Four Part CMS Satellite Broadcast From Institutional to Individualized Care

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Four Part CMS Satellite BroadcastFrom
Institutional to Individualized Care
Part 4 The How of Change What a difference
management makes!
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
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Marguerite M. McLaughlin

• Manager of Educational Development,
• Quality Partners of Rhode Island

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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!

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Cathie Brady

• Co-founder, BF Consulting
• Consultant, Quality Partners of RI

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Barbara Frank

• Co-founder, BF Consulting
• Consultant, Quality Partners of RI

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Thomas Hamilton

• Director, Survey Certification Group
• Center For Medicaid and State Operations
• Centers For Medicare Medicaid Services

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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

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Basic Premise

• Good care needs to be individualized
• That requires good relationships between
  residents and staff

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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

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The How of Change
Build this slide

• Personalize
• See how it is for residents and staff
• Whats working keep it
• Open dialogue to change whats not working
• Look at the data
• Pilot test
• Mid-course adjustments
• Spread

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Bathing Without a Battle

• www.bathingwithoutabattle.unc.edu

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Ways to personalize the experience

• sit in a shower chair
• wear a chair alarm
• lie in a residents bed
• take a shower in the shower room
• eat a meal

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Sources
Build

• The Leadership Challenge by Jim Kouzes and Barry
  Posner
• What a difference management makes! by Susan Eaton

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What a difference management makes! Five
Management Practices Associated
withLow-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
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A Positive Chain of Leadership
build

• Encouragement and Valuing
• Positive Presence
• People Development
• Personal Growth as a Leader

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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 occupancy

My InnerView 2007
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Encouragement
build

• Set clear standards
• Expect the best
• Pay attention and tune in to people
• Personalized recognition

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Effective praise is

• Timely
• Specific
• Sincere
• Proportional
• Positive

One Minute Manager Ken Blanchard
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Achieving Staff Stability
build

• Maximizing Financial Resources to Invest in Staff
  Stability
• Attendance policies
• Hiring practices
• Consistent assignment

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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
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Financial Incentives
Bonus Extra Per Hr. Annual
Baylor (work two 12s, 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
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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
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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
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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
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Instability vs. Stability
Last minute bonus 360,000 Perfect attendance 0
Baylors 268,994 Raises _at_ 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
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Stage 2 Staff Stabilization Plan

• Goals
• more full-time positions
• Improve attendance
• Improve percent of new hires who stay

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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
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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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Increase in Percent of Nurses and CNAs Working
Full-time
RN RN LPN LNA
Status 2005 Dec. 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
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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

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