Category: Motivating staff
Posted by Dr. El - May 17, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Customer service, McKnight's Long-Term Care News, Motivating staff, Something Good About Nursing Homes
Here’s my latest article at McKnight’s Long-Term Care News:
In long-term care we spend a lot of time focused on the physical health of those in our care. With increased emphasis on culture change and the update to the MDS (and hopefully as a result of this column), we’ve begun to address the mental health of our residents more adequately.
We do this not only by assessing the needs of individuals, but also by creating a healing emotional environment for all residents. It’s easier for our staff members to create an emotionally healing environment for residents when the work environment is psychologically healthy for them.
What makes a psychologically healthy workplace?
The American Psychological Association (APA) Center for Organizational Excellence recognizes five different elements that contribute to a healthy environment:
- Employee involvement includes efforts to involve employees in decision-making and give them more opportunity for autonomy.
- Work-life balance is a recognition that responsibilities outside work can impact on performance on the job, leading to programs that assist workers in managing childcare, eldercare, financial crises, etc.
- Employee growth and development focuses on offerings that provide employees with the opportunity for new skills and experiences such as coaching or mentoring, continuing education, tuition reimbursement, etc.
- Health and safety comprises programs that work to maximize employees’ physical and emotional health such as stress management programs, adequate insurance, healthy lifestyle motivators, safe practices training on the job, and Employee Assistance Programs (EAPs).
- Employee recognition includes ceremonies that acknowledge individual and group contributions to the organization, performance-based bonuses and pay increases, and acknowledgement of milestones.
The benefits of a psychologically healthy workplace
According to the APA Center for Organizational Excellence, which has been honoring exemplary company practices since 1999, having a healthy workplace isn’t just good for employees. A psychologically healthy environment can reduce staff turnover and absenteeism, improve performance, and enhance the quality of services provided.
Posted by Dr. El - May 3, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, End of life, McKnight's Long-Term Care News, Motivating staff, Psychology Research Translated
Here’s my latest article at McKnight’s Long-Term Care News:
I started working in long-term care when I was in my early 30s and I was shocked at first when the residents died. I was used to falling in love with my patients — I consider it a prerequisite for psychotherapy. I wasn’t used to them dying on me.
In the years since, I’ve lost many, many people who have touched my heart, but I can still remember very clearly the ones who passed when I was new. In order to make it in LTC, I’ve protected myself by falling in love in a different way.
A recent New York Times article, “Is Giving The Secret of Getting Ahead?”, piqued my interest when it touched on the impact of death anxiety at work, suggesting that it could have an effect on absenteeism and turnover. Working with residents in LTC is all about coping with death, and facilities have huge problems with absenteeism and turnover —surely there was a connection. I raced through the article, located the research paper it mentioned, “The Hot and Cool of Death Awareness at Work,” and plowed through that too. What I read seemed very applicable to long-term care, so I’m going to present the gist of the research and ways to reduce absenteeism and turnover based on these ideas.
Mortality cues
In “The Hot and Cool of Death Awareness at Work,” authors Grant and Wade-Benzoni outline different types of work where mortality cues can be chronic or acute, internal or external to the job, and personal or vicarious. A firefighter, for example, is constantly in a work situation that threatens his life. This would be considered a chronic, internal, personal mortality cue. A nursing home employee would have a chronic, internal, vicarious mortality cue because they are repeatedly exposed to other people at work who are dealing with end-of-life issues.
Reactions to mortality cues
The authors state that there are two different reactions to being aware of death at work. A “hot” reaction leads to self-protection and “stress-related withdrawal behaviors” such as absenteeism, tardiness, and turnover. A “cool” reaction leads to prosocial behaviors such as helping, mentoring, and thinking of work in the context of contributing to society. They refer to the hot reaction as “death anxiety” and the cool reaction as “death reflection” and note that chronic exposure to mortality cues can shift a worker from death anxiety to death reflection.
This shift from death anxiety to death reflection describes my experience as I continued in long-term care. It also explains why some new workers bail out early and others persevere to become beacons of light in a challenging environment. In addition, the researchers propose that as we age, we become more likely to experience death reflection rather than anxiety. Younger workers, therefore, are more likely to withdraw from the nursing home environment.
Retaining new young workers
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Coping with Grief, for Staff Members: Conversation with grief expert Courtney Armstrong, LPC
Beloved residents decline and then die, their families stop visiting the nursing home — coming to terms with these losses is an unacknowledged challenge of our work. Especially helpful for training directors, new employees, or those struggling with a current loss either on or off the job, this 20-minute audio will help staff members:
- Understand their feelings
- Recognize symptoms of grief
- Identify coping skills
- Assist each other in creating a supportive community
Includes FREE:
- Signs of Grief checklist
- LovingKindness Meditation Sign suitable for posting at the nursing station
Instant Download: Only $7.99
Posted by Dr. El - January 28, 2013 - Business Strategies, Long-Term Living Magazine, Motivating staff
Here’s my latest article in Long-Term Living magazine online:
3 small changes promise big impact in motivating your LTC staff
The new year has just begun and even without an official resolution, January holds the promise of a fresh start. This could be the year to address perennial problems plaguing your organization. It can be a challenge, though, to know where to begin on the mountain of tasks needing attention. Perhaps you have neither the time nor the budget for major changes. The good news is that
psychological research suggests small goals tend to be more successful than great ambitions. With that in mind, make use of the new year’s momentum by making minor adjustments in three areas for a big impact: appreciation, repair and organization.
1. APPRECIATION
Studies show that long-term care staff members aren’t in it for the money. Because workers tend to be more motivated by recognition of their efforts than by remuneration, showing appreciation will reap great rewards.
- Start small by simply thanking the people around you for their efforts. Recognize triumphs, commitment to the team and attempts even if they don’t result in success. As leaders within the organization, your attention to appreciation can create a ripple effect as others model their behavior after you and start thanking their coworkers and subordinates.
- Make it a habit to recognize one person, unit or action in each morning report or department head meeting. By calling attention to positive behaviors, you provide a roadmap for your employees or coworkers regarding the kind of work you’d like to see. Ask coworkers to “tell on” their peers, and vary who receives acknowledgement so that the unsung heroes shine as much as the obvious go-getters. Use this powerful tool, for example, if you sense a new employee might be feeling anxious, commending their work in front of colleagues to generate a feeling of inclusion and welcome.
- Take appreciation a step further by establishing an official recognition program such as “Employee of the Month.” Rewards can be as simple as a good parking spot, a plaque on the wall or a gift certificate to a local restaurant.
2. REPAIR
In any establishment there are things that break down. The New York City subway system, for example, is over 100 years old and in constant need of repair. The Metropolitan Transit Authority moves station to station with complete renovations that transform the location from dingy and crumbling to bright and freshly tiled. A recent sign in a subway car, however, announced a change in its repair program: instead of complete overhauls while most stations languished in disrepair, they’d now be attending to the most urgent needs of all stations. If the MTA can use this triage approach, so can long-term care.
Posted by Dr. El - June 6, 2012 - Business Strategies, Long-Term Living Magazine, Motivating staff
Here’s my latest article in Long-Term Living Magazine online:
5 team building practices that will make your staff WANT to stay
According to a 2011 American Health Care Association study, the average nursing home turnover rate is 35 percent for all staff and 43 percent for CNAs. By contrast, Fortune magazine reports that the 100 best companies to work for in 2011 had a turnover rate of 3 percent or less. Clearly, most nursing homes are in need of staff retention strategies. One of these strategies is team building, which has a “long term positive relationship between employee morale and retention.” When it comes to building a team, forget corporate retreats and singing “Kumbaya” around the campfire. Here are five practical, easy-to-incorporate strategies you can use at your nursing stations starting today.
1. Develop a clearly communicated larger purpose for your organization.
Give people a reason to show up for work beyond their paycheck. If you were asked to fill in the “X” of the statement, “We do X here,” what would your answer be? Is your facility goal getting a great survey? While that may be energizing for you, it’s not likely to be motivating for most of your staff. Generate a vision that excites the team. For example, Signature Healthcare, which ranked in Modern Healthcare’s top 100 best places to work in 2009 and 2010, states that part of its mission is to “earn the trust of every resident, family and community we serve.” A staff member can use this barometer to make decisions about how to handle situations, i.e., “Is this going to earn trust?” A vision for a company or facility dedicated to addressing the mental health as well as the physical health of its residents could be, “We treat the whole person,” giving staff the impetus to care for both the physical illness and the emotional distress it causes. Elaborate upon ways in which your “X” is accomplished through your mission statement, employee training, staff recognition programs, and other communications.
2. Recognize staff members who further the organization’s values.
Whether or not your facility has developed a specific mission, there are certain qualities that stand out as desirable and create an environment more conducive to staff retention, such as teamwork, helping others and kindness. Staff recognition programs provide an opportunity to promote qualities that are valued within an organization. They are the “carrot” to the “stick” of disciplinary action. Schools use this technique when, for example, they discourage bullying by presenting their students with award certificates for “helping” or “caring.” Similarly, LTC facilities can offer kudos of varying types (certificates, gift certificates, parking spaces, free lunches, first choice of holiday schedule, etc.) for good customer service, going the extra mile for the team, helping a coworker care for a resident, and other valuable contributions. Employee recognition can be done on a facility-wide or unit-by-unit basis, allowing for great flexibility and the opportunity to institute this tool immediately. For example, a charge nurse inspired by this idea could ask in the next change-of-shift report: “Let’s try to encourage each other. Did anyone notice any good qualities about a coworker today?”
3. Help new employees integrate into the team.
Posted by Dr. El - May 7, 2012 - Business Strategies, Motivating staff, Something Good About Nursing Homes
Back in August 2011, I posted about A Contest for Person-Centered Care, run by the Ensign Group, asking those working at their facilities to transform “a day in the life of the resident.” The goal was to change the daily experience of the resident as a cog going through the wheels of the nursing home routine, and to create an environment that adapts to the residents as individuals. The prize: $150,000
I spoke recently with Dave Sedgwick, who initiated the contest in his role as VP of Organizational Development and President of Ensign Facility Services, to find out the latest on the e-prize.
Me: What were you hoping to see from the contest?
Dave: What we expected was what a lot of people did – the staff looked at how limited the choices were of the residents and how constrained they were by requirements of the facilities/environments, in terms of eating, bathing, etc. We expected to see more choices, and we were looking to see more little changes that make a big difference — something as simple as not placing a resident on a pvc-type shower chair wrapped in a sheet, but instead to change them in the shower room.
There’s a poem called The Calf-Path, by Sam Walter Foss, about how a calf went down a crooked path, and that path become a road, which later turned into a highway. We tend to go down the same path just because that’s the way it’s been done before. We were hoping to create new paths.
Me: What surprised you about the contest?
Dave: I was surprised at the level of emotion of the caregivers, judges, and others involved in the contest. The status quo in most organizations is that the know-it-all of corporate figured out the jigsaw puzzle of how things work and the staff should follow along. The e-prize is the ultimate show of trust in the staff as the ones who know the residents and can express their passion, pride, and creativity.
Me: How did you engage the staff in this effort?
Dave: Each administrator had to solve the puzzle on their own of how to get the staff together to address the e-prize contest – it was announced at a meeting, and there was a follow-up call regarding whether or not they wanted to participate. Participation meant they had to contribute several hundred dollars to the pot. 100% did this, but some could only do this because they had other things going on. 75% worked on it but didn’t follow through with the applications in a timely manner. We had about 20 applications (out of about 80 facilities).
Me: How did you pick the winner?
Dave: We wanted the ideas of the winner to be replicable throughout the facilities. We wanted to look at system changes that have a big impact and don’t cost a lot of money.
Me: Who won the contest?
Dave: We plan to announce the results on May 7th. We’ll surprise the winners at their facility and stream the announcement live for Ensign employees.
For more about the e-prize and to hear about the finalists, visit the e-prize website. I’ll update my site with the contest winner ASAP after it’s announced.
Posted by Dr. El - April 27, 2012 - Business Strategies, Communication, Motivating staff
Here’s my latest article in Long-Term Living magazine online, 5 Secrets Your Line Staff Wishes You Knew:
Click-clack. Click-Clack. The hard-bottomed shoes of the administrator echoed through the halls once again, this time accompanied by the high heels of the director of nursing. The crepe-soled nursing staff moved about the floor, silently hoping the bigwigs would notice and address the problems that frustrate them on a daily basis.
Do you ever wonder what your staff isn’t telling you? Are you puzzled why, despite all your efforts, the organization isn’t functioning as efficiently as you’d hoped? In January, I revealed the secrets your line staff doesn’t want you to know. Now, here are the secrets the staff won’t say, but wants to—secrets that will transform your facility.
1. The staff members who are doing their jobs properly wish you’d be on the floors more often.
They’d never “rat out” their coworkers, but they’d like you to catch how often their colleagues disappear for unscheduled breaks, or the way they talk to some of the residents. Your frequent and unexpected presence raises the level of professionalism of your staff and keeps you in touch with the realities of day-to-day care. By taking some time to sit at the nursing station, for example, workers can observe and emulate your style of interacting with the residents and their families. Participating during the change of shift report can offer the opportunity to influence the type of information offered during this important transition. You become more familiar and approachable, rather than a “bigwig” in an office, and find out more of the information you need to know to make your nursing home proactive and productive.
2. All this disorganization is driving them crazy.
It’s not in the nursing job description to reorganize the file drawer—but isn’t it in somebody’s job description? Please, send someone over to put the forms in place, because if it takes each staff member 10 minutes to locate the MD order form, that is way too much time wasted. While you’re at it, organize the linen, pantry and supply closets—and make them the same on every floor, so floaters can quickly find the things they need. The time it takes to do this properly—with some forethought and planning about what goes where—will quickly pay off as multiple staff members on multiple floors can easily locate the tools essential for their jobs.
Posted by Dr. El - March 29, 2012 - Business Strategies, Communication, Long-Term Living Magazine, Motivating staff
Here’s my latest article, on The Silo Effect, at Long-Term Living magazine’s online site:
The employees listened carefully to their boss as he outlined a new procedure.
“Any questions?”
None were raised, and the boss, pleased at the consensus, adjourned the meeting. But outside the conference room, the murmurs started.
How do they expect us to do that? Don’t they know that’s going to lead to this other problem? If they want that to happen, why didn’t they just do it this way? You and I both know that’ll never work, but I’m not going to be the one to say anything.
Me neither.
What is the Silo Effect?
The Silo Effect refers to a lack of information flowing between groups or parts of an organization. On a farm, silos prevent different grains from mixing. In an organization, the Silo Effect limits the interactions between members of different branches of the company, thus leading to reduced productivity.
Long-term care silos
Silos operate at various levels of long-term care. They can be found in the silent acquiescence of department head meetings, hospital transfers without complete documentation, care plan meetings where key players are missing, and nursing home admissions that neglect to provide residents and families with the information they need to become proactive members of the team.
In fact, our current healthcare system is one of silos: private insurers, Medicare, Medicaid, hospitals, nursing homes, home healthcare, regulators—all working independently, but connected, to haphazardly manage the nation’s healthcare.
For more, visit LTL mag: How to eliminate the silo effect in LTC organizations
Posted by Dr. El - January 23, 2012 - Business Strategies, Long-Term Living Magazine, Motivating staff
Check out my latest article, featured in Long-Term Living Magazine Online:
Click-clack. Click-clack. The administrator’s shoes made a sound distinctly different than the rubber-soled heels of the nursing staff, alerting everyone to a foreign presence. Forced smiles and stiff greetings ensued. As the elevator doors closed, and the administrator disappeared behind them, the line staff heaved a collective sigh of relief and got back to business as usual.
Do you ever wonder what goes on after you leave the floor? Do you wish you could be a fly on the wall, observing without changing the behavior of the people you’re watching? Wonder no more, as this nursing home psychologist reveals the secrets they don’t want you to know (but you should!), and offers suggestions to help.
For more, visit LTL mag here: 5 Secrets Your Line Staff Doesn’t Want You To Know
Posted by Dr. El - November 15, 2011 - Business Strategies, Communication, Motivating staff
“I asked the nurse for a psychology consult for Gloria Teller on the third floor,” the dietician told me. “She’s not eating well, and when I went to talk to her, all she could do was cry.”
“Thanks,” I replied. “I’ll keep an eye out for it.” I jotted the name down in my book so I could follow up. Consults had a way of going missing.
Sure enough, after a week had passed and no consult appeared in my mailbox, I began to track it down. Putting on my Sherlock Holmes cap and taking out my pipe, I considered the possibilities: the nurse could have forgotten to write the consult, the order could have been written but no corresponding consultation form was generated, or the consult form could have been misplaced on the way to the mailboxes.
I wonder how many other consults go missing?
I wonder if a clinic appointment gets cancelled, how often it’s rescheduled?
I wonder if a family member tells the aide that her father does better on Medication B than on Medication A, if that information ever gets to the attending physician?
I wonder if I leave a note for the doctor on the floor where he has only one resident, will he see it in a timely fashion or at all?
I wonder if we’ve run out of MD order forms, how many orders go unwritten?
I wonder who’s in charge of the FLOW of communication, because it seems to me that while we’ve got department heads, we don’t have an INTERDepartment head, and we could use one.
Back to my consult: I started with the most likely scenario and asked the nurse, who replied, “Oh my gosh, I completely forgot!” She pulled out some papers, scribbled furiously while telling me about the emergencies she’d been fielding the day the dietician spoke to her, and thrust the yellow consult form into my hand. “Ms. Teller really needs you. She’s a mess.”
Posted by Dr. El - August 6, 2011 - Business Strategies, Motivating staff
I like the way Dave Sedgwick thinks, and always look forward to his blog posts at Transforming Long-Term Care. He tweeted me the other day about a contest he and his colleagues have created at the Ensign Group. It asks the line staff, residents, families, and others working at Ensign facilities to generate ideas to transform the day in the life of the residents, engaging the Department of Health along the way. The goal is to change the daily experience of the resident as a cog going through the wheels of the nursing home routine, and to create an environment that adapts to the residents as individuals.
You can hear Dave discuss the “eprize” contest in this video.
A book with the ideas generated from the contest will be published next year and available to those in and outside of the Ensign Group. The winners of the contest will get $150,000.
I like this contest because:
• it’s exciting and positive and the results will be shared rather than hidden
• it asks the “little guys” for their knowledge and expertise
• it engages the Department of Health instead of keeping them the enemy
• it has the goal of making nursing homes better for the residents
Does your nursing home ask for your suggestions about how to improve?
