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How Alive Hospice improved care and staff satisfaction
Training, stress levels were addressed
A Nashville, TN, hospice used well-analyzed results from staff satisfaction surveys and family satisfaction surveys to improve the quality of care, as well as staff satisfaction.
Here's how Alive Hospice Inc. of Nashville made improvements based on the problems identified in the surveys:
1. Concern: The education and training program was inadequate.
One area that needed improvement, according to the initial survey's results, involved staff education and training, says Janet L. Jones, RN, BSN, chief executive officer of Alive Hospice.
"So we focused some energy on how we conducted our internal education program for staff, and beefed up that department," Jones says. "Over the course of three years, we saw a statistical difference in how staff saw the support they received in education and training, and there was concomitant increases in parts of the family satisfaction with hospice care."
The first step the hospice took was to re-structure the education program and form a department called Organizational Excellence and Mission, which has a vice president in charge of this department, she says.
"We've focused more intensely on education, and not just on internal education," Jones says. "We've also budgeted more dollars to send staff to different workshops outside the organization."
For example, staff is sent to NHPCO seminars and local Tennessee hospice organization educational sessions, she says.
"We've also used the family evaluation of hospice care as a kind of guideline to what to focus on in our educational offerings," Jones says.
Also, the hospice began to invest in an ongoing management and leadership training program.
"When we looked at the employee evaluation survey, we found there was a high level of stress in all employees, but it was higher for those in management than in those who were in direct caregiving," Jones said. "So we invested some dollars in a robust management training program that we'll continue to invest in."
The improved staff training and education program has resulted in the hospice moving all of the required educational areas, such as infection control, to an on-line program so employees can complete these courses at their convenience in order to meet all of the requirements, Jones says.
Another educational offering is the hospice's Ethics Grand Rounds, which are held every six months.
"It involves taking a particular case, usually a difficult hospice case, and we have a panel of ethicists and staff who present the case and talk about what the ethical implications are for the case," Jones says.
"We talk about what the hospice has in place to support the staff in their ethical decision-making," Jones says. "Sometimes we come up with things to address, such as developing a new policy."
There also is an ethics roundtable discussion that is held on a quarterly basis.
"It doesn't have an agenda, but we encourage a discussion of ethical dilemmas for any employee who wants to come," Jones explains.
2. Concern: Hospice was growing too fast.
"Surveys suggested that employees are concerned that we're growing too fast," Jones says. "In any organization when you experience a lot of growth, it's difficult to find the time to take a breath and adjust to the growth you had before you step forward to grow some more."
From staff satisfaction surveys, hospice administrators have learned that it's important to communicate intently and clearly about the organization's growth plans and strategy, Jones notes.
The key is to avoid surprises, she says.
"So we are very purposeful in all staff meetings held quarterly to share what's ready to be shared," Jones says. "Some things are in an early discussion phase and are not ready for primetime, but we'll share everything we can about what our growth strategies are."
Hospice leaders also listen to employees to hear what their concerns are in regard to the growth plans and strategies, she adds.
"We hold what we call 'coffee talks,' where I meet with groups of employees on a periodic basis to share what we're doing and to hear individually about concerns regarding our growth strategies," Jones says. "So it kind of keeps us in touch with what we're doing."
Any organization's leaders need to keep in mind that growth is fearful to staff who worry whether they can deliver the intimacy and quality of care the organization is known for, while growing larger, Jones notes.
"I think those are valid concerns, and we need to stay in touch with what precisely are the areas we need to address because you don't want things to slip between the cracks during the growth," she says.
"So it's important to stay in touch with staff and find out what they're seeing and feeling," Jones says.
3. Concern: Staff experienced high levels of stress.
"We found there's a high level of stress involved in the hospice work here, and I don't think that surprises anybody," Jones says. "So this employee committee looks at what we need to do to address the high level of stress in the workplace."
For example, the committee addresses these questions:
The cultural program, called, "Infusion of Radical Loving Care Culture," involves the idea of getting people back in touch with why they came to work in the first place, and why their work is meaningful to them, Jones explains.
Other strategies for alleviating stress include having a masseuse visit the hospice office each payday to offer 15-minute massages to anyone in need, Jones says.
"We offer a lot of educational sessions about what employees can do personally to address their stress and remain healthy," Jones says.
Also, the hospice has a full-time employee health nurse, and there is a Weight Watchers meeting held on site, she says.
"There are discounts to workout facilities that are available to staff, and we encourage them to take care of themselves so they are able to take better care of others," Jones says.
The hospice also encourages the staff to have fun, and celebrations are held regularly.
"We honor employees at quarterly staff meetings, recognizing the wonderful things they do and the wonderful things they accomplish," Jones says. "Any excuse for a party around here is just great."
The all-staff meetings provide recognition pins to employees who have been at the hospice for three, five, 10, 15, and 20 years.
"We discuss the state of our organization at each of these meetings, so if people have questions about anything regarding quality performance, we can give a report on what the quality measures have shown, and answer questions," Jones says.
"We also sing 'Happy Birthday' to everyone who has a birthday in the quarter, and we serve the staff cake," she adds.
At Halloween, the staff dress in costumes and do reverse trick-or-treating, taking treats to patients and families in the 30-bed hospice residence on campus, she says.
"We have barbecues, jewelry sales, a book club, and we do all kinds of things to engage the staff and celebrate what they do, while having fun at the same time," Jones says. "Every time we come together we celebrate our work."