Scheduling changes created a ripple effect at Hillcrest Manor Say there was one technique that was proven to do all of the following: Decrease staff turnover Reduce staff absenteeism Increase resident and family satisfaction Improve clinical outcomes If such a technique existed, and didn’t cost a dime to implement, would you do it?   When one of the staff at Hillcrest Manor, a nursing home located in Sunnyside, learned about this method, she convinced the NACs and the facility’s administrator, Mary Arthur, to give it a try. Within a couple weeks, the venture was such a success that they vowed never to go back to the old way.   This miraculous-sounding technique is called “consistent assignment”—scheduling staff so that they care for the same residents at least 85% of the time. “It’s helped the NACs become closer to the elders,” Arthur said. “They can really get to know them as people, not just a diagnosis.”   According to a study conducted by Kansas-based researchers Mary Lescoe-Long and Michael Long, consistent assignment has had the same effect in other nursing homes: stronger, more trusting relationships between caregivers and elders that also tend to give family members greater peace of mind. As Arthur summarized the impact at her organization, “When we all really love the elder, we’re working for the same boss.”   At Hillcrest Manor, each shift does their own scheduling. “We just gave the authority back to where it should have been originally,” Arthur stated. “With this authority comes a greater accountability and pride. There’s this feeling that ‘I’m not going to let my team down’…they make it happen.”   The results are easy to see in terms of workforce stability. NAC call-ins were 64% lower in the first five months of this year compared to the same period in 2005. And the annualized NAC turnover rate, which was a troubling 87% in 2005, plummeted to 39% in the first half of 2006. While these improvements are impressive, Hillcrest Manor is not unique in this regard—studies as far back as 1985 have highlighted substantial reductions in staff turnover after implementing consistent assignment. [See the article below for details about the financial impact of NAC turnover.]   Studies have also shown that in homes where consistent assignment has been implemented, there was a 75% decrease in pressure ulcers, a 36% increase in the number of ambulatory patients, and patients were rated as having better hygiene and personal appearance. Not only do the clinical measures improve, but it tends to be easier to take care of the patients since staff do not have to spend so much time getting to know what each new one wants.   With consistent assignment, the staff can become very familiar with “their” set of elders and anticipate needs—which hip gives her trouble in cold weather, how she reacted to a certain medicine before, or even something as simple (and caring) as preparing the elder’s morning tea just the way she likes it, before she even asks for it. At Hillcrest Manor, each staff person “adopts” one of the elders and spends a little extra time with that person on birthdays and other events.   If you are interested in learning more about the benefits of consistent assignment, or want to locate the studies referenced in this article, please see the resources posted at out website. At the same webpage, you can also find Change Ideas for Consistent Assignment, a four-page document that provides implementation tips and success measures for making the switch to consistent assignment.

NAC turnover costs nursing homes $2.5 billion each year It’s no secret that there is a high rate of turnover for nursing home NACs. What may not be so evident, however, is the staggering financial impact. The typical Washington nursing home loses an estimated minimum of $156,000 each year in direct costs due to NAC turnover. Across the nation, this cost is approximately $2.5 billion. As summarized in The Cost of Frontline Turnover in Long-Term Care by Dorie Seavey, direct costs include losses related to unemployment insurance, use of higher-cost temporary workers, additional overtime, and increased injuries for the remaining staff—as well as advertising for, interviewing, vaccinating, and training new employees. In addition, indirect costs create an even greater burden. According to Seavey, the indirect costs of replacing NACs include lost productivity, reduced quality which may result in penalties and poor reputation, lost reimbursement, loss of new admissions, and a deterioration in morale which fuels higher turnover. What is your organization’s turnover rate? How much money are you losing because of it? Please see the tools posted on our website for help with the calculations—and for ideas about how to avoid these costs by retaining your workers.

Are you really listening? Making the most of staff surveys Your organization may already believe in the power of getting feedback, and regularly survey staff for their input. After all, staff satisfaction is strongly correlated to other key clincial and financial measures.   But what if you’ve been consistently surveying staff and haven’t managed to make improvements as a result? What might be holding you back?   In Jim Collins’ book Good to Great: Why Some Companies Make the Leap... and Others Don’t, he argues that there is a big difference between “having your say” and actually being heard. He asserts that great leaders create environments where the truth can be heard, and where the information uncovered can be converted into action. Is your organization analyzing and acting upon the results of staff surveys? Asking the questions without following up means people are not being heard.

“The true cause of burnout is the deadening effect of closing one’s emotions to people who are in obvious need of a human connection. Human life is sustained by affection.”

—Dr. Bill Thomas
What Are Old People For?
How Elders Will Save the World