2014 alfa conference if you can measure it
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If You Can Measure It, You Can Manage It:
Satisfaction in Assisted Living
ALFA – Phoenix – May 21, 2014
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Mary Tellis-Nayak RN, MSN, MPH
Vice President of Quality Initiatives
773-942-7525
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Objectives
• At the end of the session, the attendee will be able to: – Articulate how satisfaction data can be integrated
into the assisted living’s performance improvement activities
– List three things important to residents if they are going to recommend you to someone else
– Describe the relationship between employee satisfaction and resident/family satisfaction
– List three areas that are key to the satisfaction of assisted living employees, residents and families
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favorable unfavorable
Favorability (ranked by mean) Mean Ratio Hard ID
3.31 9.11 91%
3.28 8.80 98%
3.23 8.20 92%
3.21 6.00 98%
3.21 8.55 86%
3.19 7.66 78%
3.06 4.66 85%
2.92 3.23 93%
2.48 1.06 95%
2.43 1.06 95%
Home Health Care
Doctors
Assisted-living facilities
Hospitals
Rehabilitation and skilled nursing facilities
Acute rehabilitation hospitals
Long-term care facilities
Nursing Homes
Health insurance companies
Pharmaceutical companies 46%
49%
46%49%
22%71%
15%70%
9%69%
9%77%
14%84%
10%82%
10%88%
9%82%
0% 20% 40% 60% 80% 100%
Assisted living facilities are viewed Favorably by Americans
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41%48%
33%48%
26%61%
28%59%
22%49%
24%62%
24%74%
0% 20% 40% 60% 80% 100%
2.91 3.08
2.84 2.58
2.80 2.23
2.78 2.11
2.78 2.35
2.59 1.45
2.49 1.17
However, Americans are less impressed with the quality of care in assisted living
positive negative
Quality of Care Rating Mean Ratio
Hospitals
Home health care
Acute rehabilitation hospitals
Assisted-living facilities
Rehabilitation and skilled nursing facilities
Long-term care facilities
Nursing homes
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favorable unfavorable
Favorability Ratings (ranked by mean)
Assisted-Living Facilities
Rehabilitation and Skilled Nursing
Facilities
Acute Rehabilitation Hospitals
Long-Term Care Facilities
Nursing Homes 22%
71%
15%
70%
9%
69%
9%
77%
10%
82%
0% 20% 40% 60% 80% 100%
positive negative
41%
48%
33%
48%
22%
49%
26%
61%
28%
59%
0% 20% 40% 60% 80%
Quality Of Care Ratings
2.78
2.78
2.80
2.59
2.49
Mean Mean
3.23
3.21
3.19
3.06
2.92
Closing this gap is critical for assisted living
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Why are satisfaction survey data important
to providers?
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50% have problem, yet don’t complain
45% complain to frontline staff
5% complain to management
Good quality is good business (TARP studies)
Complaints that reach you: Tip of the iceberg!
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Technical Assistance Research Programs’ (TARP’s) first study for the White House Office of Consumer Affairs revealed consumers with problems who did not complain were less loyal than those who did and had their issues resolved.
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TARP surveys have revealed a decline in complaint rates, even for serious problems, due to growing cynicism that complaining doesn’t do any good. We call this behavior “trained helplessness,” which adopts the mind-set it’s futile to bother complaining because nobody will change the policy.
Complaint rates appear to be declining in all sectors.
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Most people won’t complain to you … they will just find someone else to
provide the service.
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Why do families and residents complain?
• Because they didn’t get what they were promised
• An employee was rude to them or their family member
• A perception that no one is listening • An employee projected a “can’t do” or a
negative attitude • A feeling of indifference
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What do families and residents want when they complain?
• They want – Action to be taken – Solutions to be suggested – Commitment to care of the elders – Timely responses from management – Individual, personalized attention – An apology when things go wrong (and they do) – Value for the money they (or others) are paying
for services
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Why don’t people complain?
• It won’t do any good • It’s not worth the trouble • I don’t know where to complain • I am afraid of retribution
All of these barriers can be reduced or
eliminated via effective communication.
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Did you know?
• Problems due to mistreatment, quality or incompetence evoke only 5-30% complaint rates because of a belief that nothing will be done?
• Mistreatment and incompetence result in 5x more damage to loyalty than do monetary concerns
• 4x as many angry customers post negative comments on websites as those with positive comment
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Criticism is the school book from which we learn.
It’s the negative feedback that will be of most benefit to you if you are committed to growing your census and reputation
based on outstanding service
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Did you know?
• A customer who complains and is satisfied is 30% more loyal than a noncomplainant and 50% more loyal than a dissatisfied complainant
• A friendly 90-second interaction creates an emotional connection that cemented the relationship with the customer
• Someone who goes to the effort to complain but remains dissatisfied is 50% less loyal than someone who did not bother to complain
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How do I measure satisfaction?
• Listen to concerns expressed by your residents and their families
• Conduct satisfaction surveys – At least annually – When residents move in – When residents move out
• Get actionable reports and use the results in your performance improvement programs
• Read and act upon the comments
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Where do I start?
• Let’s look at some considerations when thinking about resident satisfaction.
• Let’s look at some of the data from satisfaction from residents in assisted living to see what they find as important to them and – What will cause a resident to recommend
your community to someone else.
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When you don’t remember anything,
you’re satisfied!
Loyalty is generated by memorable things that happen that we didn’t expect
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The Law of Memorable Events
• Though it takes somebody doing something special beyond what is expected, it doesn’t take everybody doing something special all the time
• It takes only one brief experience on only one day of a stay to determine dissatisfaction or loyalty
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Loyalty comes from compassion
What words on comment cards made the residents love the staff?
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Compassion synonyms: • Caring, cares, cared +32 • Kind, kindness +24 • Compassionate +15 • Help, helpfulness +15 • Concerned +6 • Listens +4 • Loving +3 • Empathy +3
Courtesy synonyms: • Friendly +8 • Professional +9 • Attention, attentive +7 • Sweet +3 • Respect +3 • Polite +3 • Patient +3 • Smiling +2
COMPASSION 2/3rds of adjectives used …
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Compassion
• Questions from survey companies that have questions with “care,” “compassion” or “concern” in them have the highest correlation with overall satisfaction and loyalty
• Compassion dramatically influences overall satisfaction
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If one were to pick out the
synonyms for compassion,
there is an amazing consistency in the qualities that have
the greatest impact on patient loyalty
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Compassion, caring,
comforting and kindness —
these make up the bulk of the
adjectives linked to loyalty … they are all rooted in
empathy
The capacity for empathy is “the ability to
share in another’s emotions or
feelings”
When people receive empathy, they feel loved
and cared about
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For long-term care not to teach the role of empathy, or inspire compassion, is a colossal omission, because empathy
has the capacity to heal by its effect on stress, and compassion is the primary influence behind patient loyalty.
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Why are satisfaction survey data important
to providers?
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Creating a voice
• Build the first national database — Advocacy efforts
• Communicates the story of quality • Defines the product, before others
define it for you • Identifies best practices to help in state
and national improvement efforts
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For individual providers
• Drives evidenced-based decision making
• Fosters sustained change and improvement
• Allows you to tell your story in your community
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What gets measured,
gets improved.
Peter Drucker
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SUMMARY OF RELATIONSHIPS
Staff Satisfaction
Resident/Family Satisfaction
Stability Turnover
Quality of care
Financial Health
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KEY PERFORMANCE DRIVERS
higher family
satisfaction
lower nursing
assistant turnover
higher employee
satisfaction
higher family
satisfaction
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KEY PERFORMANCE DRIVERS
higher satisfaction
among families
and employees
higher occupancy
rates
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What about employee data?
What do we know today?
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Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView
50
54
58
62
66
70
Lowest Low High Highest< 75.0 75.0 to 81.4 81.4 to 86.7 > 86.7
Mean = 61.3
EMPL
OYE
E EN
VIR
ON
MEN
T SC
OR
E
FAMILY SATISFACTION
Communities with higher family satisfaction have better work environments
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Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView
50
55
60
65
70
Lowest Low High Highest
Mean = 61.6
EMPL
OYE
E TR
AIN
ING
SC
OR
E
< 75.0 75.0 to 81.4 81.4 to 86.7 > 86.7
FAMILY SATISFACTION
Communities with higher family satisfaction have better employee training
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Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView
50
60
70
80
Lowest Low High Highest
Mean = 67.8
EMPL
OYE
E SU
PER
VISI
ON
SC
OR
E
< 75.0 75.0 to 81.4 81.4 to 86.7 > 86.7
FAMILY SATISFACTION
Communities with higher family satisfaction have better supervision
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Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView
46
50
54
58
62
66
Lowest Low High Highest
Mean = 58.3
EMPL
OYE
E M
ANA
GEM
ENT
SCO
RE
FAMILY SATISFACTION
< 75.0 75.0 to 81.4 81.4 to 86.7 > 86.7
Communities with higher family satisfaction have better management
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Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView
50
55
60
65
70
75
80
Lowest Low High Highest
Mean = 70.1
EMPL
OYE
E SA
TISF
AC
TIO
N S
CO
RE
< 75.0 75.0 to 81.4 81.4 to 86.7 > 86.7
FAMILY SATISFACTION
Communities with higher family satisfaction have better employee global satisfaction
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The importance of benchmarking
• Benchmarking: A standard by which something can be measured or judged
• You can benchmark against yourself over time • Who else might you compare yourself to:
– Those in your state – Those of similar ownership – Those of similar size – Those of similar location (urban, rural,
suburban)
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Satisfaction in Assisted Living Communities
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Key Findings
Important to managing
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DATABYTE
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Voice of Residents and
Family Members
ASSISTED LIVING
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Nation’s Residents say: WHAT MATTERS MOST IN ASSISTED
LIVING COMMUNITIES
Responsiveness of management Choices/
preferences
Home-like atmosphere
Competency of staff
Comparison of charges Responsiveness of staff
“Grow as person” opportunities Quality of amenities
Source: Assisted Living Resident Satisfaction Surveys collected in 2013
Sufficiency of personal assistance Care and concern of staff
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Nation’s Families say: WHAT MATTERS MOST IN ASSISTED
LIVING COMMUNITIES
Competency of staff
Responsiveness of management
Choices/ preferences
Responsiveness of staff
Sufficiency of personal assistance Home-like atmosphere Sufficiency of healthcare needs
Respectfulness of staff “Grow as a person” opportunities Comfort of room/surroundings
Source: Assisted Living Family Satisfaction Surveys collected in 2013
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AN EXERCISE:
What Matters Most
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1 Choices/preferences 2 Respectfulness of staff 3 Respect for privacy 4 Resident-to-resident friendships 5 Resident-to-staff friendships 6 Meaningfulness of activities 7 Religious/spiritual opportunities 8 Sufficiency of healthcare needs 9 Sufficiency of personal assistance 10 Home-like atmosphere 11 Responsiveness of staff 12 Commitment to family updates 13 Competency of staff 14 Care (concern) of staff 15 Responsiveness of management
16 Safety of facility 17 Security of personal belongings 18 Cleanliness of room/surroundings 19 Control of room temperature 20 Variety of meals 21 Appeal of food 22 Sufficiency of dietary needs 23 Courteousness of dining staff 24 Comfort of room/surroundings 25 Community life opportunities 26 “Grow as person” opportunities 27 Quality of laundry services 28 Adequacy of storage space 29 Sufficiency of transportation 30 Quality of amenities 31 Accuracy of bills for services 32 Comparison of charges
Survey items
ASSISTED LIVING RESIDENT AND FAMILY
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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 average score: 1 – 100: Lowest to highest ranking score
2. How much each item influences residents, families and staff to recommend to others
Correlate each item with “Recommendation: 0 – 1: No correlation to strongest correlation
Rank order all items by correlational strength: 1 – 100: Lowest to highest ranking correlation
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1 ----- Lowest to highest ranking correlation ------ 100
Succ
esse
s
You have little control over customer expectations
You
can
mee
t cus
tom
er
expe
ctat
ions
C.
Secondary opportunitie
s
D.
Primary opportunitie
s
B.
Primary strengths
A.
Secondary strengths
Cha
lleng
es
1 - L
owes
t to
high
est r
anki
ng s
core
-
100
Recom-mendatio
n
Item score
QUADRANT AND ACTION PRIORITIES
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RESIDENT
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“EXCELLENT,” “GOOD,” “FAIR” OR “POOR” RANKED BY PERCENT “EXCELLENT”
RESIDENT
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1 Choices/preferences
2 Responsiveness of management
3 Home-like atmosphere
4 Competency of staff
5 Care and concern of staff
6 Comparison of charges
7 Responsiveness of staff
8 Sufficiency of personal assistance
9 “Grow as a person” opportunities
10 Quality of amenities
1 Competency of staff
2 Responsiveness of management
3 Choices/preferences
4 Responsiveness of staff
5 Sufficiency of personal assistance
6 Home-like atmosphere
7 Sufficiency of healthcare needs
8 Respectfulness of staff
9 ‘Grow as a person” opportunities
10 Comfort of room/surroundings
FAMILIES Source: Assisted Living Resident and Family Satisfaction Surveys collected in 2013
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The importance of “Recommendation”
• Provides crucial information – Tells you loyalty of respondents – Correlates to other quality outcomes:
• All items in survey • Occupancy • Quality indicators • Employee satisfaction
• That is why this question is used for Priority Action Agenda
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Because when customers
recommend you, they’re putting their
reputation on the line.
They will take that risk only when they are loyal.
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“In most of the industries studied, the percentage of
customers who were enthusiastic enough to refer a friend or colleague
— perhaps the strongest sign of customer loyalty — correlated
directly with differences in growth rates
among competitors.”
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Studies have repeatedly confirmed that residents and their family members value the quality of the relationships they have with the frontline caregivers higher that the quality of the medical care and the quality of the food.
NCCNHR, Public Health Institute
Resident Satisfaction
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For My InnerView users, this is “Excellent”
“Research shows that, in most industries, there is a strong correlation between
a company’s growth rate and the percentage of its customers who are raving fans — that is, those who say
they are extremely likely to recommend the company to a friend or colleague.”
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If you want to grow your business exponentially, you must get serious about building and maintaining loyal relationships
with your customers
• Loyal customers are easiest customers to serve
• Long-term customers tend to spend more with you than new customers
• Happy, loyal customers purchase other products or services in company’s line
• Satisfied, loyal customers recommend company’s products or services
FREDERICK RIECHHELD: “THE LOYALTY EFFECT”
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DATABYTE
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Voice of Employees
ASSISTED LIVING
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1 Quality of orientation
2 Support of career
3 Quality of skill training
4 Comparison of benefits
5 Comparison of pay
6 Care (concern) of supervisor
7 Appreciation of supervisor
8 Communication by supervisor
9 Clear expectations of management
10 Care (concern) of management
11 Attentiveness of management
12 Adequacy of equipment/supplies
13 Sense of accomplishment
14 Quality of teamwork
15 Staff-to-staff communication
16 Respectfulness of staff
17 Assistance with job stress
18 Fairness of evaluations
Survey items
ASSISTED LIVING EMPLOYEE
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Care (concern) of management
Attentiveness of management
Assistance with job stress
Clear expectations of management
Fairness of evaluations
Support of career Quality of skill training
Appreciation of supervisor Care (concern) of supervisor Communication by supervisor
Nation’s Employees say: WHAT MATTERS MOST IN ASSISTED
LIVING COMMUNITIES
Source: Assisted Living Employee Satisfaction Surveys collected in 2013
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EMPLOYEE
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EMPLOYEE B
D
Care (concern) of supervisor Appreciation of supervisor
Clear expectations by manager
Fairness of evaluations
Quality of skill training
Support of career
Care (concern) of management
Attentiveness of management
Assistance with job stress
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“EXCELLENT,” “GOOD,” “FAIR” OR “POOR” RANKED BY PERCENT “EXCELLENT”
EMPLOYEE
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What does research have to
tell us about the workplace?
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DATABYTE
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DATABYTE
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Employees speak out about
leadership
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Listen to your employees
• The truths of leadership you need to know: 1. We are watching everything you do If you show up late for a meeting you are telling us
you don’t value OUR time If you lose your cool over small issues, we wonder
how you will react with big ones You are ALWAYS leading, you can’t NOT lead
2. Everything you do counts Sharing juicy gossip and remove yourself from your
leadership role? NO TIME OUTS What you say to us outside the office COUNTS
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3. We have expectations of you Hire great people – this is one of the most important
things you do Don’t just hire any “warm body” just to fill a position You can be the best manager in the world but if we have
people on the team who are not talented we will not be successful
“De-hire” those on the team who are NOT contributing to the mission They are more detrimental than any of our competitors If we get lucky, our competitor will hire them
Treat us with respect You need us just as much as we need you…sometimes
even more
Listen to your employees
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Long-term care will continue to evolve
and change. As leaders, our duty is to
successfully lead the profession through
this never-ending change.
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We did the best we could, with what we knew, And when we knew better, we did better.
MAYA ANGELOU
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Thank you!
Questions? 800-601-3884 [email protected]