By investing in a positive work environment, as well as workforce supports to attract and retain staff who will provide consistently high-quality care, nursing homes can improve their advantage in an increasingly competitive market.
PHI partnered with Edgewood Centre, a skilled nursing facility in New Hampshire, and 11 other long-term care organizations as part of the PHI Northern New England Leadership, Education, and Advocacy for Direct Care and Support (LEADS) Institute, a three-year initiative to improve direct care jobs and establish person-centered care.
What We Did
We provided training and technical assistance for a range of efforts at Edgewood Centre, including: implementing the PHI Coaching Approach® with all staff through a train-the-trainer approach; implementing a peer mentoring program among Licensed Nursing Assistants (LNAs), with mentors earning an additional dollar per hour; creating other enhanced roles for LNAs, including Medication Nursing Assistant (MNA) and LNA team leader; implementing additional workforce supports such as on-site childcare; and restructuring the nursing home into resident “communities” with consistent staff assignment.
Who Was Involved
230 staff, about half of whom were LNAs, including 19 LNAs trained as peer mentors, eight LNAs trained as MNAs, and three supervisory staff trained as PHI Coaching Approach trainers.
Edgewood’s participation in the PHI LEADS Institute was associated with a range of improved employee outcomes. Turnover rates among LNAs dropped from 52 percent to 37 percent (2006-8), and “call-outs” (staff absences with less than 24 hours’ notice) dropped from 9.5 to 4.9 per LNA annually. Lost work days due to work-related injuries fell from 73 to 4 in one year, and workers’ compensation claims dropped by 85 percent (2006-8). Together, these improvements generated an estimated $400,000 or more in cost savings. Additionally, annual surveys showed a statistically significant increase in employee satisfaction in general and satisfaction with organizational support.
Success at Edgewood Centre was attributed to the creation of a strong staff team, natural leadership opportunities within the team, and organizational structures to sustain improvements—including an ongoing coaching and communication training program for all staff; new job descriptions, roles, and responsibilities; and a new performance evaluation system to support these changes.
“If there’s an issue on the floor… some of the staff we have [who] didn’t talk a lot are now actually speaking up because they feel more equal on the floor.” – Licensed Nursing Assistant (LNA) team leader