Tapping the Power of Peer Mentoring

This is the second in a series of PHI Expert Interviews, which bring you insights from four senior PHI staff. They’re an impressive group – among the nation’s leading experts on long-term care’s direct-care workforce – and collectively they’ve spent decades studying the challenges facing the workforce and how to address them. We think you’ll be interested in what they’ve learned.

Peggy Powell is one of the founders of Cooperative Home Care Associates, the worker-owned home health agency that started PHI, where she served as director of education. Since joining PHI in 1991, she has worked with CHCA and other employers to develop strategies for recruiting, training, supervising, and supporting direct-care staff.

One of those strategies, peer mentoring, is gaining in popularity – and no wonder. Done right, a peer mentor program helps new direct-care workers get oriented to the job and the organization, bolstering their skills and their confidence. It also creates a career ladder for experienced workers.

And that’s not all, as Peggy has learned.

Moving away from the blame game

Since helping CHCA launch its peer mentor program in 2002, Peggy has helped turn the program into a published curriculum and adapted it to two other organizations. The PACE CNY program at Loretto, a large, multi-setting elder services provider in central New York, started peer mentoring with funding from a grant to improve workforce practices. The Center for Nursing and Rehabilitation (CNR), a Brooklyn nursing home with subacute care and short-term rehabilitation units, established peer mentoring as part of its culture change initiative.

CHCA’s leaders got interested in peer mentoring when they looked at why turnover was so heavy during the first few months their aides spent on the job and concluded that new workers needed more support.

“We wanted to move away from the blame game,” says Peggy. “You often had the newer workers complaining that they needed more support. Meanwhile, the coordinators complained that the new workers needed too much of their time – and that they didn’t seem to know the procedures and tasks they should have learned in training. That led the coordinators to blame the trainers. And then the trainers blamed the recruiters, for not screening candidates adequately.

“The idea behind the peer mentor system was that the problem was with the system, not with the people. People need time to learn their jobs and to learn the culture of the places where they work. New workers need someone they can ask questions of – someone they can trust.”

If you’ve seen one program, you’ve seen one program

Each mentor program needs to be tailored to the needs of the organization, Powell stresses. “I always say: If you’ve seen one mentor program, you’ve seen one mentor program.”

Before an organization writes job descriptions or starts recruiting its mentors, Peggy and her PHI colleagues interview staff at all levels, from aides to operations managers. In part, they’re generating buy-in and making sure everyone understands how peer mentoring will work, but they’re also gathering valuable information about particular needs that may affect how the program is structured.

For example, both CHCA and PACE have used their mentor programs to change the way they assigned cases. Rather than assigning a challenging case to a new aide and expect her to manage the case competently on her own, they alert the aide’s mentor, to make sure someone will check in to offer support and answer questions. In the past, Peggy says, tough cases contributed to high turnover rates amonth new aides at both organizations. “They’d get overwhelmed and they wouldn’t have anyone to turn to for advice, so they would just leave.”

To handle the volume of new workers at their fast-growing organization, CHCA also amended its program to create a two-tiered mentor structure. Level 1 mentors work full-time as aides and do 10 hours of mentoring a month. Level 2 mentors work as mentors full-time and handle more complicated cases.

Key elements

PHI has identified 10 elements of a formal peer mentor program. Peggy singles out five as crucial:

• Create a clear program design. Explain the role mentors will play and how it fits in with your existing orientation.
• Get buy-in from management. Make sure the mentor program will solve a business problem in the organization – e.g., improving job satisfaction or reducing turnover – to ensure that management invests the time and money needed.
• Compensate mentors adequately, either through a raise in their hourly wage or through a monthly stipend. “A lot of organizations will say, ‘We’ll pay 20 or 25 cents more an hour,’ because that’s all they feel they can afford – and because they’re not really looking at the cost of turnover,” says Powell. She recommends that raises be at least 50 cents an hour.
• Train and support mentors adequately. PHI starts its mentors with a two-day training session, followed by two booster sessions within the first two months. In addition, the program director checks in regularly to offer support as needed.

The payoff

“You can get a mentor program up and running in four to six months, and if you do it right you’ll see changes very soon,” says Peggy.

Done right, she adds, peer mentoring helps residents and other staff, not just direct-care workers. “A good peer mentor helps the relationships thrive between the residents, the nurses, the other workers, and the aides. They help the system achieve its goals around quality care and staff satisfaction.”

At CNR, a survey of workers, residents, and family members before and after the intervention found that ratings rose significantly on many key indicators. Residents and their relatives were much more likely to recommend CNR to others, for example, and far more satisfied with the “friendliness and skill of CNAs.” And in the PACE program, the turnover rate for new hires dropped from 48 percent in the first six months in 2005, just before the program was implemented, to 12.5 percent in 2007.

Peggy points to ECCLI, LEADS, and the Foundation for Long Term Care as initiatives that have fostered successful peer mentor programs.

Developing leaders

One unexpected bonus of peer mentoring for Peggy has been its capacity to create new leaders within an organization. “The outcome is a more confident and empowered worker who’s willing to take greater risks, to grow,” she says. “As these mentors begin to see the growth in people they’ve worked with, it allows them to grow in their own self-confidence about what they’re capable of doing.

“At CHCA, after about a year and a half of CHCA organizing their support meetings, the mentors decided they could do it themselves. Now they organize every meeting, with a check-in on where people are at and a skills piece where people are learning something new. It’s been the most amazing thing for me to see.”

Peggy built that new knowledge into her recent collaboration with CNR, whose peer mentor program is called Mentors as Leaders. The home, which had restructured its units into neighborhoods, wanted CNAs to be leaders in its culture change initiative as well as mentors for workers in the neighborhood.

“Peer mentoring can be a powerful tool for building leaders,” says Peggy.

Interview by Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org