Turning Around Turnover

Transcription

1 Turning Around Turnover Improving Employee Satisfaction & Retention With 6 Staffing Practices A Whitepaper from OnShift

2 Contents The Power of Satisfaction & Retention Make Employees Part of the Process Minimize Paperwork Share Open Shifts and Overtime Consider Consistent Assignments Balance Staffing Levels Provide Incentives Happy Staff, Better Care About OnShift, Inc

3 Turning Around Turnover: Improving Employee Satisfaction & Retention With 6 Staffing Practices Staff turnover rates in long-term care and senior living are at devastating heights. In nursing facilities, employee turnover is 35% 1, while turnover for Certified Nursing Assistants whom many would say are the glue in a long-term care environment -- reaches 43% 1 (see Figure 1). These are just the averages. Some providers are operating with turnover rates that reach 70 80%. And, in facilities with high turnover rates, most nurses aides leave the job within the first three months 2. Figure 1: Turnover rates by nursing facility job category, American Health Care Association 1. While many providers have grown accustomed to such volatile staffing patterns, this is nothing short of a crisis. From cost to care, the impact of a revolving door is significant. Poor satisfaction threatens the financial viability of your organization. - My InnerView 1 American Health Care Association, Report of Findings Nursing Facility Staffing Survey 2010, October High Turnover of Nurse s Aids Affects Nursing Home Residents, FindLaw Knowledgebase, October 18,

4 Consider the massive costs alone in staff turnover: recruiting, interviewing, hiring, shift coverage, training, onboarding, productivity hits, and the list goes on. Some studies show that the financial loss of losing a single nurse is up to twice the nurse s salary 3, while other estimates point to an average loss of $3,500 4 upon a direct care employee turnover. This is an industry-wide problem, draining a staggering $4.1 billion a year 4. Now consider the impact to care and added disruption when staff members walk out the door. Research shows that inconsistent staffing is associated with poor quality care 5. Residents, patients and their families are left wondering what happened to their care takers. All familiarity and relationship are gone. Staff morale plummets. New faces come and go. Sometimes the care may be provided, and sometimes not. Providers are left in the lurch, looking for a good enough replacement just to fill the gap, at a time when nursing shortages make hiring even more difficult. Excessive staff turnover in long-term care and senior living is not something that providers should just live with. Much can and should be done to take a bite out of turnover rates and improve retention. Each and every provider in the industry should invest the time in a solid strategy to turn over their approach to employee turnover. It s worth it. The Power of Satisfaction & Retention Strong employee satisfaction, retention and stability go a long way. Your employees are your greatest asset. Facilities and communities with higher workforce satisfaction also have higher resident and family satisfaction. Patient and resident outcomes are better. Staff members are happier and call-off less. Occupancy rates are improved with a more stable workforce. Even occupancy rates are improved with a more stable workforce (see Figure 2). In addition, initiatives 3 Nursing Turnover: Costs, Causes and Solutions, 2009, Success Factors for Healthcare. 4 The Cost and Benefits of Nurse Turnover: A Business Case For Nurse Retention, Cheryl Jones, Kayser-Jones and Schell 1997 and Kramer, et al

5 like Quality First and Advancing Excellence in America s Nursing Homes put a premium on a stable workforce, while reimbursements can be tied to employee satisfaction and retention as well. Figure 2: High satisfaction delivers powerful benefits. My InnerView, The Bridge to Reality: What will We Hear if We Really Listen, August 10, 2005 Much research, policy, standards and best practices have focused on tackling turnover and improving employee satisfaction and stability. Issues like hiring practices, leadership strategies, and employeeresident relationships have typically grabbed those headlines. But the importance of staffing and scheduling is often lost in the shuffle when discussing improving retention and lowering turnover. However, staffing and scheduling have one of the greatest influences on employee satisfaction and retention

6 With some modifications to current staffing and scheduling practices, providers will gain immediate improvement to satisfaction and, over time, a reduction in staff turnover. The following six practices provide the guidance and tips required to minimize the black cloud over the industry, creating happier staff, delivering better outcomes, and operating with a more stable employee base. 1. Make Employees Part of the Process The more engaged employees are in scheduling, the happier they will become. This doesn t mean that providers need to adopt a self-scheduling model, but it does mean that employees value input into their own work schedules. Start by asking staff members what their shift preferences are. Take the time to understand when and where they like to work and when and where they don t. Track preferences and try to avoid conflicting assignments. Provide visibility into scheduling and predictability so employees understand not only what the guidelines are, but how things play out on a day-to-day basis and the patterns they can expect. Most will understand that they will not always get 100% of their requests, but showing that you are listening and making attempts to meet their needs will not go unnoticed. Make sure that schedules are visible and easily accessed, and published in advance. Having to call into work and ask someone when am I working? is not the most efficient method. Post schedules in prominent places. Consider using the web to issue updated schedules so employees can access them from anywhere, 24x7. Full transparency and accessibility keep staff engaged in scheduling and eliminate any airs of secrecy that may have existed. According to Kerry Bohac, Administrator at Foundation Healthcare, Staff really like that they can get their schedules from home. In addition, self-scheduling models do transfer considerable control over schedules to the employees. With the proper policies in place, self-scheduling can prove to be an effective tool for boosting satisfaction. Even if you re not ready to embrace full self-scheduling, consider allowing employees to swap shifts. They re on the hook for finding suitable replacements when time away may be needed. Be

7 sure to establish policies for overtime and final approvals to keep costs and compliance in check. But, remember that even small steps like allowing shift swaps will empower employees and give them added control over schedules. Employees will appreciate it. 2. Minimize Paperwork One of the most effective ways to boost satisfaction and drive retention is by giving direct care employees more time for what they do best spending time with residents and patients. Look for ways to minimize administrative tasks and the mounds of paperwork that can consume some positions. One of the most common complaints heard within long-term care and senior living communities is that direct care workers Documentation consumes more than a third of nurses time. Robert Wood Johnson Foundation spend hours upon hours on paperwork and administrative tasks. Unfortunately, each task leaves less and less time to spend with residents and patients. In fact, a study by the Robert Wood Johnson Foundation found that documentation consumes more than a third of nurses time. Caregivers work in the field because they enjoy helping people. Spending hours a day updating schedules, sorting through PTO requests and making shift changes will cause headaches and frustration. Identify some of the most time-consuming processes that can be automated and consider the role of technology in simplifying the practice. In addition, consider how a part- or full-time administrative position could be used to handle the paperwork for one or more caregivers. After all, managing resident outcomes is what matters most in a long-term care and senior living environment. Prioritize your staff and residents by prioritizing caregiving duties and doing everything possible to ensure that direct care staff don t spend unreasonable amounts of time managing paperwork and administrative tasks. A recent staff survey at a multi-facility senior living organization supports these findings. The area where employees indicated the most dissatisfaction was in staff scheduling. In addition to the time that was spent on paperwork instead of at the bedside, staff scheduling was complicated and stressful!

8 This type of inefficient and frustrating environment hinders staff satisfaction and puts resident care at risk. The organization s outdated scheduling process across facilities was to blame for such inefficiencies and wasted time. Schedules were created and managed by pen and paper, a typical method for many providers today (Figure 3). Figure 3: Providers commonly hand-write staff schedules, which is a complex and time-consuming process. 3. Share Open Shifts and Overtime Because of growing pressures to reduce costs, due much in part to recent Medicare and Medicaid reductions, more providers are focusing on controlling labor costs. Overtime and extra shifts may not be as plentiful as they once were. This makes it even more important to ensure that the distribution of open shifts and overtime is fair to all staff members. Many common practices of managing open shifts must end. For example, last minute call-offs are often handed to the same group of go-to employees because the scheduler knows that the answer will be yes. While it may be critical to fill the shift to avoid understaffing, management must be aware that practices like this cause major dissatisfaction among staff. It s common for the majority of staff to

9 never even be notified about available shifts. Employees end up frustrated, and it can create a rift against those who receive overtime and extra shifts time and again. Avoid unhappiness and hostility among staff by making the process of managing open shifts and overtime what it should be equal and open. Establish a process whereby all available and qualified staff are made aware of open shifts when they happen. and text messages can go a long way in such a scenario, and further keep employees engaged. Be sure the scheduler tracks responses and the shift recipient. This is important for two reasons: 1 the history of who received bonus shifts should always be considered when a new shift becomes available to ensure fair distribution; 2 tracking responses can come in handy during an employee performance review, indicating responsiveness or willingness to help out when needed. In addition, careful measures to control overtime will not only benefit your organization from a cost standpoint, but employees will benefit as well. The more overtime you work employees, the more they get sick, the higher workers comp because they end up getting injured because they are tired, stated Kip Kransdorf, Director of Payroll & Labor Reporting, Five Star Quality Care. You have higher turnover because you burn out employees Really the big cost savings is in the employee morale and employee appreciation. Even though people like the extra money in their paychecks, no one likes to be over worked. Establishing a fair and open process for sharing available overtime and extra shifts will boost staff satisfaction and mitigate claims of favoritism or other gaming that may once have existed. 4. Consider Consistent Assignments One of the most significant trends in senior care staffing today is the adoption of 1:1 care staffing models through consistent assignments. These models focus on individualized care. By assigning the same caregiver or team of caregivers to each resident, employees really get to know their residents, forming strong bonds and relationships that research shows improve care

10 Studies have shown that after one year of adoption, consistent assignment models have reduced staff turnover 29%. In addition, the benefits of such models are many (see Table 1), creating a positive environment for not only staff, but residents and patients, too. Consistent Assignment Key Benefits Residents receive better care Residents are more comfortable and secure Improved job satisfaction Staff feel valued and empowered Strong foundation for persondirected care More familiarity with residents needs Less call-offs Studies indicated that after a year of consistent assignments, turnover rates were reduced 29% Staff feel more accountability and responsibility for their clients Residents form bonds with caregivers Staff become familiar with and can anticipate resident needs and desires Staff are less likely to call-off because residents may miss them Table 1: Key benefits of consistent assignment staffing models. Based on information from the California HealthCare Foundation Evolving to consistent assignments can be a major undertaking. Always consider acuity when making assignments, to ensure proper balance and workload among staff. You may want to adopt a hybrid model, providing some level of flexibility within staff schedules. One-size-fits-all may not apply in this scenario, so do your research and talk with those who have made the transition to a consistent assignment model. It can be a big transition with major payoff, but consider it alongside other priorities as you work to optimize care and your business

11 5. Balance Staffing Levels Quality of care is affected with each and every employee who leaves the organization. What s more, remaining staff are left to care for the residents, which can take much longer and add stress to employees. Residents may be at serious risk. According to Seniorhomes.com, Call bells may take longer to answer, medications may not be dispensed at appropriate times, and serious hygiene issues can occur, especially among patients who are bed-bound or incontinent. Improvements to retention will certainly help to avoid this complex cycle, but that doesn t happen overnight. When an employee is terminated or leaves the organization, be sure to have a back-up plan to deal with the turnover in order to avoid understaffing at all costs. Equally distribute the open shifts. Avoid assigning stay-overs or doubles, which can quickly lead to staff burnout. Also, leverage a pool of part-time staff in such instances to ensure coverage. In addition, be sure to calculate how much filling the open shift is actually needed. Carefully review your labor budget vs. actuals when the shift opens up. For example, if you are targeting 3.2 HPPD but you are running at 3.3 HPPD, you are overstaffed. The impact of an open shift may not be as detrimental as originally thought. Put a process in place so staffing levels are compared against actual census at the start of every shift. Put a process in place so staffing levels are compared against actual census at the start of every shift. Get proactive and use an estimated census for coming days to project scheduled staffing levels. The more balanced your staffing levels are and the more that they are aligned with your actual census, the more effective staff will be at your organization. There s no question that understaffing can be a serious risk, but have you considered the effects of overstaffing? Overstaffing is not only an additional expense to the organization, but it does not necessarily mean better care. In fact, it can lead to more unproductive workers

12 If you have too many people on the floor at any given time, they are just going to be hanging around the nursing station talking about what happened on Grey s Anatomy last night as opposed to actually going and dealing with the patients and residents. So we really want to make sure that we have an appropriate staffing level for the number of patients and residents that we have in our building, said Kip Kransdorf, Director of Payroll & Labor Reporting, Five Star Quality Care. With checks and balances in place to pinpoint staffing requirements at each shift, balanced staffing can result. It s not only efficient, but mitigates risk and gives staff more balance in their work lives, too. In addition, more effective use of your own staff eliminates any reliance on agency workers that may have existed. With the right number of staff on hand, at all times, employees gain the time they need to spend with residents to ensure proper care. 6. Provide Incentives Keeping staff motivated among high turnover rates can be challenging. Consider rewards and recognition for employees and the staffing patterns that you are working so hard to maintain. A little bit can go a long way in helping employees feel valued and appreciated. Consider awarding gift cards or public recognition to incentivize employees on a variety of criteria: Perfect attendance Responsiveness to open shifts Hitting overtime reduction targets Positive feedback from residents or families Willingness to pick up shifts that no one wants to work Make the effort. A $0.25 raise Make disappears the the effort the smile when rewards an employee will come. receives A a reward $0.25 raise for perfect disappears attendance the smile when is priceless. an employee LinkedIn receives discussion, a reward Licensed for perfect Nursing Homes Administrators Group attendance is priceless. LinkedIn discussion, Licensed Nursing Homes Administrators Group Take it from an Executive Director who recently discussed the issue of retention in the Licensed Nursing Homes Administrators group on LinkedIn, Make the effort - the rewards will come. A $0.25 raise disappears...the smile when an employee receives a reward for perfect attendance is priceless

13 And, be sure to communicate the incentives. Employees will adapt their behaviors to achieve the goals. When the milestones are achieved, congratulate the winners and share the news with staff. Keep the incentives going! Some friendly competition may ensue, which keeps staff involved, on target and motivated. Getting creative with incentives can go a long way. One faith-based multi-facility provider puts a big emphasis on keeping employees motivated and aligned with their staffing and labor management goals. Each month, an administrator holds a drawing among all building employees who worked their shifts without any unapproved overtime or overages. The winner receives a $25 gift card. The company is working to control labor costs, given the regulatory and economic climate. Reducing incremental overtime is one of their top goals, and management has found that employees are excited about the monthly drawing. It s a fun way for staff to stay on track. They love it. Happy Staff, Better Care Reducing turnover and improving satisfaction is beneficial across many fronts. Perhaps the most critical benefit to a happy staff and higher retention is reflected in quality of care (see Table 2). How does retention benefit residents? Residents don t have to explain to new caregivers how to care for them day after day. Staff can anticipate needs and respond more quickly, confidently and naturally, when they know the residents. Residents are more comfortable with the intimate aspects of care when they know their caregivers. Residents with dementia are much more comfortable with familiar caregivers. Residents relationships with staff are strengthened. Table 2: Retention benefits residents. Fast Facts: Staff Retention, Advancing Excellence in America s Nursing Homes

14 Better outcomes, higher occupancy, and lower costs are also realized with higher satisfaction and retention (see Figure 2). Consider that organizations with higher retention provide higher quality care, and research shows that better care actually costs less than lower quality care to the tune of $13.58 per patient day 6, for an annual savings of $440,000 in a home with 90 residents 7. Whatever the case, management should be sure to balance the needs of employees with the needs of the organization. Careful alignment, taking into consideration culture, costs, and resident needs, will pay off. Key to getting there and running a top performing organization is the consideration of staffing and scheduling practices. Automating key processes to save time, drive efficiencies, and lower costs can be a tremendous aid in achieving lower turnover and better outcomes. OnShift staff scheduling and shift management software helps long-term care and senior living providers reach these goals. Improving Employee Satisfaction and Retention with OnShift Long-term care and senior living providers use OnShift staff scheduling and shift management software to control labor costs and increase efficiencies so nurses and other staff members have more time for care. With OnShift, employees gain greater control over their schedules, participate in scheduling processes, and gain more time to do what they love spend time with residents and patients. As a result, providers experience higher staff satisfaction. At Holland Management, an OnShift client, morale is up and turnover is down. Key capabilities of OnShift include: OnShift helps to keep the nurse at the bedside rather than on the phone or dealing with paper related issues due to schedule changes. Rose Anderson, Director of Nursing, Friendship Village Tempe Automated scheduling Replace hand-written schedules by automating the creation and maintenance of staff schedules. Intelligent scheduling tools automate the placement of 6 Nursing Home Quality, Cost, Staffing, and Staff Mix, MJ Rantz, et al., The Gerentologist volume 44, #1, 24-38, Old Age in a New Age: The Promise of Transformative Nursing Homes, Beth Baker,

15 qualified, available staff where and when you need them. Automated scheduling minimizes complexities and gives back time to spend on care, and full visibility into schedules eliminates employee guesswork. Intelligent communications platform - When open shifts occur, OnShift automatically identifies potential staff replacements and flags those with overtime risks. OnShift automatically contacts potential replacements through text message, , or automated phone call, whichever method each employee prefers. Call-offs and open shifts are typically resolved in 15 minutes or less. In addition, OnShift automatically documents changes and open shift management for a comprehensive audit trail of staffing efforts. Employee self-service With OnShift s SaaS model, employees can access schedules anytime, anywhere, 24x7. Staff members stay engaged and gain more control over their own schedules with the ability to manage schedules, bid on open shifts, request fill-ins, and request time-off through OnShift. In addition, employees establish their own preferences, including how and when to be contacted, preferred working hours, etc. Align staffing levels with census Avoid understaffing and eliminate stressful environments by making sure you have the right number of staff where and when you need them, at all times. OnShift automatically captures census data from clinical and assessment systems, and calculates staffing requirements by hours, employee and location. Use OnShift to record an estimated census in the future. Compare and adjust scheduled labor in OnShift based on census estimates to stay compliant with PPD budgets and staffing minimums. Managers get real-time visibility into staffing levels with dashboards and reports. OnShift automatically projects and alerts management of potential over/under-staffing situations so corrective action can be taken. With OnShift, our buildings are now staffed appropriately, and the ability to communicate open shifts to all available and qualified personnel in an instant means we get the shifts filled by our own staff. They re happy, and a happy staff provides great care. Dale Zaletel, CEO, Lexington Health Network

16 About OnShift, Inc. Long-term care and senior living providers rely on OnShift staff scheduling and shift management software to control labor costs and increase efficiencies so nurses have more time for care. OnShift predicts and prevents overtime and understaffing while dramatically reducing time spent on scheduling and managing open shifts. Fully integrated with time-keeping, HR, clinical and payroll systems, OnShift provides a unified view into staffing levels and labor costs across buildings. Customers choose OnShift because it s the easiest-to-use scheduling solution with a tightly integrated communications platform, delivering fast ROI. For more information visit Euclid Avenue Cleveland, OH