Employee Satisfaction:

What do we do with the

data?

Mary Tellis-Nayak, RN, MSN, MPH

VP Quality Initiatives
My InnerView
mary@myinnerview.com
Objectives
The participant will be able to:
— Identify three issues which staff say
cause them to recommend a nursing
home as a good place to work
— Describe the relationship between
the quality of the workplace and
3 other measures
— Discuss what must be done with
employee satisfaction results
— List 2 things a leader can do with the
results of staff satisfaction surveys
Our Mission

To provide long-term care

leaders evidence-based
management tools to
better achieve their
organization’s goals
My InnerView Nationwide
» 5,600+ providers in all 50 states and
District of Columbia use our tools

» Largest satisfaction benchmark

database in long-term care
» Recommended by:
— 3 national associations
— 32 state associations
 Providers will
commit to focus on
at least 3 of 8
measurable goals
CLINICAL GOALS: OPERATIONAL/
PROCESS GOALS:
1. Reducing high risk
1. Establishing individual
pressure ulcers targets for improving
2. Reducing use of quality
daily physical 2. Assessing
restraints resident and family
3. Improving pain
satisfaction with the
management for longer quality of care
term nursing home 3. Increasing staff
residents
retention
4. Improving pain
management for short 4. Improving consistent
stay, post-acute nursing assignment of nursing
home residents home staff, so that
residents regularly
receive care from the
same caregivers
Looking
at
National
Results
 National Employee
Satisfaction
Survey Results

2006

Nearly 107,000 responses

» First
nationwide
report
» 1,933
nursing
homes in
49 states
and D.C.
participated
in 2006
NOTE: Alaska not included
 FIGURE 2a

Employee’s age
 FIGURE 2b

Employee’s job category

 FIGURE 2d

Length of employment
 FIGURE 1

SATISFIED NURSING HOME

WORKERS BY CATEGORY
Based on the percent of total weighted respondents who rated their overall satisfaction
as “excellent” or “good” in each job category
 An Exercise:
What Matters Most?
Survey items:

1 Quality of orientation 11 Safety of workplace

2 Quality of in-service education 12 Adequacy of
equipment/supplies
3 Quality of resident-related training
13 Sense of accomplishment
4 Quality of family-related training
14 Quality of teamwork
5 Comparison of pay
15 Fairness of evaluations
6 Care (concern) of supervisor
16 Respectfulness of staff
7 Appreciation of supervisor
17 Assistance with job stress
8 Communication by supervisor
18 Staff-to-staff
9 Attentiveness of management
communication
10 Care (concern) of management
 FACTORS THAT DRIVE
WORKFORCE RECOMMENDATION

Ranked correlations (p < 05) between employee workplace recommendation and employee satisfaction items
 TABLE 5

FACTORS THAT DRIVE

WORKFORCE RECOMMENDATION (continued)

Ranked correlations (p < 05) between employee workplace recommendation and employee satisfaction items
 TABLE 6

PRIORITY ITEMS FOR NURSING STAFF

Ranked by average scores and correlations with workplace recommendation

 FIGURE 3

Recommendation for care

 FIGURE 3

Does not total 100% due to rounding

Recommendation for job

 FIGURE 3

Overall satisfaction
 TABLE 1

TRAINING

May not total 100% due to rounding

 TABLE 2

WORK ENVIRONMENT

May not total 100% due to rounding

 TABLE 3

SUPERVISION

May not total 100% due to rounding

 TABLE 4

MANAGEMENT

May not total 100% due to rounding

 What does
research tell us
about satisfaction
survey data?
What about employee data?

What do we know today?

 Key Performance Drivers
lower
higher
nursing
family
assistant
satisfaction
turnover

higher higher
employee family
satisfaction satisfaction
 Key Performance Drivers

higher
satisfaction higher
among occupancy
families rates
and employees
 Key Performance Drivers

better
higher clinical
satisfaction outcomes
among related
families to falls,
and employees pressure ulcers
and catheters
 SUMMARY OF RELATIONSHIPS

Improve
Staff care outcomes
Satisfaction Improve relationships

HR
Decrease nurse absenteeism
Decrease nurse turnover
Decrease CNA turnover

Resident/Family
Financial
Satisfaction Increase occupancy
Facilities with higher family satisfaction
have better work environments
EMPLOYEE ENVIRONMENT SCORE (%)

80
Mean = 68.0

70

60

50
Lowest Low High Highest
< 54% 54% to 58% 58% to 64% > 64%

FAMILY SATISFACTION
Facilities with higher family satisfaction
have better employee training
64
EMPLOYEE TRAINING SCORE (%)

Mean = 57.1
60

56

52

48
Lowest Low High Highest
< 54% 54% to 58% 58% to 64% > 64%

FAMILY SATISFACTION
Facilities with higher family satisfaction
have better supervision
EMPLOYEE SUPERVISION SCORE (%)

90
Mean = 72.2

80

70

60
Lowest Low High Highest
< 54% 54% to 58% 58% to 64% > 64%

FAMILY SATISFACTION
Facilities with higher family satisfaction
have better management
EMPLOYEE MANAGEMENT SCORE (%)

80
Mean = 66.5

70

60

50
Lowest Low High Highest
< 54% 54% to 58% 58% to 64% > 64%

FAMILY SATISFACTION
Facilities with higher employee
satisfaction have:
» More residents without falls
» More residents without pressure ulcers
» More residents without acquired catheters
» Less nurse turnover
» More nurse stability
» Less CNA absenteeism
» Less nurse absenteeism
» Higher occupancy
 Quality of leadership
and quality of the workplace:
The interface

CNAs speak up!

• A 2004 study
• 156 nursing facilities in the Southeast
• 3,579 CNAs, 6,502 families surveyed
• November 2004
 Indicators of
quality of workplace

1. Pay compared to other nursing homes

2. Safety of workplace
3. Adequate equipment and supplies to do your job well
4. Work allows you to make a difference in people's lives
5. Co-workers work as a team
6. Fair performance evaluations
7. Staff are respectful of residents
8. Helps you get to deal with job stress
9. Communication between shifts
 Quality of leaders produce a quality workplace
Rating by 6,305 CNAs in 156 Nursing Facilities:
4 4 percentile ranked groups, 2004
Group avg score: 1-4..

3
Quality of workplace .

Quality of workplace .

Quality of workplace .

Quality of workplace .
2
Leadership .

Leadership .

Leadership .

Leadership .
1

0
Lowest 2nd lowest 2nd highest Highest
4 percentile ranked groups of NHs
 Group avg score: 1-4..

0
1
2
3
4

Q of workplace.

Lowest
Recommend NH.

Q of workplace.

Recommend NH.

2nd lowest
Q of workplace.

Recommend NH.
2nd highest
4 percentile ranked groups of NHs

Q of workplace.
A quality workplace earns staff recommendation

Highest

Recommend NH.
 Group avg score: 1-4..

0
1
2
3
4

Quality of workplace..

Lowest
Families recommend..

Quality of workplace..

Families recommend..

2nd lowest
Quality of workplace..

Families recommend..
2nd highest
4 percentile ranked groups of NHs

Quality of workplace..
A quality workplace earns family recommendation

Highest

Families recommend..
 Group avg score: 1-4..

0
1
2
3
4

Quality of workplace..

Lowest
QoLife..

Quality of workplace..

QoLife..

2nd lowest
Quality of workplace..

QoLife..
2nd highest
4 percentile ranked groups of NHs

Quality of workplace..
A quality workplace creates QoL for resident

Highest

QoLife..
 As Staff are
Treated

So will the elders be treated.

 Group avg score: 1-4..

0
1
2
3
4

Quality of workplace..

Lowest
QoCare..

Quality of workplace..

QoCare..

2nd lowest
Quality of workplace..

QoCare..
2nd highest
4 percentile ranked groups of NHs

Quality of workplace..
A quality workplace creates QoCare for resident

Highest

QoCare..
 Group avg score: 1-4..

0
1
2
3
4

Quality of workplace..

Lowest
QoService.

Quality of workplace..

QoService.

2nd lowest
Quality of workplace..

QoService.
2nd highest
4 percentile ranked groups of NHs

Quality of workplace..
Highest

QoService.
A quality workplace creates QoService for resident
 Group avg score: 1- 10 .

0
2
4
6
8
10

Quality of workplace,,

Compliance score..

Lowest
# of survey citations..

Quality of workplace,,

Compliance score..

2nd lowest
# of survey citations..

Quality of workplace,,
2nd highest Compliance score..

# of survey citations..
4 percentile ranked groups of NHs

Quality of workplace,,

Compliance score..
A quality workplace results in better state surveys

Highest

# of survey citations..
 Group avg score: 1- 100 .

20
40
60
80
100

0
Quality of workplace .,

Lowest
Occupancy 92.0% .

Quality of workplace .

Occupancy 92.1% .

2nd lowest
Quality of workplace .

Occupancy 93.2% .
2nd highest
4 percentile ranked groups of NHs

Quality of workplace .
A quality workplace makes business sense

Highest

Occupancy 94.8% .
We did the best we could,
with what we knew,
And when we knew better,
we did better
Maya Angelou
 Now you
know better
so …

… what do you do?

 If you do not plan to use
the results of your employee
satisfaction survey
to improve the work
environment,
it is far better that
you not conduct
the survey at all.
Using Satisfaction Data
» One member of the leadership
team must be responsible and
held accountable for managing
this initiative
— Human Resources
— Department Manager(s)
— Administrator/Assistant
Administrator
— Staff Development
Using Satisfaction Data
» Use current structures or create
new ones
— QA&A committee
— Staff meetings
— Neighborhood/unit meetings
— Interdepartmental teams
— Focus groups
Communicating results
» Determine what you want to communicate initially
and to whom
— Depends on your current facility structure (e.g.
neighborhoods vs. units; universal workers vs. departments)

» Consider the current culture of your community when

considering how to proceed
— Use a bulletin board to post results
— Pull together an employee group to obtain feedback
— Publish results in a newsletter format
— Have unit/team meetings to present the results
— Have an all staff meeting on each shift
— Initially present the results to department heads
Where do we start?
» Choose the issues
— Start with “low hanging fruit”
— Choose an area where you know you can
show staff that you are listening to them
— Choose an area which is important to the staff
even if you may not have scored too badly
— Choose an area where you know you can
achieve results quickly
— Choose an area which is no surprise because
you’ve “heard it before”
My InnerView’s reports
help you to choose
the topic(s) which are
most important
to your staff.
 Quadrant analysis: Two key concepts
1. How residents, families and staff rate your care and services
• Your average score on each item:
1 – 4: “Poor” ”Fair” ”Good” ”Excellent”
• Rank order all items by their average score:
1 – 100: lowest to highest ranking score

2. How much each item influences residents, families and

staff to recommend the facility to others.
• Correlate each item with “Recommendation”
0 - 1: no correlation to strongest correlation
• Rank order all items by their correlational strength:
1 – 100: lowest to highest ranking correlation
 The Quality Quadrant and Action Priorities
Recom-
mendation
1 --- Lowest to highest ranking score  100
You can meet customer expectations

A. B.

Successes
Secondary Primary
strength strength

C. D.

Challenges
Secondary Primary
opportunties opportunities

Item
score 1 ---------- Lowest to highest ranking correlation -------- 100

You have little control over customer expectations

Just ask why!
My work is stressful —

I gave Mrs. J her supplement

and she threw up —

No one told me she had been

sick all morning —
There is no communication
between the morning and evening
shifts of CNAs —
Take Home Tips
» Just ask until there are no
more ‘whys’ to ask
» Focus on systems and processes
» LISTEN
» OBSERVE
» Don’t BLAME
» Involve the team
Turn Information
Into Knowledge
Study current process
Gather more information
Evaluate process

Identify contributing factors

Determine root cause(s)

 Develop Drill Down Questions
Issue – Orientation
Drill down suggested questions:
» New CNAs are oriented specifically to their unit
» New CNAs are oriented specifically to their shift
» New employees are taught the proper use of equipment
which they will be using
» New employees are shown the location of the supplies
and equipment they need to do their job
» New employees are assigned to a mentor or a
buddy system
» New employees are not given a full a workload initially,
but in gradual steps
» New employees are introduced individually to the
residents assigned to them
Use the Workplace Scale
as Starting Point
»Pay compared to other nursing homes
»Safety of workplace
»Adequate equipment and supplies to do your job well
»Work allows you to make a difference in people's lives
»Co-workers work as a team
»Fair performance evaluations
»Staff are respectful of residents
»Helps you get to deal with job stress
»Communication between shifts
A Valuable Resource
» “Better Jobs Better Care: Issue Paper”
— No. 7/April 2007
— “Respectful Relationships: The Heart of
Better Jobs Better Care”
» Link to this paper
— http://www.bjbc.org/Page.asp?PgID=27
» This paper addresses the key issue of the
long-term care workforce — RESPECT
Whether individuals feel
respect in the workplace
is largely a function
of how they are treated
by their supervisors,
their clients and
family members
or advocates and,
many times, their peers,
particularly for new workers.
 Studies suggest
that the quality
of these relationships
has a defining impact
on workers’ decisions
to stay on the job
or leave to pursue
opportunities elsewhere.
Lessons Learned
Practical Suggestions
» Take a “relationships inventory”
» Listen to what workers say about respect
» Identify changes necessary to “operationalize”
respect
» Think in terms of maximizing human potential
» Understand the needs of new immigrants and
non-English speakers
» Commit to making continuous improvement
Take a “relationships inventory”
» Do managers at all levels of your
organization have positive and professional
relationships with the people they
supervise?
» Does the disciplinary action make up a large
portion of interaction between frontline staff
and managers?
» Do direct care staff see managers as
mentors they feel comfortable going to for
advice and problem solving?
Without a foundation of healthy relationships
among frontline workers and between direct
care workers and their supervisors, other
initiative to create a more respectful work
environment are unlikely to be successful.
Listen to what workers say
about respect
» When workers say they feel a lack of
respect, it often reflects their sense that no
one is listening to them.
» Everyone knows how to listen but knowing
how to listen to information that is
emotionally charged is difficult.
» Responding without blaming or being
judgemental requires training and practice.
Identify changes necessary
to “operationalize” respect
» Review existing P&Ps to understand what
changes, big or small, will make workers feel
more respected, valued and heard.
» Do you have a process in place to provide
emotional support to workers who are caring
for consumers or encountering family
members who are verbally or physically
abusive?
» How does your organization support workers
who feel they are being discriminated
against?
Think in terms of maximizing
human potential.
» When workers have the opportunity to
improve themselves, personally or
professionally, they feel better about
themselves and have a more positive
attitude about their workplace.
» Do you have a career track for direct care
workers?
» Do you offer educational opportunities
through scholarships or on-site distance
learning?
 Understand the needs of new
immigrants and non-English speakers

» Does your workforce include

immigrants or those with limited
English skills?
» How well do you understand their
customs?
» What are you doing to help them
operate in their new language and
cultural environment?
 Commit to making
continuous improvement
» There is no “one-time fix” for creating a
respectful work environment
» To be successful, the work must be an
ongoing process, fully supported by all
levels of people within the organization
and owned by more than one person
» One innovation to create a more
respectful work environment is likely to
lead to another as workers feel more
empowered to articulate their needs
and interests.
“A resident’s satisfaction with
his/her relationship to nursing
staff was found to be
significantly related to the
proportion of CNAs on the
resident’s unit who said they
intended to stay in the job,
and to the proportion of CNAs
who had positive
relationships with their
supervisors.”
- Bishop, October 2006
 Using employee
satisfaction surveys
will help leaders
to improve the
tenure of staff
by addressing
those issues
most important to them.
 Don’t miss this
valuable opportunity
to improve quality of life
for your residents
by improving
quality of life
for your employees
QUESTIONS?
Contact:
Mary Tellis-Nayak
mary@myinnerview.com

773-942-7525