What A Difference Management Makes!

Operationalizing High-Performance Human Resource Management Practices This material was designed by Quality Partners, the Medicare Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. Contents do not necessarily represent CMS policy. 8SOW-RI-NHQIOSC-082006-2

This Work…

• Integrates the research and teaching of Susan C. Eaton with the quality improvement work of Quality Partners of Rhode Island and field work and teaching of B&F Consulting

Susan C. Eaton

About Susan Eaton

• PhD from MIT’s Sloan School • Taught graduate courses in human resource management • Researched impact of high performance human resource management practices in nursing homes

Susan’s Research from 1997 – 2003

• Pennsylvania's Nursing Homes: Promoting Quality Care and Quality Jobs, Keystone Research Center 1997 • Beyond ‘Unloving Care:’ Linking Human Resource Management and Patient Care Quality in Nursing Homes; June 2000 • Extended Care Career Ladder Initiative (ECCLI), Massachusetts, 2001 •

What a difference management makes!

Better Care, 2003 , CMS 2002 • Improving Institutional Long-Term Care for Residents and Workers: The Effect of Leadership, Relationships and Work Design, for Better Jobs,

Susan’s research applied “High Performance Human Resource Management Practices” to Long-Term Care

PA Study links Quality Job and Quality Care Links Pioneer Practices with HR Management Practices Organizational Approach is key factor in success of Career Ladders Management is the Determinant in High and Low Turnover What leadership practices improve QJ & QC?

1997 2000 2001 2002 2003

Sphere of Influence

• ECCLI • DCWI • Pioneer Network • Direct Care Workers Alliance • Better Jobs, Better Care

The Science & Psychology of Change

Science of Change:

Quality Improvement Practices Root-cause analysis Small pilot-tests Evaluation and Re-evaluation Mid-course adjustments Evidence-based solutions Collaborative Learning, Spread

The Science & Psychology of Change

Psychology of Change:

Relationship-Based Practices Build on Intrinsic Motivation Holistic Approach - Personalize Start where people are Build capacity for change Experiential learning Climate Where Truth is Heard

IMPROVING NURSING HOME CULTURE Special Study Person Directed Care

recruit 5-10 Nursing Homes from their state

Workforce Retention

& 2 State Triads (QIO, State AASHA & AHCA) recruit 10-12 nursing homes

Training 1 year September 2004– August 2005 Training QIO 4 Sessions

168 NH Participants

Nursing Home Sessions N H Sessions

Outcomes Congress

Corps 4 Sessions

86 NH Participants

Holistic Approach to Transformational Change HATCh  Government & Regulations Family Leadership Community

Five Management Practices Associated with High Retention, Attendance and Performance High quality leadership at all levels of the organization Valuing staff day-to-day in policy and practice, word and deed High performance, high commitment HR policies Work systems aligned with and serving organizational goals Sufficiency of staff and resources to care humanely

Concepts Experiential Exercises Practical Examples Homework Drill downs Change Ideas

Eaton, 2002

Phase 1: Irritant

An annoyance based on a belief, behavior or practice that becomes a tolerated part of the culture.

Way of Inquiry Phase 2: Catalyst

An external influence suggesting news of a difference that change is possible and necessary.

Phase 3: Awakening

A heightened sense of awareness creating a tipping point in one’s personal sense of under standing and responsibility in changing the belief, behavior or practice .

Hope vs . Despair

Gives rise to growth, Produces resignation action, & our greatest humanity & surrender

Phase 4 Action Step

Now ready to create action

Immobilization

Continue the current process

Outcomes of INHC – WFR

• Results in 9 months from 4 MPQ’s with a total of 55 SNFs • Nursing Department (RN, LPN, CNA) turnover rates: – Relative change =

-10%

– Annualized =

196 fewer terminations

– Annualized direct-cost savings =

$490,000

INHC - WFR Collaborative

• Results from 95 SNFs • Impact on Quality Measures • Comparing Quarter 1 2004 to Quarter 1 2005: – Pain – chronic care population • Dropped from 6.32 to 5.44

– Greatest impact – Physical Restraints • Dropped from 6.51 to 5.94

• 66% of all SNFs had a decline • 4 dropped to 0%

Adult Learning Methods

• Experiential Learning • Reflection on experiences you bring and on experiences created in the room