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Workforce Engagement improves culture and decreases turnover

For Diversicare there is a clear connection between engaged team members and performance excellence. Diversicare’s leaders are passionate in their pursuit of performance excellence and desire to build a cohesive culture of service. Diversicare had to find a way to scale their culture across each of their centers. Knitting together the system’s 60+ centers, and more than 10,000 team members, proved to be an enormous challenge. Using NRC Health’s Workforce Engagement, Diversicare quickly found results.

System Governance | Attract & Acquire | Quality & Outcomes | Loyalty & Retention | Service Culture







The opportunity

Over the last several years, Tennessee-based Diversicare faced a considerable challenge. While all of the senior living system’s 60+ centers boasted an excellent standard of care for patients and residents, each of them also possessed a unique culture. This meant 60 different approaches to mission statements, team member engagement, attendance policies, and on-boarding processes — all within a single organization.

Diversicare’s leaders valued the distinct identities of its centers and also recognized that having such diffuse practices created managerial challenges. They wanted to rally Diversicare’s team under a single, coherent culture of service. No small feat, with a team member roster of more than 10,000 people.

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Historic peak in employee retention

Diversicare has a philosophical position that the answers to their greatest challenges lie closest to the bedside of their patients and residents—that is, with the Diversicare care team members. In order to create a culture that Diversicare’s entire team could endorse and embrace, leaders understood the importance of leveraging the knowledge and experience of their team members and turned to NRC Health.

The solution

NRC Health’s Workforce Engagement solution is a comprehensive platform for employee intelligence. The solution uses short, targeted surveys to capture a complete and candid picture of staff morale. By exploring two dimensions of team members’ working lives — Quality of Leadership and Quality of Workplace — Workforce Engagement questionnaires uncover the trends that correlate to crucial measures of employee attrition and customer satisfaction.

Quality of Leadership questions assess staff members’ confidence in their leadership. They explore whether employees believe leaders are sincere, receptive, invested, and competent.

Quality of Workplace questions, on the other hand, explore employees’ relationships with their working environment, as well as with their coworkers. These give a broader sense of employee fulfillment.

“There’s a lot to fall in love with, at Diversicare, but there was so much variability from center to center to center. We wanted the experience of working at Diversicare to feel much more unified. That’s why we partnered with NRC Health.”

Leslie Cunningham Campbell, Chief Operating Officer, Diversicare

NRC Health’s Workforce Engagement surveys uncovered what leadership had suspected for some time: that, while team members enjoyed their work for Diversicare, the experience of working for the company varied tremendously between centers.

They used what they discovered to develop four initiatives to stitch Diversicare’s cultural identity together:

A New Identity
First, they had to develop a company identity that could endear itself to the Diversicare team. Leaders knew they could not do this in isolation. They systematically sought input from bedside team members to help articulate Diversicare’s new vision. The result was Diversicare redefining an identity based on a central Mission, Core Values and Service Standards.

“In crafting our new branding, we tapped into the hearts and minds of those closest to their patients and residents. We knew that if we wanted their passion and alignment, our message would have to resonate with them.”

Laura Bucciarelli, Senior Director of Sales & Marketing, Diversicare

Setting a New Standard
Of course, revising the company’s identity would not suffice to motivate the cultural shift desired. The work itself would have to change. Leaders engaged Diversicare’s team members to help with this, too.

They invited a cross functional group of team members to join leadership on an off-site standard-setting retreat. There, huddled together around the common problem of employee engagement, the team defined all-new service standards for Diversicare’s team to bring to their workdays.

“We build on trust, respect, customer focus, compassion, diplomacy, appreciation and strong communication skills to shape the culture in our workplace. Diversicare team members play a critical role in fostering an environment of Service Excellence. Our Service Standards are in place to offer support and a guideline for how we all aspire to interact and engage with all of our customers—including one another. We do not take our team members for granted. We understand the contributions of every team member are the parts that make up the whole. They are appreciated for all that they do, every day, to showcase their talents and gifts. We endeavor to honor the unique “story” of everyone in our care—including our team members. To that end, we encourage our team members to share their stories. Their stories are what fosters their passion and purpose that promotes them to care for our patients/residents, work hard and succeed.”

Leslie Cunningham Campbell, Chief Operating Officer, Diversicare

“We felt it was imperative to infuse our new identify into all facets of Diversicare. A brand is not just a logo or visual representation of a company; rather our brand and culture reinforce our Mission, empower brand ambassadors and serve as the drivers for everything we do.”

Bonnie Levi, Director of Marketing & Communications, Diversicare

A High Hurdle to Clear
The above initiatives help current staff adapt to Diversicare’s cultural shift. In addition to that, there had to be consideration for new hires as well.

Although screening for skill set is important, Diversicare believes screening for “heart” is most important. To ensure that any prospective team member would bring authentic empathy to their roles, leaders devised a ‘Heart Test.’ It is a simple approach to uncovering passion and commitment to working in our setting. Before offers of employment are made, the prospective team member is taken on a walk through one of the centers.

Stringent as it was, the Heart Test is applied across the line, from nurse aide positions to executive roles. No matter how skilled applicants are, if they do not have a heart for what Diversicare does, they are not a fit for the team. This way, Diversicare’s leaders could be assured that any new hire would contribute to a culture of care.

“If, during the walk through the center, a candidate fails to engage with a patient or resident, they would not be considered suitable for the role. When one has a heart for caring for patients and residents, you can’t help but reach out and touch or engage with them.”

Camille Calloway, Senior Director of Human Resources, Diversicare

The final piece of Diversicare’s transformation was accountability. Using NRC Health’s Workforce Engagement solution became a continuous practice. Utilizing survey responses empowers Diversicare to not make assumptions, to deal with facts, and then start building business plans, making strategic decisions and incentivizing performance based on those facts.


With such a thorough and multi-pronged approach, it’s no surprise that Diversicare’s efforts quickly produced important benefits.

    Year-over-year employee turnover went from 112% to 85%, within just nine months of deploying Workforce Engagement surveys.
    From 2017 to 2018, the proportion of employees who would recommend Diversicare as an employer rose from 28% to 37%—an enormous increase in such a short time.
    The uptick in employee satisfaction made itself most apparent in customers’ reports of their own experiences. Here, too, customers’ “Would Recommend” scores rose from 53% to 57%, in just one year.
    Finally, the cumulative effect of these initiatives help to distinguish the organization among its peers. As a result of the efforts from Diversicare’s dedicated staff, the organization received two awards from NRC Health: the Customer Approved Award and the Employee Approved Award, a distinction shared by only a handful of senior-living systems, nation-wide.

“We measure everything, and we publish everything. The results from Pulse surveys were integral to keeping leadership focused on the objective—impacting team member engagement.”

Leslie Cunningham Campbell, Chief Operating Officer, Diversicare


With the clear success from Diversicare’s approach so far, leadership is now focused on sustaining the momentum of change. As ever, their focus will be on building a team that authentically connects with patients and residents — and using Workforce Engagement to track their success along the way.

“These two things are always connected. Higher team member engagement leads to a better care, outcomes and quality of life for our patients and residents. That’s the center of all of our efforts.”

Leslie Cunningham Campbell, Chief Operating Officer, Diversicare

For more on Workforce Engagement solutions from NRC Health,
call 800.388.4264 or visit nrchealth.com/demo.