If You Can Measure It, You Can Manage It: Satisfaction in Assisted Living ALFA – Phoenix – May 21, 2014 www.nationalresearch.com
Mary Tellis-Nayak RN, MSN, MPH Vice President of Quality Initiatives
mary@myinnerview.com 773-942-7525 www.nationalresearch.com
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
www.nationalresearch.com
Assisted living facilities are viewed Favorably by Americans Mean Ratio Hard ID
Favorability (ranked by mean) 82%
Home Health Care
9% 88%
Doctors 10%
82%
Assisted-living facilities 10%
Hospitals
84% 14%
Rehabilitation and skilled nursing facilities
77% 9% 69%
Acute rehabilitation hospitals
9% 70%
Long-term care facilities
15% 71%
Nursing Homes
22%
Health insurance companies
49% 46%
Pharmaceutical companies
49% 46% 0%
20%
40%
60%
favorable unfavorable
80%
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%
100%
www.nationalresearch.com
However, Americans are less impressed with the quality of care in assisted living Quality of Care Rating
Mean Ratio 74%
Hospitals
24%
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
62%
Home health care
24% 49%
Acute rehabilitation hospitals
22% 59%
Assisted-living facilities
28% 61%
Rehabilitation and skilled nursing facilities
26%
positive negative
48%
Long-term care facilities
33% 48%
Nursing homes 0%
2.91
41%
20%
40%
60%
80%
100% www.nationalresearch.com
Closing this gap is critical for assisted living Favorability Ratings (ranked by mean) favorabl unfavorable e Assisted-Living Facilities Rehabilitation and Skilled Nursing Facilities Acute Rehabilitation Hospitals
Quality Of Care Ratings positive negative
Mean
Mean 59%
82% 3.23
28%
10% 77%
61% 2.78
3.21 26%
9% 69%
49%
3.19
70%
48%
3.06
71%
Nursing Homes
48%
2.92
60%
80%
100%
2.49
41%
22% 40%
2.59
33%
15%
20%
2.80
22%
9%
Long-Term Care Facilities
0%
2.78
0%
20%
40%
60%
80%
www.nationalresearch.com
Why are satisfaction survey data important to providers? www.nationalresearch.com
Complaints that reach you: Tip of the iceberg!
5% complain to management 45% complain to frontline staff 50% have problem, yet don’t complain
Good quality is good business (TARP studies)
www.nationalresearch.com
www.nationalresearch.com
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.
www.nationalresearch.com
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. www.nationalresearch.com
Most people won’t complain to you ‌ they will just find someone else to provide the service. www.nationalresearch.com
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
www.nationalresearch.com
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 www.nationalresearch.com
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.
www.nationalresearch.com
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 www.nationalresearch.com
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 www.nationalresearch.com
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 www.nationalresearch.com
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 www.nationalresearch.com
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.
www.nationalresearch.com
When you don’t remember anything, you’re satisfied! Loyalty is generated by memorable things that happen that we didn’t expect www.nationalresearch.com
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
www.nationalresearch.com
Loyalty comes from compassion What words on comment cards made the residents love the staff? www.nationalresearch.com
COMPASSION 2/3rds of adjectives used … 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 www.nationalresearch.com
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
www.nationalresearch.com
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 www.nationalresearch.com
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 www.nationalresearch.com
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. www.nationalresearch.com
Why are satisfaction survey data important to providers? www.nationalresearch.com
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
www.nationalresearch.com
For individual providers
• Drives evidenced-based decision making • Fosters sustained change and improvement • Allows you to tell your story in your community
www.nationalresearch.com
What gets measured, gets improved. Peter Drucker
www.nationalresearch.com
SUMMARY OF RELATIONSHIPS Staff Satisfaction
Quality of care
Stability Turnover Resident/Family Satisfaction
Financial Health www.nationalresearch.com
KEY PERFORMANCE DRIVERS higher family satisfaction
lower nursing assistant turnover
higher employee satisfaction
higher family satisfaction
www.nationalresearch.com
KEY PERFORMANCE DRIVERS
higher satisfaction among families and employees
higher occupancy rates
www.nationalresearch.com
What about employee data? What do we know today? www.nationalresearch.com
EMPLOYEE ENVIRONMENT SCORE
Communities with higher family satisfaction have better work environments 70
Mean = 61.3 66 62 58 54 50 Lowest < 75.0
Low 75.0 to 81.4
High 81.4 to 86.7
Highest > 86.7
FAMILY SATISFACTION Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView www.nationalresearch.com
EMPLOYEE TRAINING SCORE
Communities with higher family satisfaction have better employee training 70
Mean = 61.6 65
60
55
50 Lowest < 75.0
Low 75.0 to 81.4
High 81.4 to 86.7
Highest > 86.7
FAMILY SATISFACTION Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView www.nationalresearch.com
EMPLOYEE SUPERVISION SCORE
Communities with higher family satisfaction have better supervision 80
Mean = 67.8 70
60
50 Lowest < 75.0
Low 75.0 to 81.4
High 81.4 to 86.7
Highest > 86.7
FAMILY SATISFACTION Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView www.nationalresearch.com
EMPLOYEE MANAGEMENT SCORE
Communities with higher family satisfaction have better management 66
Mean = 58.3
62 58 54 50 46 Lowest < 75.0
Low 75.0 to 81.4
High 81.4 to 86.7
Highest > 86.7
FAMILY SATISFACTION Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView www.nationalresearch.com
EMPLOYEE SATISFACTION SCORE
Communities with higher family satisfaction have better employee global satisfaction 80
Mean = 70.1 75 70 65 60 55 50 Lowest < 75.0
Low 75.0 to 81.4
High 81.4 to 86.7
Highest > 86.7
FAMILY SATISFACTION Source: Assisted living employee and family satisfaction surveys conducted in 2008 by My InnerView www.nationalresearch.com
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) www.nationalresearch.com
Satisfaction in Assisted Living Communities www.nationalresearch.com
Key Findings Important to managing
www.nationalresearch.com
DATABYTE
www.nationalresearch.com
ASSISTED LIVING
Voice of Residents and Family Members www.nationalresearch.com
Nation’s Residents say: WHAT MATTERS MOST IN ASSISTED LIVING COMMUNITIES Choices/ preferences
Responsiveness of management Competency of staff Home-like atmosphere
Care and concern of staff Comparison of charges Responsiveness of staff
Sufficiency of personal assistance “Grow as person” opportunities Quality of amenities Source: Assisted Living Resident Satisfaction Surveys collected in 2013 www.nationalresearch.com
Nation’s Families say: WHAT MATTERS MOST IN ASSISTED LIVING COMMUNITIES Competency of staff
Responsiveness of management Responsiveness of staff Choices/ preferences
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 www.nationalresearch.com
AN EXERCISE:
What
Matters Most
www.nationalresearch.com
www.nationalresearch.com
ASSISTED LIVING RESIDENT AND FAMILY
Survey items 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Choices/preferences Respectfulness of staff Respect for privacy Resident-to-resident friendships Resident-to-staff friendships Meaningfulness of activities Religious/spiritual opportunities Sufficiency of healthcare needs Sufficiency of personal assistance Home-like atmosphere Responsiveness of staff Commitment to family updates Competency of staff Care (concern) of staff 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
â&#x20AC;&#x153;Grow as personâ&#x20AC;? 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 www.nationalresearch.com
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 www.nationalresearch.com
QUADRANT AND ACTION PRIORITIES
Item score
B.
Secondary strengths
Primary strengths
C.
D.
Secondary opportunitie s
Primary opportunitie s
Successes
A.
Challenges
1 - Lowest to highest ranking score 100
You can meet customer expectations
Recommendatio n
1 ----- Lowest to highest ranking correlation -----100
You have little control over customer expectations www.nationalresearch.com
RESIDENT
www.nationalresearch.com
RESIDENT
“EXCELLENT,” “GOOD,” “FAIR” OR “POOR” RANKED BY PERCENT “EXCELLENT”
www.nationalresearch.com
Source: Assisted Living Resident and Family Satisfaction Surveys collected in 2013
FAMILIES 1 Choices/preferences
1 Competency of staff
2 Responsiveness of management
2 Responsiveness of management
3 Home-like atmosphere
3 Choices/preferences
4 Competency of staff
4 Responsiveness of staff
5 Care and concern of staff
5 Sufficiency of personal assistance
6 Comparison of charges
6 Home-like atmosphere
7 Responsiveness of staff
7 Sufficiency of healthcare needs
8 Sufficiency of personal assistance
8
9 “Grow as a person” opportunities
9 ‘Grow as a person” opportunities
10 Quality of amenities
www.nationalresearch.com 10 Comfort of room/surroundings
Respectfulness of staff
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 www.nationalresearch.com
Because when customers recommend you, theyâ&#x20AC;&#x2122;re putting their reputation on the line. They will take that risk only when they are loyal.
www.nationalresearch.com
“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.” www.nationalresearch.com
Resident Satisfaction 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 www.nationalresearch.com
“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.”
For My InnerView users, this is “Excellent” www.nationalresearch.com
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” www.nationalresearch.com
DATABYTE
www.nationalresearch.com
ASSISTED LIVING
Voice of Employees
www.nationalresearch.com
www.nationalresearch.com
ASSISTED LIVING EMPLOYEE
Survey items 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
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
10 Care (concern) of management
www.nationalresearch.com
Nationâ&#x20AC;&#x2122;s Employees say: WHAT MATTERS MOST IN ASSISTED LIVING COMMUNITIES Care (concern) of management
Attentiveness of management
Clear expectations of management
Assistance with job stress
Fairness of evaluations
Appreciation of supervisor
Support of career
Care (concern) of supervisor
Quality of skill training
Communication by supervisor Source: Assisted Living Employee Satisfaction Surveys collected in 2013 www.nationalresearch.com
EMPLOYEE
www.nationalresearch.com
EMPLOYEE
B
Care (concern) of supervisor Appreciation of supervisor Clear expectations by manager Fairness of evaluations
Support of career Quality of skill training Care (concern) of management Attentiveness of management Assistance with job stress
D
www.nationalresearch.com
EMPLOYEE
“EXCELLENT,” “GOOD,” “FAIR” OR “POOR” RANKED BY PERCENT “EXCELLENT”
www.nationalresearch.com
What does research have to tell us about the workplace? www.nationalresearch.com
www.nationalresearch.com
DATABYTE
www.nationalresearch.com
DATABYTE
www.nationalresearch.com
Employees speak out about leadership www.nationalresearch.com
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 www.nationalresearch.com
Listen to your employees 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 www.nationalresearch.com
Long-term care will continue to evolve and change. As leaders, our duty is to successfully lead the profession through this never-ending change. www.nationalresearch.com
We did the best we could, with what we knew, And when we knew better, we did better.
MAYA ANGELOU www.nationalresearch.com
Thank you! mary@myinnerview.com 773-942-7525 800-601-3884 www.nationalresearch.com
Thank you!
800-601-3884 mary@myinnerview.com Questions?
www.nationalresearch.com