Retention is a challenge during major changes

Keep lines of communication open, act decisively

(Editor's note: This is the second of a two-part article that looks at the successful reorganization of a failing home care agency. Last month, we examined the process to identify areas that need improvement and steps taken to address cash flow problems. This month, we look at tips and suggestions on how to handle staff morale and retention challenges during a transition period.)

The managers of Gaston Memorial Home Care in Gastonia, NC, were able to keep their agency off the chopping block after hospital administrators started questioning the value of maintaining a service that consistently lost money. They did it by evaluating payer agreements and restructuring the agency to improve productivity.

The word "restructure" in a health care setting usually means layoffs, admits Kimber Walters, MBA, executive director of the agency. "Luckily, we were not looking at layoffs," she says. "We just eliminated two management positions, and those employees took positions elsewhere in the agency."

Elimination of the two manager positions was the result of streamlining the process in which the field nurse reports to the clinical manager who passes the Outcome and Assessment Information Set (OASIS) to the OASIS clerk, she explains. "When we evaluated our organizational structure, we realized we had too many chiefs and not enough Indians to work efficiently," she admits.

Even though there weren't mass layoffs, the changes and reorganization did create a tense work environment, Walters admits. "My managers and I worked hard throughout the process to keep everyone informed on the progress we were making and to keep the lines of communication open," she says. A big concern for agency management was that good employees would become overly concerned about an uncertain future and leave for a more stable job in another agency.

"We did such a good job of keeping people in the loop that we did not lose one employee," Walters adds.

Be open and honest

At staff meetings, they talked openly about what they were doing and why they were considering different changes, she recalls.

"We knew that staff members were unnerved because they were hearing that the agency was losing money and the hospital might close us," Walters explains. "We explained that we were looking at a number of different ways to improve our financial performance and one of those ways was to evaluate staff responsibilities."

Because the agency's financial problems were related more to organizational processes rather than a lack of patients, Walters knew that field staff would not be cut. "As we worked our way through the process of evaluating our processes, we very quickly saw that we would have to cut two manager positions," she admits. "As soon as we knew that we would reduce the number of managers from five to three, we posted the job responsibilities for the new manager positions and interviewed existing managers for the positions."

Because the restructuring added new responsibilities to the manager position, Walters points out that simply relying on seniority might not have resulted in keeping the best person in the job because it was a new job description. "We used an assessment tool developed by the human resources department to identify the best candidates for the new positions that did include additional responsibilities for reviewing a team of nurses' OASIS documents before passing them on to an OASIS clerk," she says.

While it is tempting to stay behind closed doors to make tough decisions related to organizational changes, don't make it look as if you're hiding something, recommends Walters. "While we were able to give employees a lot of information during staff meetings, the most effective thing that I and other members of the home health leadership team did was to be available all of the time for questions from employees," she says.

Many times, this availability meant that Walters and other home health managers might be stopped in hallways with questions or comments about rumors. "We had to be ready to stop, listen, and answer questions all the time so that it did not look like we were hiding anything," she says.

Rebuilding your agency is a terrible process to undergo, "but by sticking together and communicating honestly with all employees throughout the entire year that it took, we were able to keep morale up," says Walters.

They have seen a change in the way everyone approaches their jobs, she says. "All of the different areas talk with each other to solve problems before they develop, and everyone feels responsible for the success of our agency," Walters says.

For more information on employee relations during restructuring, contact:

  • Kimber Walters, MBA, Executive Director, Gaston Memorial Home Care, CaroMont Health Ser-vices, P.O. Box 2568, 200 E. Second Ave., Gastonia, NC 28503. Telephone: (704) 834-2025. E-mail: