Coaching: A key tool for change at Genesis Healthcare Northeast
By Dinah Cardin
“People think working in a nursing home is depressing. It can be, but there’s more than that,” says Tracy Howe, assistant director of activities at Ridgewood Nursing Center in Bedford, New Hampshire. “There is a lot of life here.”
Howe and the rest of the staff at Ridgewood are committed to ensuring that life there remains engaging and meaningful for residents.
“Auntie Joan” (the name she wishes to be called), for example, first arrived at Ridgewood, depressed and uninterested in life. But by establishing a relationship, Howe was able to find ways to re-engage Auntie Joan in activities that lifted her spirits. Auntie Joan now runs a small canteen that sells snacks and gifts. She spends her days with Tracy Howe’s little Yorkie, Mason, who provides company, while also attracting residents and visitors to the canteen.
Auntie Joan’s story may not sound extraordinary, but in many nursing homes, the relationship-building that pulled Auntie Joan out of her depression isn’t a top priority. Genesis Healthcare Northeast, in a journey that began several years ago, made person-centered care–i.e., supporting not only the physical but also the emotional and spiritual needs of each individual resident–a guiding principle. The values, underlying organizational systems, and communications skills that enabled staff to notice Aunty Joan’s needs–and come up with a plan to address them–are transforming their over 70 nursing homes in the Northeast.
Building relationships
An increasing number of eldercare organizations are seeking to grow more person-centered cultures that give residents control over their daily lives. At Ridgewood, making this shift has made staff more aware that their work is about building relationships with the residents, says administrator Bonnie Kisielewski.
“Good relationships make their job easier and the residents happier,” she says.
The old institutional rules and traditional way of running a nursing home is “winding down in its effectiveness,” says Mary Tess Crotty, vice president of quality management for Genesis Northeast. That’s why Genesis centers are shifting their focus to relationships between staff and residents.
“No one wants to give up their independence and have to follow someone else’s rules for the rest of their life,” Crotty says. “And we don’t think that you really need to do that. People need a richness of activity and relationships no matter what stage of life they’re in. That should really be the fabric of how we do our business. We want our nursing centers to be a great place to live and to work.”
The culture change journey
Genesis Northeast started this journey several years ago under visionary leadership of Crotty and the region’s president, Dick Blinn. The culture change process now well underway makes it possible for residents to eat meals when they want and has inspired the leadership to divide large facilities into neighborhoods run by staff and residents together.
As part of the process, these nursing centers have also made the change to consistent assignment, assigning staff teams to neighbor hoods where they can develop and sustain relation ships with the residents. Genesis Northeast adopted the practice as a goal and expectation two years ago and provided the training and support for all of its nursing centers to make the change possible.
“I think that the staff certainly feels more personal satisfaction and it’s just easier for residents. They don’t have to describe what they need over and over again,” says Crotty. “It requires a real shift in management philosophy, and that’s what takes time.”
Crotty explains that consistent assignment is not inflexible. In fact she has found that the staff is more willing than before this initiative to help colleagues with their assignments. “Clearly, one person can’t meet all the needs of their assignment all the time,” says Crotty. “This way the CNAs are willing to help out their team and stay committed to a certain group of people.”
Partnering with PHI
In 2006, Genesis turned to PHI to help expand their vision of a person-centered culture. Mary Tess Crotty and Susan Misiorski, PHI director of organizational culture change, teamed up to develop and implement a strategy to deepen the person-centered culture across this multi-site for-profit organization. Misiorski describes Crotty as “a national leader and dynamic teacher, with the critical ability to navigate a complex corporate structure.”
Under Crotty’s leadership, Genesis Healthcare Northeast hosts culture change conferences that convene teams from all of its nursing centers to explore and learn together. At these conferences, Misiorski and PHI colleagues Kate Waldo and Maria Elena Del Valle have facilitated learning sessions on a variety of topics, including:
- Leading and participating in learning circles
- Neighborhood development
- Building community
- Developing self-managed work teams
- Dining with choice
The conference design engages Genesis leader ship, staff from different nursing centers at different stages of change, and PHI in facilitating sessions that build knowledge about and support for the culture change process.
Communication and relationships
“When organizations approach their change process, it’s common to look at changing a specific service, such as eliminating the tray service for meals and going instead with family or restaurant-style dining,” says Sue Misiorski. “But there is more to it than that,” she explains.
“What we have learned through helping organizations change their service delivery is you can make all kinds of changes and still not have satisfied residents and staff, because of a lack of teamwork, communication and inclusion,” she says. “In addition to training that focuses on changing care giving practices, we have designed skill-building training for fostering healthy, trusting relationships throughout an organization, because that is the heart of what shifts the culture. Without strong relationships that support both independent and team problem solving, organizations cannot successfully change the way they deliver services.”
Misiorski goes on to explain that “communication techniques that build healthy relationships are a learned skill. We cannot assume that being a caring person is enough to make a task go well. It’s a great start, but not enough. Person-centered communication requires intentional skill building.”
The “coaching approach”
PHI brought to Genesis Healthcare Northeast its “coaching approach” to creating relationship-centered cultures. The PHI coaching approach teaches a set of communication skills that strengthen relationships between supervisors and direct-care staff, while also helping direct-care staff to grow professionally and become more capable problem solvers.
Because department heads and executive leaders need to model the same communication skills they are asking others to apply, Genesis initially focused on training executive leaders, managers, and department heads in coaching supervision. Once these individuals were trained as coaches, the training was offered to supervisors and licensed nurses, which has improved relationships between nurses and direct-care workers–supporting effective neighborhood teams.
Using a train-the-trainer program, PHI trained 70 coaching supervision trainers across all Genesis Healthcare Northeast facilities. In turn, these Genesis trainers have delivered PHI’s two-day skill-building workshop to over 1,800 staff members. Genesis plans to continue training new trainers every year and will continue to offer the two-day coaching supervision every month in three or more locations throughout the Northeast area.
The impact on staff
“We now have a new coaching language,” says Sandra Chaplin, human resources manager for Genesis in New Hampshire. “I’ve heard people in meetings say, ‘I had to pull back,’ when making a point.” This is something that everyone who has participated in the coaching training understands as referring to managing one’s emotions in stressful circumstances.
Chaplin used to spend her days on the phone listening to complaints from nurses and managers, but that’s not the case anymore.
“Employees would wait until things blew up and tempers flared. Now when an employee calls out, a manager will sit with them and find out what’s going on,” Chaplin says. Rather than being punitive and judgmental, Chaplin explains, supervisors now have the skills to say something like “How are you? Is everything okay? We missed you yesterday.” This creates an opening where important information can be exchanged. “Obviously, there are things that can’t be avoided, but before any type of a pattern sets in, [the supervisor] gets there right at the beginning,” Chaplin continues. “It’s handled early. We no longer attack with words. It’s all about the employee and how to be successful.”
This training has also resulted in an increase in retention rates and overall morale. “With each round of hands-on training, there has been a noticeable shift in attitude,” concludes Chaplin.
The impact on care
Resident care has also improved. At Harris Hill Center in Concord, New Hampshire, for example, Deborah Goldman, the third floor resident life coordinator, says that the training has made staff more responsive to resident needs. Goldman went through coaching supervision training first, and subsequently 14 nursing assistants on her floor–as well as housekeeping and dietary staff–have received a complementary training in communication skills.
Goldman says that improved communication has resulted in more personalized care and has helped nursing assistants to ask the right questions to provide residents with personalized meals. “The training has also opened up dialogue between housekeeping and the nursing assistants, giving them a way to communicate without hurting feelings or becoming defensive,” says Goldman.
A valued resource
“We introduced the coaching approach and people have really embraced it,” says Crotty. “People continue to volunteer to be coaching trainers and manage to fit training in with all their other responsibilities. It’s that enthusiasm that has let me know it’s truly a valued resource within the organization.”
