After four transformative years, PHI’s Center for Coaching Supervision and Leadership (CCSL) program culminated in late October with a two-day summit attended by scores of nursing home, home care, and community-based care leaders from 31 organizations in 14 states who participated in the initiative.
During the meeting, these leaders had the opportunity to share their experiences using the PHI Coaching ApproachSM, provide feedback, and be briefed on the program’s preliminary evaluation findings.
Ambitious Goal
By all accounts PHI’s CCSL program was a huge success in transforming management styles and organizations, resulting in greater staff satisfaction and other positive outcomes.
About 100 people were trained to deliver the PHI Coaching SupervisionSM training, and they in turn trained 1,340 nurses and other supervisors of direct-care staff at their organizations. Some site leaders wanted to implement broader training in PHI’s Coaching Approach to Communication, which target all staff. These trainings reached an additional 2,670 staff.
“PHI had an ambitious goal for the CCSL project: to work with nurses and other supervisors to shift how supervision happens, and — more broadly — bring a more relational approach to communication and problem-solving at all levels throughout the participating organizations,” said Sara Joffe (left), CCSL director and PHI organizational and executive coach.
“We are very pleased with the results, which indicate that the coaching skills are a powerful tool to create a culture in which both workers and consumers are central and honored,” Joffe said.
Breaking the Cycle of Instability
PHI Coaching SupervisionSM was designed to break the cycle of instability that plagues the long-term eldercare and disability services system by using a non-punitive, problem-solving approach to managing direct-care staff.
PHI developed this skill-building approach (pdf) to improve working relationships and care outcomes, recognizing that both direct-care workers and their supervisors experience a lack of mutual support and a resulting high rate of turnover, which threatens the quality of care.
Reports from the Field
Many organizations implemented PHI Coaching SupervisionSM within the context of furthering their transition to person-directed cultures.
“PHI Coaching Supervision provided the educational foundation for culture change, which is all about relationships,” said Paul Hollings, executive director of Orchard Cove, a Boston-area based continuing care retirement community, at a summit workshop. “Coaching supervision is about how we communicate more effectively, creating better relationships.”
Elizabeth Canelos-Ragusa, Preceptor and Coaching Trainer, VNS of Central NJ
Corporate Director of Human Resources Celeste Smith at the New York-based Beth Abraham Family of Health Services, a long-term residential and community-based health care provider, shared her experience with the PHI Coaching Approach, noting that “it came in on the heels” of an intervention between management and labor that was “not enough.”
Smith said that Beth Abraham’s executive director suggested trying PHI Coaching Supervision Approach, which “supported our culture change efforts and helped reinforce our organization’s integrity, diversity, creativity, mutual accountability and caring for residents and each other.”
“PHI’s Coaching Approach gave us a common language, empowered workers, and helped employers manage staff with less trepidation. The big surprise,” Smith said, “was the talent and leadership that emerged in the cross-functional teams.”
Intervention
PHI conducted train-the-trainer workshops at all of the sites to introduce staff to the PHI Coaching Supervision curriculum and prepare the leaders to lead internal training sessions. PHI provided ongoing support to trainers and booster sessions to reinforce and sustain the use of coaching skills throughout the organizations.
Rick Surpin, President of Independence Care System and PHI Board Chair (front left) with conference participants
Eleven of the sites were Comprehensive Sites where PHI held executive leadership seminars and provided executive coaching to support leaders in managing a high-involvement change process. The core leadership development strategy was to form cross-functional teams, to ensure participation by staff at all levels of the implementation.
Annual CCSL events, which bring together CCSL leaders and trainers, are aimed at supplementing the site training, sharing ideas and experiences, further developing their training skills and roles as organizational coaching champions, and discussing the leadership responsibilities and advantages of participating in CCSL.
Positive Outcomes
A large majority of participating supervisors report actively using the coaching skills, and many have applied these skills to work with residents, clients and their families. Coaching skills were found to have increased the capacity of managers and line staff to solve problems on their own, releasing time for nurses and leaders to focus on concerns more appropriate to their roles. Sites with robust implementation have reported improved job satisfaction and job retention.
“As executive director I got a ‘monkey’ [on my back] when things got dysfunctional,” reported Margaret Franckhauser, executive director at Community Health & Hospice in New Hampshire, on the outcomes of the initiative at her home health and community support service agency.
“The Coaching Approach has empowered the organization to make decisions, so they don’t need me in the same way. Not every problem gets kicked up north, which was an unexpected gift that changed decision-making in the organization and freed me up to handle the bigger issues,” Franckhauser said.
The Evaluation
“The CCSL initiative had a strong evaluation component because we felt it was important to be able to describe and quantify the impact of this work,” said Marcia Mayfield, PHI director of evaluation. Mayfield directed the collection of quantitative and qualitative data at the sites and conducted the project analysis.
Marcia Mayfield, PHI Director of Evaluation
“Findings from both qualitative and quantitative data suggest that the train-the-trainer model accompanied by organizational development support can result in strong, sustainable behavior change within organizations, which in turn leads to greater employee satisfaction and organizational efficiencies,” Mayfield said.
The preliminary findings on the outcomes and impact of the train-the-trainer program show:
- Trained staff use coaching with coworkers and clients
- Increased staff capacity to solve problems on their own
- Organizational policies and procedures are aligned with coaching principles and approaches
- Improved job satisfaction
- Improved organizational efficiencies
- Impact on quality of care (reported)
- Improved retention
More Than A Method of Supervision
Rick Surpin, president of Independence Care System (ICS), a nonprofit Medicaid managed long-term care plan and PHI affiliate, and PHI Board Chair, wrote a letter to PHI President Steven Dawson and Sara Joffe following the event.
Congratulating PHI on the widespread, positive impact of the CCSL project, Surpin went on to describe his experience:
As President of ICS, I felt a great deal of kinship with the other sites and their experience using the approach. We have embraced the approach fully, as you know…. And, we firmly believe, like many of the people at the conference, that the Coaching Approach is a commitment of a way to manage throughout the organization and not only a method of supervision.
The CCSL program was made possible with support from The John A. Hartford Foundation and The Atlantic Philanthropies.
For more information about the PHI Coaching Approach and how to build these skills in your organization, contact Susan Misiorski, PHI director of training and organizational development.
– by Deane Beebe
“I think the movement to improve the nursing home as a workplace and the movement to improve it as a place to live are coming together in a very positive way, so that a nursing home can be both a better place to live and to work,” says Thomas Konrad. “I think those tendencies reinforce each other.”
