1. Telling Our Story: From Nursing Home in Need to Nursing Home in the Lead Alden Princeton

2.  Call-offs  Tardiness  New employee retention  Decreasing facility acquired pressure ulcers

3.  During the calendar year 2010, 10 complaint surveys with a total of 8 findings, last complaint 12/2010 yielded 5 tags  Policies and procedures not being consistently followed by facility staff  History of negative survey outcomes, including F314  Poor customer service attitudes among some staff  No formal daily communication process

4.  Where we started: ◦ Chaotic, very loud!! ◦ Limited professionalism-Including Dress Code!  misunderstanding of “grace” period-being late  Questionable reasons for call-offs or no reason provided at all  Issues with nursing scheduler ◦ Increase in overtime (both scheduled and utilized) ◦ First tracking period  800 tardies in two week period/ All Departments  Average of 7-9 times per employee per pay period  35 call-offs per month (nursing department only) Call-offs and Tardiness

5.  Daily stand-up and stand-down meetings initiated immediately  Administrator initiated Call In Log and reviewed all call-offs and tardy data for trending and root cause ◦ Staff were creating overtime for one another ◦ Why were people calling off-Have to call Laura ◦ Re-Interviewed current staff, placed on 30 day corrective action plan if needed.  Clarified language in union contract  Lots and Lots of in-servicing and education

6.  Clearly communicated expectations, with discipline as necessary.  Reviewed AMS code of conduct, labor laws  Answered all staff questions, “That’s the way we've always done it!!…Doesn’t make it right!  Following extensive education, facility administrative and management staff strictly enforced policies and held staff accountable

7.  The pay period ending 9/17/2011 ◦ Yielded only 26 tardies for all facility staff!!  As of 9/23/2011: ◦ Average call-offs for the month of September were six!!

8.  Overall retention was historically good, however, new hires were leaving at a very high rate, due to the attitudes of long standing staff: ◦ Lack of Team Work from Seasoned Employees ◦ “Bullying” of new hires ◦ Staff attitudes- “I’ve seen Administrators and DON’s come and go” ◦ “You’ll never make it”

9.  Changes to orientation ◦ Initiated a day-long core orientation day with refreshments and lunch  In addition to orientation shadowing staff ◦ During daily stand-up meetings, managers are informed of all new hires  Managers make it a point to go meet and greet new hires and discuss how their orientation is progressing/ Get to know them! ◦ During daily stand-down meetings, managers provide an updated report on the new hires ◦ This change has generated a tremendous amount of positive feedback! New employees feel valued~ ◦ New hires given a survey at the end of their orientation asking for suggestions for improvement

11. Where we were:  Facility Acquired in 2010 was 80 YIKES!!!  January of 2011, we had 11 facility acquired in just one month! Then along came Advancing Excellence!!!

12.  Instituted ‘Rock and Roll Rounds’ ◦ Every 2 hours 8 a.m. to 8 p.m. ◦ Manager involvement/QA Environment tools ◦ Beyond “turning and repositioning”  Continence checks  Exercising  Ambulating  Off Loading  AAROM/PROM  Splint Quality Assurance ◦ Non-punitive approach

13.  Pressure Ulcers:  February: 6  March: 1 Staff now running to Clinical Support  April: 0 Supervisor for more Zinc Oxide!!!!  May: 2  June: 1 Staff reporting every little skin issue!!!  July: 3  August: O  Sept. 1  Total of 25- All Healing, non necrotic  Regulatory Compliance: ◦ As of today, only 3 complaint surveys with NO findings ◦ Princeton’s Annual survey resulted in only 5 minor tags requiring only desk review by IDPH- nothing in skin!!!

14.  Interview process based on corporate core values and mission statement.  Administrator involvement in all interviews  Exit interviews-data analysis  Staff development-staff satisfaction survey  Continuous efforts to develop meaningful staff recognition: ◦ Thank you goodie basket ◦ Dessert with the managers ◦ Public praise/Lunch with “Laura” ◦ Certificates of Recognition ◦ Personalized cards with scratch off lottery tickets

15.  Absolute importance of a ‘collaborative partnership’/ Unified front from all managers  Consistency and fairness  Don’t let things fall through the cracks  Follow the process and it will result in continued positive clinical outcomes

16.  Dear Alden Management Services…..

17.  Advancing Excellence: www.nhqualitycampaign.org www.nhqualitycampaign.org  LANE: LBridwell@ilqio.sdps.orgLBridwell@ilqio.sdps.org  Alden Princeton: Laura Kelly pr_administrator@aldengroup.org pr_administrator@aldengroup.org