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In Her Own Words. An Overview of the Work of Susan C. Eaton.

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in her own words

In Her Own Words

An Overview of the Work of

Susan C. Eaton

This material was designed by Quality Partners, the Medicare Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. Contents do not necessarily represent CMS policy. 8SOW-RI-NHQIOSC-082006-2

in her own words1
In Her Own Words

Susan C. EatonJuly 9, 1957 – Dec. 30, 2003


My relationships with hundreds of workers convinced me that work itself, no matter how low paid or “unskilled,” is fundamental to most people’s lives – not just in the sense of earning their livings, but in their own sense of who they are and what they are accomplishing in this world.


Most people have a sense of “making a difference” in the world through what they do, whether it is cleaning toilets, changing bandages, teaching others, or running a sewing machine. If they do not have such a sense, they yearn for it.


…most people both want to do a good job and to make a difference through their labor. They hate not having the proper tools or training to complete their tasks. They hate not being asked how they might do their jobs better.


And those who are not asked – which in my experience was especially true for those at the bottom of the workplace ladder – especially have a lot to contribute. I saw people everywhere being undervalued and their skills and ability to contribute underestimated.


When I became a manager in the national union in 1985, I found myself suddenly in the role of those I had so often criticized from the bargaining table.


I gradually learned the difficult skills of supporting the growth of others and negotiating the employment relationship from the “managerial” side. Eventually I came to feel that here, too, I could make a difference.

pennsylvania s nursing homes promoting quality care and quality jobs keystone research center 1997
Pennsylvania's Nursing Homes: Promoting Quality Care and Quality Jobs Keystone Research Center 1997

The central question for the future is: will the PA long-term care industry be dominated by approaches that deliver quality care and provide quality jobs?

Or … by approaches that deliver poor care at the expense of customers and workers?

Beyond ‘Unloving Care:’Linking Human Resource Management and Patient Care Quality in Nursing Homes June 2000

For now, unfortunately, the traditional low-skill, low-wage, low-performance model is the dominant one. "But fortunately, it does not have to be. The evidence demonstrates that alternative models of work and care organization exist, and at least some actors have the power to enact those alternatives.

5.0 What a difference management makes! Nursing staff turnover variation within a single labor market

CMS Staffing Study 2002

Why does turnover among nursing staff vary widely in long-term care institutions, even facilities in the same labor market?
second what difference can management practices make in helping to understand high or low turnover
Second, what difference can management practices make in helping to understand high or low turnover?
First-hand ethnographic research and interviews in nine long-term care facilities in four labor markets in three states.

If specific managerial practices can be seen in a close, qualitative study to berelated to reductions or increases in nursing staff turnover, then perhaps such practices could be documented and made available to practitioners with the ultimate goal of providing better care at lower cost, as well as more stable jobs to nursing staff members.

five practices associated with low turnover homes
Five Practices Associated with Low-Turnover Homes:
  • High quality leadership
  • A culture of valuing caregivers
  • High Performance Human Resource Policies
  • Effective, motivational work organization and care practices
  • Adequate staffing ratios and support for good care
better jobs better care winners of national competition announced september 17 2003
Better Jobs Better Care winners of national competition announcedSeptember 17, 2003
  • Improving Institutional Long-Term Care for Residents and Workers: The Effect of Leadership, Relationships and Work Design

Intensive case studies in 18 high-quality MA nursing homes to describe the ways the homes organize and supervise the work of frontline caregivers and study how organizational factors and care philosophy affect resident and employee satisfaction.


Study how organizational and management practices in long-term care organizations influence teamwork and care-giving relationships, and how those in turn affect frontline workers and residents.


The findings will be used to identify management and policy interventions that improve the working environment for direct- care staff, as well as the care provided to residents.




Better Jobs Better Care


When you hear the term “Human Resource Management” what do you think it includes? Make a list at your table of all the functions this includes.

Take your list of human resource management functions and identify who typically does which of them in a nursing home

This course will familiarize managers with key human resource management policies, practices and dilemmas. It focuses on organizational-level dynamics of work design, building effective systems, and change.


What makes this course unique will be the special focus on the design of work to maximize individual and group effectiveness; on the importance of giving and receiving feedback and building in accountability; on motivation and team-building

Skills we focus on particularly include: motivating and developing others, structuring collaboration, and ongoing learning
actor centered course with a focus on practice drawing reflectively on experience and knowledge
“Actor-centered” course with a focus on practice, drawing reflectively on experience and knowledge
Work organization is integrally linked to performance and outcomes, both for employees and firms, as many skilled researchers have shown.

Usually how work is organized is decided at the “top” of the organization, not at the bottom or even in the middle. I am interested in HR because, in some cases, it focuses a light on those in the middle and the bottom of the ladder. These are the people who have so much to give, but are often not asked.


Whether we “work to live” or “live to work,” we still spend the majority of our lives working. Surely we can do better than we do now at ensuring that most people enjoy and are enriched by their work.


Most people have tremendous untapped potential, in my view. [Human Resource Management] can help us identify ways to improve how work can help individuals and companies realize their full potential in creativity, relationships, and growth.


At the end of the day it is our relationships that teach, motivate, and sustain us in our efforts to become the people we hope to be, engaged in making the world we hope to make.