B&F Consulting, Inc.

 

Staff Stability Toolkit

Produced by B&F Consulting

for Healthcentric Advisors (formerly Quality Partners of Rhode Island)

With funding from The Commonwealth Foundation

To access Excel Worksheets, see links below. You cannot access them from the toolkit links.

For more information on staff stability, see:

  1. Bullet Achieving Staff Stability: Using Data Driven Decision-Making to Rethink Industry Norms

  2. Bullet From Institutional to Individualized Care Part Four interview with Scott West and Sue Fortin about their work to stabilize staffing at Birchwood Terrace in Burlington, VT

  3. Bullet What a difference management makes! by Susan Eaton

  4. Bullet Attendance Strategies includes excerpt from From Institutional to Individualized Care Part Four on Attendance, excerpt from Staff Stability Tool-kit on Attendance, and Drill down worksheet on Attendance.

  5. Bullet Consistent Assignment includes excerpt from From Institutional to Individualized Care Part Four and interviews from one home’s residents, staff, and families.

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This Staff Stability Tool-kit was developed by B&F Consulting under contract and in collaboration with Healthcentric Advisors (formerly Quality Partners of Rhode Island). Its development was suppported through funding from The Commonwealth Foundation and informed by work done through Better Jobs Better Care and in collaboration with David Farrell.


Get the staff stability toolkit.

Note: To get the 10 Excel Worksheets referenced in the Toolkit, use the links below. The worksheets are for Data Collection to provide a snapshot of your current workforce and analyze the impact of your financial incentives.


Worksheets


  2. •Worksheet 1 - Employment Status.xls


  4. •Worksheet 2 - Current Staff by Length of Service.xls


  6. •Worksheet 3 - Vacancies.xls


  8. •Worksheet 4 - Turnover Rates.xls


  10. •Worksheet 5 - Turnover Replacement Costs.xls


  12. •Worksheet 6 - Terminations by Length of Service.xls


  14. •Worksheet 7 - Absenteeism.xls


  16. •Worksheet 8 - Call-In Log.xls


  18. •Worksheet 9 - Incentives.xls


This tool-kit draws from experiences and lessons learned in over 400 nursing homes over a three-year period. It is designed to serve as a resource for homes just getting started with efforts to reverse turnover as well as employers who have already started to address recruitment and retention and need further assistance in a specific area. 


Use: Getting to stability and staying there


This tool-kit will provide you with the information to achieve sustained stability. It will help you identify the root causes of your instability and give you proven strategies you can put into action.


The same practices that help you improve clinically can help you improve operationally, in stabilizing staffing in your building. The tool-kit combines concepts, practices, and tools to support you in a systematic process of determining the root cause of a problem and identifying potential remedies. It offers ways for you to gather information by collecting data and by listening to your staff.


This tool-kit is organized to allow each reader to use it in your own way. Retention of current staff is the best place to start. Too many organizations make the mistake of focusing mainly on recruitment. Recruiting new staff does not help if your nursing home is not able to retain them. Recruitment is always more successful when new employees come in to a more stable organization.  Stabilize through retention and the rest will follow.


Sections:

•Section One of the Tool-Kit describes a process for getting started and outlines how to include staff from every department in your efforts


•Section Two provides tips on management practices that support stability related to:

  1. Bullet  Recruiting

  2. Bullet  Hiring

  3. Bullet  Welcoming Staff

  4. Bullet  Attendance

  5. Bullet  Scheduling

  6. Bullet  Consistent Assignment

  7. Bullet  Creating A Positive Chain of Leadership.


•Section Three introduces a tool for “drilling down” into the data to learn more about your current state of stability or instability. It explains how to gather and analyze data about turnover, absenteeism, and financial incentives. Step by step instructions are included.


•Section Four is a Case Study describing how Birchwood Terrace put these very tools and practices to use to achieve staff stability. It shares how they used the drill down process to identify the root causes of their instability and re-allocate their financial and management resources to support stability.


•Section Five describes how to use training strategically to grow your staff’s abilities and thereby grow your organization’s capacity. It provides information about workforce development and other resources available to help employers provide training. It also includes information about state-based technical assistance resources to aid in stabilizing staffing.


Origins of the Tool-kit:

This tool-kit applies concepts and practices based on the work of Susan Eaton who in 2002 completed a CMS funded study, What a Difference Management Makes for CMS.pdf.  Dr. Eaton’s study compared practices at high and low turnover nursing homes in the same labor market. Strategies and techniques based on her findings have been successfully piloted in Better Jobs Better Care - Vermont (BJBC-VT); a CMS funded pilot involving 254 nursing homes in 21 states, called Improving the Nursing Home Culture (INHC); with nursing homes nationally through the QIO program and in New England through workforce development programs, and now is being used in New Orleans and Lake Charles, Louisiana among approximately 100 nursing homes.


Additional Resource on Workplace and Management Practices:

Meeting the Leadership Challenge in Long-Term Care: What You Do Matters by David Farrell, Cathie Brady, and Barbara Frank (2011, Health Professions Press)


HATCh:

The INHC core faculty - Cathie Brady, David Farrell, Barbara Frank, and Marguerite McLaughlin - developed HATCh (available at www.medqic.org), a model for a Holistic Approach to Transformational Change. HATCh identifies three domains: the environment, care practices, and workplace practices, each of which affects the other, and all of which have an impact on both the quality of care and the quality of the work environment.


Using the HATCh model, participating nursing homes focused first on stabilizing their workforce through high impact management practices using evidenced based tools and strategies. Recognizing the link between management and fiscal practices, a “drill down” tool was provided to assist the nursing homes in analyzing how particular financial practices were contributing to its staffing instability.


The drill down comes in excel worksheets (created by David Johnson of IPRO based on initial work by David Farrell) The worksheets are designed to allow individual nursing homes to customize the drill down to focus on the precise issues of concern in their workplace.


Section IV of the Toolkit provides a Case Study of Birchwood Terrace Healthcare in Burlington, Vermont. With assistance provided under the Better Jobs Better Care - VT project,administered by COVE,  Birchwood was able to achieve staff stability by applying the principles and practices described here. The Case Study is part of a series being published nationally by BJBC capturing the great work done under that impressive initiative.


Section V’s discussion of strategic use of training to stabilize your staff and grow your organization, describes state workforce development resources and adult education and literacy programs. Contributors to this section include Geri Guardino, an independent consultant with extensive experience in health care workforce development, and information developed by Carolyn Blanks of the Massachusetts Senior Care Association and Carol Kapolka, of the Extended Care Career Ladder Initiative (ECCLI) of the Commonwealth Corporation of Massachusetts. Other workforce development sources include workforce projects in Connecticut, Massachusetts, and Rhode Island: a U.S. Department of Labor grant in CT administered by Capital Workforce Partners; the CT Culture Change and Career Ladder Initiative, funded through the state of CT and administered by the CT Women’s Education and Legal Fund; grants from ECCLI, the Extended Care Career Ladder Initiative operated by Commonwealth Corporation of MA; and grants to Quality Partners of Rhode Island through the RI Department of Labor and Training and the Department of Education.


Nursing home administrators whose experiences and ideas are used in this tool kit include David Farrell, drawing from his work as administrator at Medical Hill in Oakland, CA; Bill Graves, Administrator at St. Camillus Health Center in Whitinsville, MA; Connie McDonald, Executive Administrator of Maine General at Glenridge in Augusta, ME; Loren Salvietti, Administrator of Quaboag on the Common in West Brookfield, MA; Lori Todd, Administrator of Loomis House in South Hadley, MA; and Scott West, while administrator at Birchwood Terrace in Burlington, VT.


The Appendix to this Tool-kit contains references to additional reading on staff stability and leadership. Also available are “homework” assignments that help readers learn more about root causes of instability and assist in implementation of the practical tools contained in the following pages.

See our two newest articles on 10 Steps to Staff Stability, published in Provider magazine January and March 2016.

Part One: Good Hires and Welcomehttp://www.providermagazine.com/archives/2016_Archives/Pages/0116/10-Steps-To-Staff-Stability.aspx#magazine-article
Part Two: Support and Engage Staffhttp://www.providermagazine.com/archives/2016_Archives/Pages/0216/Ten-Steps-To-Staff-Stability-Part-Two.aspx