4/15/2018. Disclosure of Commercial Interests. Reducing Staff Vacancy in Senior Care Organizations

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1 Disclosure of Commercial Interests I have commercial interests in the following organization(s): I work for HEALTHCARESOURCE I work there as the CHIEF MARKETING OFFICER HEALTHCARESOURCE provides healthcare talent management software and services to over 4,000 healthcare organizations in the United States across acute, post acute, and senior living organizations, as well as contingent staffing agencies. Reducing Staff Vacancy in Senior Care Organizations David Wilkins Chief Marketing Officer HealthcareSource Trey Mullins Senior Director HealthcareSource 1

2 Agenda 01. Labor Force Trends and Industry Benchmarks 02. Up is Down: Turnover & Clinical Outcomes 03. Assessing Financial and Clinical Impacts 04. The Science of Quality Hiring & Retention 05. Preparing Risk Assessment and Plan Labor Force Industry Benchmarks Talent Challenges in Healthcare Scarcity Healthcare Hires vs. Openings KEY INSIGHT 53% of Senior Care Providers say that insufficient numbers of quality applicants is their #1 problem /2010 5/2010 9/2010 1/2011 5/2011 9/2011 1/2012 5/2012 9/2012 1/2013 5/2013 9/2013 1/2014 5/2014 9/2014 1/2015 5/2015 9/2015 1/2016 5/2016 9/2016 1/2017 5/2017 Projected Percent Change KEY INSIGHT 34% of Healthcare jobs are Hard to Fill; Hard to Fill Jobs Take an AVERAGE of 124 Days (4 Months) to Fill Job Openings Hires To meet growing demand, Senior Care Workforce: Needs to DOUBLE in 12 Years Time to fill for CNA roles averages: 29 Days 2

3 Talent Challenges in Healthcare Retention Long term Care Turnover 74.5% KEY CNA s INSIGHT 56.1% Registered Nurses DON Turnover 51.0% Workload LPN s/ understaffing CNA Turnover 55.0% 90 Day Turnover Three causes of dysfunctional turnover? 1st Year Turnover is typically x% of Total Turnover, By Year 2, Nearly 2x% Value based Purchasing and the Impact Act Based on CMS rule changes this year, not collecting enough data may negatively impact your annual percentage update by as much as 2% of your reimbursement. KEY INSIGHT For FY 2020, CMS is proposing that SNFs begin reporting standardized patient assessment data in the following five CMS categories, is withholding as required by $564M law: (1) in functional reimbursement status; (2) to cognitive 2,573 hospitals function; (3) due special to services, high readmission treatments and rates interventions; What s (4) the medical number conditions going and to co morbidities; be in LTC? and (5) impairments. Per diem rates are being reduced by 2% to fund value based incentive payments which will be based on achievement and improvement on performance standards And you are already reporting Resident to Staff Ratios Up is Down Staffing and Clinical Outcomes The Effect of Nursing Assistant Staffing As number of Nursing Assistant s per 100 residents increases, turnover for RN s, LPN s and Nursing Assistants decreases. It s the only patient care role of any kind to decrease turnover for all three roles. Total Voluntary Involuntary 3

4 The Effect of Turnover on Survey Citations As the rate of turnover increases, the number of quality of care health deficiencies increases. For RNs, involuntary turnover increases between 5.7% and 6.8% per unit increase in deficiency citations, whereas voluntary turnover increases between 3.5% and 4.2%. Total Voluntary Involuntary Resident Health And Staffing Readmission & Mortality 10% increase in nurse retention in LTC =.2% decrease in readmission NHs with licensed nurse retention in the highest quartile had a rehospitalization rate that was about 1 percentage point lower than NHs with a retention rate less than 55%. 10% increase in turnover results in a % increase in discharge death rate. Clinical Outcomes Increased CNA turnover is strongly correlated to increased: % of physical restraint use % of residents w/ moderate to severe pain % of residents with pressure sores % of residents with indwelling catheters Staffing and Clinical Impacts RN s LPN / NA At relatively low levels of turnover, there are significant increases to both restraint use and predicated contractures that continue linearly as turnover increases. 11 4

5 Staffing and Clinical Impacts RN s LPN / NA Catheter use increases dramatically at low levels of RN turnover and continues to increase linearly as turnover increases. The same pattern emerges with pressure ulcers, but with NA turnover as the early trigger. 12 Staffing and Clinical Impacts RN s LPN / NA Anti psychotic drug use starts high and remains high at increasing rates of turnover. At low levels of RN turnover, overall quality is severely and negatively impacts, but at higher levels, there is a leveling of effect. 13 Business and Patient Impacts 5

6 Solving the Problem Science + Research + Practice = Success 15 Group Discussion Horror Stories! CNA Turnover? How bad is it? Nursing Turnover? Kitchen Staff? CNO s Who is using Indeed as sole strategy? What s Working? Hiring the right people in the first place Behavioral competency assessment Job fit assessment Structured interviews Empowering practices Best Performance Predictors During Hiring Procedure Correlation (R) General IQ Test.51 Work Sample Test.54 Structured Interviews.51 Job Knowledge.48 Integrity Tests.41 Job Experience.18 Years of Education.10 6

7 Hire to Keep Job Family Validity Entry Level Service.30 Technical/Professional.32 Nursing.24 Patient Care.33 Administrative/Clerical.19 Average =.28 Medical Procedure Validity Aspirin and reduced risk of heart attack.02 Chemotherapy and surviving breast cancer.03 Antihistamine use and reduced runny nose and sneezing.11 Effect of ibuprofen on pain reduction.14 Nicotine patch and smoking abstinence.18 Sleeping pills and short term improvement in chronic insomnia.30 Evaluating Competencies and Behaviors Behavior Assessments give you the ability to see what good looks like across candidates apply to the same job. With enough assessment data and real world performance data, you can begin to accurately predict specific behaviors and competencies in a given role. Evaluating Job Fit Job Fit Assessments give you the ability to see what good looks like across candidates apply to the same job. With enough assessment data and real world performance data, you can begin to accurately predict degree of job fit against a particular candidate and role. 7

8 Structured Interviews Most hiring managers have no idea what to ask and frequently flub the interview, failing to ask the right questions to get at the candidate s gap areas. Structured Interview Guides that are based on behavioral and job fit gaps enable even inexperienced interviewers to ask the right questions to the right applicants. Ideal Hires: Quality + Retention Ideal hires are not just the ones who can do the job. You also need quality hires to stay. Hire fast. Hire quality. Higher retention. Behavioral Assessment Job Fit Assessment Structured Interviews + + = IDEAL HIRES Real World Case Study Whole Organization Hires 90 Day Terms Turnover Rate Ideal % Not Ideal % IDEAL HIRES were 42% Less Likely to be a New Hire Termination. CNA s Hires 90 Day Terms Turnover Rate Ideal % Not Ideal % IDEAL HIRES were 64% Less Likely to be a New Hire Termination. 8

9 Simple Math What If? WHAT IF? What if all the Not Ideal candidates had been Ideal candidates? There would have been 38 fewer 90 day terms. What would that mean in terms of cost savings? Minimum replacement cost is $3K per CNA. Total potential cost savings? 38 x $3K = $114,000 over first 90 days. Annually, this works out to $202,000 just in hard costs. CNA Empowerment Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention... Greater opportunities for CNA empowerment are associated with longer CNA retention. Key Drivers of CNA Retention In survey research with 3,039 direct care workers in nursing homes and other settings, Brannon, Barry, Kemper, Schreiner, and Vasey (2007) found that intent to leave was positively related to perceived lack of opportunity for advancement. Banaszak Holl & Hines (1996) learned that facilities involving nursing assistants in resident care planning experience lower turnover rates. Research based on a nationally representative sample of nursing homes and 2,897 CNAs revealed a positive association between job satisfaction and organizational climate, supervisor behavior, having sufficient time for tasks, being valued, and hourly earnings (Probst et al., 2010). A mixed methods study found that the empowered work teams approach in which CNAs have decision making authority about their work had modest, positive effects on CNA empowerment, performance, satisfaction, resident care and choices, and improved procedures, coordination, and cooperation with other staff. 9

10 Quick Show of Hands HOW MANY OF YOU: Involve CNA s in resident care planning discussions? Ask CNA s to participate in activities design or execution? Allow CNA s some say in which resident s they care for? Give bonuses, raises or other rewards to CNA s who receive extra training or education? Action Plan Thank You 10

11 Questions? Contact Information David Wilkins 11

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