2014 alfa conference if you can measure it

www.nationalresearch.com

If You Can Measure It, You Can Manage It:

Satisfaction in Assisted Living

ALFA – Phoenix – May 21, 2014


Mary Tellis-Nayak RN, MSN, MPH

Vice President of Quality Initiatives

[email protected]

773-942-7525


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


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


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


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


Why are satisfaction survey data important

to providers?

Presenter

Presentation Notes

Next we are going to look at why it is important to the assisted living providers…


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!

Presenter

Presentation Notes

Note to presenter: This graph “hangs off” the side of the “page” but will be fine in slide show.


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.


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.


Most people won’t complain to you … they will just find someone else to

provide the service.


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


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


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.


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


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


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


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


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.


When you don’t remember anything,

you’re satisfied!

Loyalty is generated by memorable things that happen that we didn’t expect


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


Loyalty comes from compassion

What words on comment cards made the residents love the staff?


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 …


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


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


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


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.


Why are satisfaction survey data important

to providers?

Presenter

Presentation Notes

Next we are going to look at why it is important to the assisted living providers…


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


For individual providers

• Drives evidenced-based decision making

• Fosters sustained change and improvement

• Allows you to tell your story in your community


What gets measured,

gets improved.

Peter Drucker


SUMMARY OF RELATIONSHIPS

Staff Satisfaction

Resident/Family Satisfaction

Stability Turnover

Quality of care

Financial Health


KEY PERFORMANCE DRIVERS

higher family

satisfaction

lower nursing

assistant turnover

higher employee

satisfaction

higher family

satisfaction


KEY PERFORMANCE DRIVERS

higher satisfaction

among families

and employees

higher occupancy

rates


What about employee data?

What do we know today?


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

Presenter

Presentation Notes

From Amy 3/22/09



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



50

60

70

80


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



46

50

54

58

62

66


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



50

55

60

65

70

75

80


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


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)


Satisfaction in Assisted Living Communities


Key Findings

Important to managing


DATABYTE


Voice of Residents and

Family Members

ASSISTED LIVING


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

Presenter

Presentation Notes

Nation’s ALF –Resident, 2013


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

Presenter

Presentation Notes

Nation’s ALF – Family, 2013


AN EXERCISE:

What Matters Most


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


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

Presenter

Presentation Notes

Explain how the average score is computed Vs what percent of respondents recommend the facility as “Excellent” (also used in the facility report) Explain how each care-related survey item can “influence’” “drive,” or “motivate” the respondent to recommend. Explain why the 1 to 4 scale and the 0 to one correlation are each depicted in the report as a 1 to 100 rank.


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


RESIDENT

Presenter

Presentation Notes

Nation’s ALF – Resident 2013


“EXCELLENT,” “GOOD,” “FAIR” OR “POOR” RANKED BY PERCENT “EXCELLENT”

RESIDENT

Presenter

Presentation Notes

Nation’s ALF – Resident 2013


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

Presenter

Presentation Notes

Nation’s ALF – Family & Resident, 2013


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


Because when customers

recommend you, they’re putting their

reputation on the line.

They will take that risk only when they are loyal.


“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.”


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

Presenter

Presentation Notes

Public Health Institute Research Research from a variety of areas coming to the same conclusions: Staff and resident satisfaction are the key to improved outcomes-care and financial.


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.”


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”


DATABYTE


Voice of Employees

ASSISTED LIVING


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


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

Presenter

Presentation Notes

Nation’s ALF – Employee, 2013


EMPLOYEE

Presenter

Presentation Notes



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

Presenter

Presentation Notes



“EXCELLENT,” “GOOD,” “FAIR” OR “POOR” RANKED BY PERCENT “EXCELLENT”

EMPLOYEE

Presenter

Presentation Notes



What does research have to

tell us about the workplace?


DATABYTE


Employees speak out about

leadership


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


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


Long-term care will continue to evolve

and change. As leaders, our duty is to

successfully lead the profession through

this never-ending change.


We did the best we could, with what we knew, And when we knew better, we did better.

MAYA ANGELOU


Thank you!

[email protected]

773-942-7525

800-601-3884


Thank you!

Questions? 800-601-3884 [email protected]

Presenter

Presentation Notes

Please put proper information on this closing slide

2014 alfa conference if you can measure it

Documents

living facilities

facilities rehabilitation

mean mean

assisted living alfa

quality of care ratings

satisfaction data

home health care doctors

employee satisfaction