A Partnership For Quality

1. A Partnership For Quality AND OCTOBER 5, 2008 • NASHVILLE, TN

2. Objectives • The participant will be able to: • Identify three issues which staff say cause them to recommend assisted living as a ‘good place to work’ • Articulate three ways My InnerView can assist NCAL members in achieving their quality goals • Describe three areas where satisfaction level of resident’s family member is correlated to employee satisfaction

3. To provide long-term care leaders evidence-based management tools to better achieve their organization’s goals

4. Sources of data • Largest private dataset of resident and family satisfaction in nation • From mailed resident and family surveys returned to third-party • Respondents rate communities using four-point scale (excellent, good, fair or poor)

5. Evidence-based philosophy Evidence-based management calls for a paradigm shift in the approach to quality improvement: An appreciation of data, the ability to turn data into information and knowledge, and to use that information and knowledgeto improve quality.

6. My InnerView’sevidence-basedpath to quality Evaluateoutcomes:measurevariation Collectdata:ensure validity,organize Turn plan intoaction: improveprocess Turn data intoinformation:benchmark, studyvariation Turn knowledgeinto plan:apply new wisdomto process Turninformation intoknowledge:study currentprocess

7. AN EXERCISE:WhatMatters Most

8. QUADRANT ANALYSIS: A DISCOVERY TOOL MY INNERVIEW’S GOAL Help providers achieve their quality targets OUR APPROACH • Help providers: • Turn data into information— discover patterns • Turn information into knowledge— discover their roots • Turn knowledge into action— plan, mobilize, act QUADRANT ANALYSIS: AN EFFECTIVE TOOL

9. 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

10. QUADRANT AND ACTION PRIORITIES Successes A. Secondary strengths B. Primary strengths 1 - Lowest to highest ranking score  100 You can meet customer expectations Challenges C. Secondary opportunities D. Primary opportunities 1 ----- Lowest to highest ranking correlation ------ 100 You have little control over customer expectations

11. ASSISTED LIVING Voice of Residents andFamily Members

13. ASSISTED LIVING RESIDENT AND FAMILY Safety of facility Security of personal belongings Cleanliness of room/surroundings Control of room temperature Variety of meals Appeal of food Sufficiency of dietary needs Courteousness of dining staff Comfort of room/surroundings Community life opportunities “Grow as person” opportunities Quality of laundry services Adequacy of storage space Sufficiency of transportation Quality of amenities Accuracy of bills for services Comparison of charges Survey items 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

14. ASSISTED LIVING RESIDENT AND FAMILY 22,090VOICES HEARDNATIONWIDE 49% FAMILIES 51% RESIDENTS

15. DATABYTE

16. DATABYTE

18. RESIDENT A B 2 16 24 23 3 19 14 SECONDARY STRENGTHS PRIMARY STRENGTHS 9 4 18 8 12 11 5 13 10 17 30 27 31 7 6 25 1 29 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 26 15 32 22 28 20 C D 21

19. FAMILY A B 2 16 14 23 24 SECONDARY STRENGTHS PRIMARY STRENGTHS 3 10 5 4 30 8 13 31 9 1 12 11 18 19 25 6 7 20 15 22 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 17 28 29 27 26 21 C D 32

20. RESIDENT FAMILY A B 2 2 16 16 24 23 14 23 24 3 19 14 SECONDARY STRENGTHS PRIMARY STRENGTHS 3 10 5 4 9 4 18 30 8 8 12 11 13 31 5 13 9 1 12 11 10 17 30 18 19 27 31 7 25 6 7 6 25 1 29 20 15 22 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 17 26 15 28 32 29 22 28 20 27 26 21 C D 21 32

21. Care (concern)of staff Sufficiency ofhealthcare needs Comfort of room/surroundings Competencyof staff RESIDENT FAMILY A B 2 2 16 16 24 23 14 23 24 3 19 14 SECONDARY STRENGTHS PRIMARY STRENGTHS 3 10 5 4 9 4 18 30 8 8 12 11 13 31 5 13

22. Resident-to-stafffriendship Responsivenessof staff RESIDENT FAMILY A B SECONDARY STRENGTHS PRIMARY STRENGTHS 10 5 9 11 5 5 9 11 10 PRIMARY OPPORTUNITIES D

23. Sufficiency ofpersonal assistance RESIDENT FAMILY A B Homelikeatmosphere SECONDARY STRENGTHS PRIMARY STRENGTHS 10 9 9 10 PRIMARY OPPORTUNITIES D

24. Responsivenessof management Comparisonof charges Choices/preferences “Grow as person” opportunities RESIDENT FAMILY 1 12 17 30 18 19 27 31 7 25 6 7 6 25 1 29 20 15 22 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 17 26 15 28 32 29 22 28 20 27 26 21 C D 21 32

25. Quality ofamenities Commitmentto family updates RESIDENT FAMILY A SECONDARY STRENGTHS 30 12 12 17 30 18 19 27 31 7 25 6 7 6 25 29 20 22 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 17 28 29 22 28 20 27 21 C D 21

26. ASSISTED LIVING Voice of Employees

28. ASSISTED LIVING RESIDENT AND FAMILY Survey items Quality of orientation Support of career Quality of skill training Comparison of benefits Comparison of pay Care (concern) of supervisor Appreciation of supervisor Communication by supervisor Clear expectations of management Care (concern) of management Attentiveness of management Adequacy of equipment/supplies Sense of accomplishment Quality of teamwork Staff-to-staff communication Respectfulness of staff Assistance with job stress Fairness of evaluations

29. DATABYTE

30. FACTORS THAT DRIVEWORKFORCE RECOMMENDATION Ranked correlations (p <05) between assisted living employee workplace recommendation and employee satisfaction items 0.69 0.66 0.65 0.61 0.60 0.59 0.57 0.56 0.55 0.55 1 Management cares 2 Management listens 3 Help with job stress and burnout 4 Clear expectations by management 5 Fairness of evaluations 6 Support of career 7 Quality of skill training 8 Supervisor appreciates 9 Supervisor cares 10 Supervisor communicates Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

31. FACTORS THAT DRIVEWORKFORCE RECOMMENDATION Continued 0.54 0.54 0.51 0.51 0.50 0.46 0.46 0.43 11 Staff-to-staff communication Adequate equipment/supplies Quality of orientation Comparison of pay Comparison of benefits Quality of teamwork Sense of accomplishment Respectfulness of staff Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

32. EMPLOYEE A B 13 16 6 8 SECONDARY STRENGTHS PRIMARY STRENGTHS 7 14 1 18 9 12 2 10 3 SECONDARY OPPORTUNITIES PRIMARY OPPORTUNITIES 15 11 4 17 C D 5

33. EMPLOYEE Care (concern) of supervisor Appreciation of supervisor Fairness of evaluation Clear guidelines by management Care (concern) of management Support of career Quality of skill training Attentiveness of management Assistance with job stress B 6 PRIMARY STRENGTHS 7 18 9 2 10 3 PRIMARY OPPORTUNITIES 11 17 D

34. ASSISTED LIVING EMPLOYEE 8,923VOICES HEARDNATIONWIDE

35. 45% 40 ormore years EMPLOYEE’S AGE 11% 60 or older 22% 6% 19 or under 50–59years 21% 23% Less than30 years 17% 40–49years 30–39years Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

36. 50% Personal Care/Nursing EMPLOYEE’S JOB CATEGORY Recreation, Activities, other position 11% 28% 11% Housekeeping,Maintenance,Laundry,Transportation PersonalCare 12% Supervisor,Business Office,Administration 22% 17% Nursing FoodService Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

37. 44% 1 to 5years LENGTH OF EMPLOYMENT 17% 22% 1 to 2years 3 monthsto 1 year 3 monthsor less 27% 12% 2 to 5years 16% More than10 years 6% 5 to 10years Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

38. ASSISTED LIVING Satisfaction

39. DATABYTE Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

40. SATISFIED ASSISTED LIVING EMPLOYEES BY CATEGORY Based on the percent of total weighted respondents in each job category who rated their overall satisfaction as “excellent” or “good” Supervisor/Business Office/Administration Hskpg./ Maint./ Laundry/ Transp. FoodService Recreation/Activities/Otherposition PersonalCare/Nursing Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

41. RECOMMENDATION OF ASSISTED LIVING EMPLOYEES BY CATEGORY Based on the percent of total weighted respondents in each job category who rated their willingness to recommend the facility as a place to work as “excellent” or “good” Supervisor/Business Office/Administration Hskpg./ Maint./ Laundry/ Transp. FoodService Recreation/Activities/Otherposition PersonalCare/Nursing Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

42. PRIORITY ITEMS Ranked by average scores and correlations with workplace recommendation ADMINISTRATOR PERSONAL CARE 1 Assistance with stress 2 Quality of skill training 2 Staff-to-staff communication 3 Support of career 3 Clear guidelines by management 1 Assistance with stress 2 Care (concern) of management 3 Attentiveness of management 4 Support of career 5 Quality of skill training Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

43. 82%satisfied RECOMMENDATION FOR CARE Does not total 100% due to rounding EXCELLENT GOOD 41% 41% FAIR 13% POOR 4% Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

44. 73%satisfied RECOMMENDATION FOR JOB GOOD 44% EXCELLENT FAIR 29% 20% POOR 7% Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

45. 71%satisfied OVERALL SATISFACTION Does not total 100% due to rounding GOOD 47% FAIR EXCELLENT 22% 24% POOR 6% Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

46. TRAINING May not total 100% due to rounding EXCELLENT 21% 19% 19% 19% GOOD 50% 45% 43% 46% FAIR 22% 25% 27% 25% POOR 8% 11% 12% 10% Quality of orientation Support of career Quality of skill training OVERALL AVERAGE Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

47. WORK ENVIRONMENT May not total 100% due to rounding EXCELLENT 14% 10% 20% 22% 49% 29% 17% 46% 13% 23% 24% GOOD 35% 31% 46% 43% 42% 40% 42% 43% 37% 45% 40% FAIR 30% 34% 24% 24% 8% 22% 28% 8% 30% 21% 23% POOR 21% 26% 9% 11% 1% 9% 13% 2% 21% 11% 12% Comparison of benefits Comparison of pay Clear expectations by management Adequacy of equipment/supplies Sense of accomplishment Quality of teamwork Staff-to-staff communication Respectfulness of staff Assistance with job stress Fairness of evaluations OVERALL AVERAGE

48. SUPERVISION May not total 100% due to rounding EXCELLENT 41% 36% 33% 37% GOOD 33% 32% 40% 35% FAIR 17% 18% 19% 18% POOR 9% 13% 9% 10% Supervisor cares Supervisor appreciates Supervisor informs OVERALL AVERAGE Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

49. MANAGEMENT May not total 100% due to rounding EXCELLENT 22% 20% 21% GOOD 40% 37% 39% FAIR 25% 26% 25% POOR 13% 16% 15% Management cares Management listens OVERALL AVERAGE Source: Assisted living employee satisfaction surveys conducted in 2007 by My InnerView Inc.

50. What aboutemployee data? What do weknow today?