drivers


higher
family
satisfaction

lower
nursing
assistant
turnover

higher
employee
satisfaction

higher
family
satisfaction

Key Performance Drivers

higher
satisfaction
among
families
and employees

higher
occupancy
rates

Key Performance Drivers

higher
satisfaction
among
families
and employees

better
clinical
outcomes
related
to falls,
pressure ulcers
and catheters

SUMMARY OF RELATIONSHIPS
Improve
care outcomes
Improve relationships

Staff
Satisfaction
HR

Decrease nurse absenteeism


Decrease nurse turnover
Decrease CNA turnover

Resident/Family
Satisfaction

Financial
Increase occupancy

EMPLOYEE ENVIRONMENT SCORE (%)

Facilities with higher family satisfaction


have better work environments
80

Mean = 68.0
70

60

50
Lowest

Low

High

Highest

< 54%

54% to 58%

58% to 64%

> 64%

FAMILY SATISFACTION

EMPLOYEE TRAINING SCORE (%)

Facilities with higher family satisfaction


have better employee training
64

Mean = 57.1
60
56
52
48
Lowest

Low

< 54%

54% to 58%

High
58% to 64%

FAMILY SATISFACTION

Highest
> 64%

EMPLOYEE SUPERVISION SCORE (%)

Facilities with higher family satisfaction


have better supervision
90

Mean = 72.2

80

70

60
Lowest

Low

High

Highest

< 54%

54% to 58%

58% to 64%

> 64%

FAMILY SATISFACTION

EMPLOYEE MANAGEMENT SCORE (%)

Facilities with higher family satisfaction


have better management
80

Mean = 66.5

70

60

50
Lowest
< 54%

Low

High

Highest

54% to 58%

58% to 64%

> 64%

FAMILY SATISFACTION

Facilities with higher employee


satisfaction have:

More residents without falls


More residents without pressure ulcers
More residents without acquired catheters
Less nurse turnover
More nurse stability
Less CNA absenteeism
Less nurse absenteeism
Higher occupancy

Quality of leadership
and quality of the workplace:
The interface
CNAs speak up!
A 2004 study
156 nursing facilities in the Southeast
3,579 CNAs, 6,502 families surveyed
November 2004

Indicators of
quality of workplace
1. Pay compared to other nursing homes
2. Safety of workplace
3. Adequate equipment and supplies to do your job well
4. Work allows you to make a difference in people's lives
5. Co-workers work as a team

6. Fair performance evaluations


7. Staff are respectful of residents
8. Helps you get to deal with job stress

9. Communication between shifts

Quality of leaders produce a quality workplace


Rating by 6,305 CNAs in 156 Nursing Facilities:
4 percentile ranked groups, 2004

Lowest

2nd lowest

2nd highest

4 percentile ranked groups of NHs

Quality of workplace .

Leadership .

Quality of workplace .

Leadership .

Quality of workplace .

Leadership .

Quality of workplace .

Leadership .

Group avg score: 1-4..

Highest

Group avg score: 1-4..


1

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs

Recommend NH.

Q of workplace.

Recommend NH.

Q of workplace.

Recommend NH.

Q of workplace.

Recommend NH.

Q of workplace.

A quality workplace earns staff recommendation


4

Highest

Group avg score: 1-4..


2

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs

Families recommend..

Quality of workplace..

Families recommend..

Quality of workplace..

Families recommend..

Quality of workplace..

Families recommend..

Quality of workplace..

A quality workplace earns family recommendation


4

Highest

Group avg score: 1-4..


2

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs

QoLife..

Quality of workplace..

QoLife..

Quality of workplace..

QoLife..

Quality of workplace..

QoLife..

Quality of workplace..

A quality workplace creates QoL for resident

Highest

As Staff are
Treated

So will the elders be treated.

Group avg score: 1-4..


2

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs

QoCare..

Quality of workplace..

QoCare..

Quality of workplace..

QoCare..

Quality of workplace..

QoCare..

Quality of workplace..

A quality workplace creates QoCare for resident


4

Highest

Group avg score: 1-4..


2

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs

QoService.

Quality of workplace..

QoService.

Quality of workplace..

QoService.

Quality of workplace..

QoService.

Quality of workplace..

A quality workplace creates QoService for resident


4

Highest

Group avg score: 1- 10 .


4

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs


Highest

# of survey citations..

Compliance score..

Quality of workplace,,

# of survey citations..

Compliance score..

Quality of workplace,,

# of survey citations..

Compliance score..

Quality of workplace,,

# of survey citations..

Compliance score..

Quality of workplace,,

A quality workplace results in better state surveys


10

Group avg score: 1- 100 .


60

40

20

0
Lowest
2nd lowest
2nd highest

4 percentile ranked groups of NHs

Occupancy 94.8% .

Quality of workplace .

Occupancy 93.2% .

Quality of workplace .

Occupancy 92.1% .

Quality of workplace .

Occupancy 92.0% .

Quality of workplace .,

A quality workplace makes business sense

100

80

Highest

We did the best we could,


with what we knew,
And when we knew better,
we did better
Maya Angelou

Now you
know better
so
what do you do?

If you do not plan to use


the results of your employee
satisfaction survey
to improve the work
environment,
it is far better that
you not conduct
the survey at all.

Using Satisfaction Data

One member of the leadership


team must be responsible and
held accountable for managing
this initiative
Human Resources
Department Manager(s)
Administrator/Assistant
Administrator
Staff Development

Using Satisfaction Data

Use current structures or create


new ones

QA&A committee
Staff meetings
Neighborhood/unit meetings
Interdepartmental teams
Focus groups

Communicating results

Determine what you want to communicate initially


and to whom

Depends on your current facility structure (e.g.


neighborhoods vs. units; universal workers vs. departments)

Consider the current culture of your community when


considering how to proceed

Use a bulletin board to post results

Pull together an employee group to obtain feedback

Publish results in a newsletter format

Have unit/team meetings to present the results

Have an all staff meeting on each shift

Initially present the results to department heads

Where do we start?

Choose the issues


Start with low hanging fruit
Choose an area where you know you can
show staff that you are listening to them

Choose an area which is important to the staff


even if you may not have scored too badly
Choose an area where you know you can
achieve results quickly
Choose an area which is no surprise because
youve heard it before

My InnerViews reports
help you to choose
the topic(s) which are
most important
to your staff.

Quadrant analysis: Two key concepts


1. How residents, families and staff rate your care and services

Your average score on each item:

1 4:

Poor Fair

Good

Excellent

Rank order all items by their average score:

1 100: lowest to highest ranking score


2. How much each item influences residents, families and
staff to recommend the facility to others.
Correlate each item with Recommendation
0 - 1: no correlation to strongest correlation
Rank order all items by their correlational strength:
1 100: lowest to highest ranking correlation

The Quality Quadrant and Action Priorities

Item
score

B.

Secondary
strength

Primary
strength

C.

D.

Secondary
opportunties

Primary
opportunities

1 ---------- Lowest to highest ranking correlation --------

Successes

A.

Challenges

1 --- Lowest to highest ranking score 100

You can meet customer expectations

Recommendation

100

You have little control over customer expectations

Just ask why!


My work is stressful
I gave Mrs. J her supplement
and she threw up

No one told me she had been


sick all morning

There is no communication
between the morning and evening
shifts of CNAs

Take Home Tips

Just ask
until there are no
more whys to ask

Focus on systems and processes


LISTEN
OBSERVE
Dont BLAME
Involve the team

Turn Information
Into Knowledge
Study current process
Gather more information
Evaluate process

Identify contributing factors


Determine root cause(s)

Develop Drill Down Questions


Issue Orientation
Drill down suggested questions:

New CNAs are oriented specifically to their unit


New CNAs are oriented specifically to their shift
New employees are taught the proper use of equipment
which they will be using
New employees are shown the location of the supplies
and equipment they need to do their job
New employees are assigned to a mentor or a
buddy system
New employees are not given a full a workload initially,
but in gradual steps
New employees are introduced individually to the
residents assigned to them

Use the Workplace Scale


as Starting Point
Pay compared to other nursing homes
Safety of workplace
Adequate equipment and supplies to do your job well
Work allows you to make a difference in people's lives
Co-workers work as a team
Fair performance evaluations
Staff are respectful of residents
Helps you get to deal with job stress
Communication between shifts

A Valuable Resource

Better Jobs Better Care: Issue Paper


No. 7/April 2007
Respectful Relationships: The Heart of
Better Jobs Better Care

Link to this paper


http://www.bjbc.org/Page.asp?PgID=27

This paper addresses the key issue of the


long-term care workforce RESPECT

Whether individuals feel


respect in the workplace
is largely a function
of how they are treated
by their supervisors,
their clients and
family members
or advocates and,
many times, their peers,
particularly for new workers.

Studies suggest
that the quality
of these relationships
has a defining impact
on workers decisions
to stay on the job
or leave to pursue
opportunities elsewhere.

Lessons Learned
Practical Suggestions

Take a relationships inventory


Listen to what workers say about respect
Identify changes necessary to operationalize
respect
Think in terms of maximizing human potential
Understand the needs of new immigrants and
non-English speakers
Commit to making continuous improvement

Take a relationships inventory

Do managers at all levels of your


organization have positive and professional
relationships with the people they
supervise?
Does the disciplinary action make up a large
portion of interaction between frontline staff
and managers?
Do direct care staff see managers as
mentors they feel comfortable going to for
advice and problem solving?
Without a foundation of healthy relationships
among frontline workers and between direct
care workers and their supervisors, other
initiative to create a more respectful work
environment are unlikely to be successful.

Listen to what workers say


about respect

When workers say they feel a lack of


respect, it often reflects their sense that no
one is listening to them.
Everyone knows how to listen but knowing
how to listen to information that is
emotionally charged is difficult.
Responding without blaming or being
judgemental requires training and practice.

Identify changes necessary


to operationalize respect

Review existing P&Ps to understand what


changes, big or small, will make workers feel
more respected, valued and heard.
Do you have a process in place to provide
emotional support to workers who are caring
for consumers or encountering family
members who are verbally or physically
abusive?
How does your organization support workers
who feel they are being discriminated
against?

Think in terms of maximizing


human potential.

When workers have the opportunity to


improve themselves, personally or
professionally, they feel better about
themselves and have a more positive
attitude about their workplace.
Do you have a career track for direct care
workers?
Do you offer educational opportunities
through scholarships or on-site distance
learning?

Understand the needs of new


immigrants and non-English speakers

Does your workforce include


immigrants or those with limited
English skills?
How well do you understand their
customs?
What are you doing to help them
operate in their new language and
cultural environment?

Commit to making
continuous improvement

There is no one-time fix for creating a


respectful work environment
To be successful, the work must be an
ongoing process, fully supported by all
levels of people within the organization
and owned by more than one person
One innovation to create a more
respectful work environment is likely to
lead to another as workers feel more
empowered to articulate their needs
and interests.

A residents satisfaction
with his/her relationship to
nursing staff was found to be
significantly related to the
proportion of CNAs on the
residents unit who said they
intended to stay in the job,
and to the proportion of CNAs
who had positive
relationships with their
supervisors.
- Bishop, October 2006

Using employee
satisfaction surveys
will help leaders
to improve the
tenure of staff
by addressing
those issues
most important to them.

Dont miss this


valuable opportunity
to improve quality of life
for your residents
by improving
quality of life
for your employees

QUESTIONS?
Contact:
Mary Tellis-Nayak
mary@myinnerview.com
773-942-7525

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