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Secrets of long-term-care success from award-winning industry leaders

No one disputes the importance of the long-term-care and senior-living industry. But too few truly take the time to celebrate it.

Staff in long-term-care (LTC) and senior-living communities perform a vital service. The very best of them not only see to their customers’ care needs, but also go further, creating an environment that feels like home. These organizations—and the people within them—are among the hardest-working in healthcare. They deserve special recognition.

That’s why NRC Health created the Customer Approved and Employee Approved Awards for senior care.

Award-winners were selected by Net Promoter Score, as measured by results from NRC Health’s 2018 Resident and Family Member Experience and Employee Experience surveys. For each category, only the 20 top-performing organizations—those with the highest percentages of  “would recommend” respondents—qualified.

In this article, three leaders from these award-winning organizations share the secrets to their success.

– David Franz, Director of Mission Integration, a Customer Approved Award winner from Austin-based Ascension.

– Tammy Jo Painter, VP of Compliance and Operations, a Customer and Employee Approved Award winner from American Medical Facilities Management (AMFM) in West Virginia.

– Beth Dault, VP of Social Work Services, a Customer Approved Award winner from National Healthcare Corporation (NHC) in Tennessee.

Their insights reveal that, while no two communities approach care the same way, there are three universal principles behind building a high-performing organization.

Engage the staff

The biggest point of consensus? An engaged staff is crucial to any senior-living community’s success. Each of these winning organizations has found a remarkable way to find—and keep—dedicated employees.

NHC grows its leaders

“There’s a very well-observed correlation between happy patients and happy partners,” says Dault. “And we call them ‘partners’ because that’s how we see them, and how we want them to see themselves.”

NHC takes the long view on keeping their employees in the fold. The organization’s robust incentives show just how much it’s willing to invest in its people.

“We’re committed to growing our own leaders internally,” Dault says. “We have tuition reimbursement programs and a two-year-long training program for future administrators. That’s unique in our industry.”

Also unique is NHC’s outstanding employee retention. They’ve had several housekeepers who have gone on to become directors of nursing and regional supervisors. One administrator who went through the training program has been with NHC for over 40 years.

“When we commit to our staff, they commit to our residents. It’s as simple as that,” Dault says.

AMFM encourages healthy competition

Painter recommends that multi-site long-term-care organizations embrace a spirit of radical transparency. Not only does that build trust with resident and family members—it’s also extremely motivating for the staff.

“Our facilities are very competitive with one another,” Painter says. “If one facility gets a 100% would-recommend score, it fires up all of their peers.”

No matter which facility comes out on top, the clear winners in these competitions are AMFM’s customers.

However, Painter is careful to note that only happy staff are willing to take such pride in their facilities. “We can’t have happy customers if we don’t have happy staff,” she says. “We have to make it easy for them to like where they work.”

The secret to that? Painter says it’s simple: just ask.

“Always be asking your staff what it would take to make them happy,” she says. “They always appreciate it. Wouldn’t you?”

 Ascension affirms the humanity of its staff

 In an organization as large as Ascension (with 35 communities in 11 states), it can be easy for staff members to feel depersonalized, like small cogs in a huge machine. Franz and his team take great pains to make sure that doesn’t happen.

“We do everything we can to respect the individuality of our associates,” he says. “It’s the little things that make them feel more human: celebrating birthdays, work anniversaries, other events in their personal lives.”

Ascension also uses a peer-recognition system to reward associates who best uphold the organization’s core values. They call these “Inspiration Awards,” and they’re handed out on both the local and national level.

“Our communities are nothing more than what our individual associates do, every day,” Franz says. “So when associates do an outstanding job and live out our ministry, we think that’s something that should be encouraged.”

Know the customer

The bedrock mission of senior living is to serve the customer. It may not always be obvious, however, what customers need. Effectively serving them, then, depends on organizations’ ability to understand them.

AMFM affirms the importance of one-on-one communication

Painter whole-heartedly believes that senior-living organizations should strive to exceed customer expectations, not just meet them. But at the same time, she thinks far too many communities fall short on the basics.

“Complaints only come when someone fails to meet a need,” Painter says. “You have to get those basics right. For us, the goal is to get our employees to understand that we will always meet our residents’ needs, one hundred percent of the time.”

AMFM’s experience leaders believe that Real-time feedback surveys are essential for revealing what those needs are, in the aggregate. But to discern individuals’ needs, Painter says, there’s no substitute for one-one-conversation.

“The relationship is what matters,” she emphasizes. “It’s old-fashioned communication. It may not even be a clinical person who forms it—it could be an EVS on the evening shift who has that bond with the customer or the family member. We have to be open to that, because once we have that bond, it’s a whole lot easier to serve them.”

Ascension looks to the trends

Customer expectations are always evolving. For Franz and the rest of the staff at Ascension, survey data has been invaluable for charting that evolution’s trajectory.

Says Franz, “We teach our people not just to look at individual responses, but to examine the comments and look at the trends. That’s what’s going to sharpen the effectiveness of our performance-improvement efforts.”

Themes in patient comments can be very revealing, especially when they’re consistent over a wide cross-sample of the customer population.

One particular trend has been critical for keeping Ascension’s residents happy: higher standards for dining.

“It’s astounding how much residents’ dining tastes have been elevated,” Franz says. “People don’t just want variety now. They want healthy options. They want a pleasant atmosphere. They expect excellent service. It’s not just the food—it’s the whole experience.”

Observing survey comments—analyzed through natural language processing—enabled Ascension to get ahead of this trend, and deliver the dining experience that residents wanted.

 NHC targets the low points

Of course, no organization excels on every front, all the time. There will always be room for improvement. At NHC, Dault found that NRC Health’s quadrant analysis (a tool that uses survey data to identify an organization’s relative strengths and weaknesses) was extraordinarily helpful.

“It’s been phenomenal,” Dault says. “Prior to our relationship with NRC, we had a very painstaking, manual survey process, which effectively made our data invisible to us. Getting that visibility into our residents’ satisfaction is what enabled us to target specific areas for process improvement.”

Quadrant analysis of NHC’s operations uncovered a surprise: NHC’s customers occasionally complained about the responsiveness of management.

This was at odds not only with the organization’s priorities, but also with management’s perception of its work. “We had no idea that’s what our customers were thinking,” Dault says. “We empower our frontline staff to resolve almost all service concerns, and one byproduct of that was that our managers weren’t always super visible. That was a very enlightening example.”

It didn’t take the team long to devise a solution. “We took steps to encourage management to get out on the floor more, to interact with residents and family members more often,” Dault says. “It worked. We don’t see that complaint anymore.”

Build the culture, and the scores will follow

One final commonality between these outstanding organizations is their devotion to culture. If there’s one secret ingredient to their success, culture is it.

“It’s not our size or our amenities that gets us these ‘would-recommend’ scores,” Franz says. “It’s the connection that our staff has with our residents. It’s all of our associates coming together in one cohesive culture.”

That’s a point that Painter reiterates. “Culture is what makes our staff have good days at work,” she says. “The more good days we have, the better our residents are served.”

Dault couldn’t agree more. NHC borrows a culture-building technique from the Ritz-Carlton, where, every shift of every day, team-members huddle to re-affirm one of the organization’s core values. “I see going through our promises as a culture-maintenance exercise,” Dault says. “It’s a building-block of our resident-centered care.”

Opinions from these leaders converge on culture’s importance. It’s not hard to see why. Recommendations, whether from customers, family members, or employees, amount to a vote of confidence in an organization’s capacity to care.

As Franz puts it, “It takes a community to provide a community.” And the communities that these organizations have built stand as remarkable examples for the industry.

Kudos to them, and to all of our 2019 Customer Approved and Employee Approved Award winners.