Train home care staff for leadership roles in agency
Train home care staff for leadership roles in agency
Training improves morale
Although it’s increasingly difficult for home care agencies these days to recruit qualified professional staff, it’s also hard to find or develop good leaders and managers.
The Detroit-based Henry Ford Health System Home Health Care has applied performance improvement principles to developing home care leaders. The organization initiated a leadership program that incorporated these major components of quality leadership: leaders who can use the tools of strategic planning, process improvement, data analysis, and employee attentiveness to produce business results and customer satisfaction, says Greg Solecki, vice president for home health care with this large, urban health care system.
The agency has incorporated that model into its business by using this criteria during performance evaluations and during the strategic planning process.
"We began to look at the distinction between traditional managers and what we hope are new-thinking leaders," Solecki says. "We want to instill in all types of staff the passion for leadership, so even a file clerk, a home health aide, and a home health nurse would be encouraged to think like leaders."
Here’s how the home care agency has developed its leadership training program:
1. Identify ideal leadership characteristics.
The home care agency’s management identified these leadership abilities:
• one who would accept leadership changes that are needed for success;
• one who would grasp and value relationships within an organization;
• one who will help staff put an emphasis on mission, vision, and values;
• those who can think in terms of change and renewal and instill confidence in staff, taking them places and encouraging them to do things they might be afraid to attempt;
• those who are willing to be coaches and facilitators and work beside employees rather than being the traditional type of bosses;
• those who can focus on quality, service, and customers, and not just the bottom line;
• those who can gain commitment from others rather than demanding compliance.
The last characteristic of a leader is especially important, Solecki says. "As we continue to experience labor shortages in critical key positions within the home health industry, the old style of being a boss and demanding compliance is not going to work with the new-style employee," he explains, "so leaders are those who can gain a commitment from folks."
While discussing the important characteristics of a leader, the agency’s managers debated the nature vs. nurture question, which is whether a leader is born with a certain personality that leads him or her to seek leadership skills or whether a leader is cultivated by mentors/teachers.
Finally, they decided that even if leaders are born, not made, the leadership program could help them be better leaders. And if leaders can be cultivated, then the agency could find out what that formula would be and develop it, Solecki says.
2. Develop program to provide technical skills.
As a result, the agency developed the Leadership Home Health Care program, which teaches staff the technical skills needed to deal with conflict and other issues.
The program teaches participants standard human resources skills such as how to hire staff and help employees improve and how to understand rules and regulations. They also learn how to do home care billing and other technical issues.
"We tried to instill the concept that the process you own is tangential and has an effect on a multitude of other processes throughout the home health agency," Solecki says. "So we tried to connect the dots for people, and we put them through training every month to give them a bigger picture."
Leadership program participants attended classes on a variety of subjects, taught by various people, including physicians. (See leadership program activities, p. 91.)
The program consisted of classroom educational meetings one day a month for six months and various hands-on learning experiences.
Each month, different guest leaders speak to participants. One month, physicians from the Henry Ford Health System talked about home health and physician communication. Their lecture was direct and met the leadership program’s objectives partly because the program leaders told the physicians in advance what they thought were the barriers to good communication and how those barriers could be turned into opportunities, Solecki says.
3. Offer hands-on learning opportunities to potential leaders.
"We required leadership home health care participants to have a number of learning experiences that we felt would solidify the classroom-learning experience," Solecki says.
These hands-on activities might include attending a medical advisory board meeting and attending a monthly income-statement meeting.
"We had them process bills in the billing department and we had the office staff make home visits with the clinical staff," Solecki explains. "Ultimately, we tried to make sure the participants were getting a better glimpse and a better grasp of the bigger picture, not just within our agency, but also within the health care system and community."
The idea was to show potential leaders how it feels to be at some other job or to have different medical responsibilities. For instance, a leadership program participant might learn from a lecture by a physician or from attending medical advisory board meetings that physicians have a variety of daily challenges that make it difficult for them to always communicate effectively with home care staff.
Through these empathy-building sessions, potential leaders learned that barriers to success were not unique to them or to home health care, but were universal throughout the health care industry.
4. Test participants.
The agency gave participants a pre-test to assess their baseline knowledge and leadership ability and a post-test within six months to measure their improvement.
"What we saw was that participants valued the leadership home health care experience and did grow in understanding of the bigger picture," Solecki says. "They better understood tasks and interrelated processes."
During National Home Care Month, the leadership program graduates were recognized at the annual employee recognition reception. So far, 17 people have volunteered and successfully completed the Leadership Home Health Care program.
"It dovetailed in with all of our other employee recognition efforts and was very positive and well-received," Solecki notes. "We made sure we got plenty of splash within our systems’ newsletter and other in-house publications, and we made sure in the home health newsletter that they were honored as well."
5. Identify outcomes.
The post-test showed that leadership training participants had improved in their understanding of what it takes to be a good leader.
"They all understood the difference between being a new leader vs. a traditional boss," Solecki says.
Some of the program graduates were promoted to management positions. Those who did not apply for a promotion had at least gained some enrichment in their current positions and were content to stay where they were. "From our perspective, that’s OK, too," Solecki says.
"We wanted to deploy leadership to every level and to every type of employee, and some left for better positions outside the organization, which was OK," he adds.
Due to the program, home care managers began to see some improvements in the relationships between various processes, such as clinical operations and financial operations. Members of the leadership training program began to volunteer to participate on process improvement teams that were cross-functional in nature.
"We had them working on processes like the timeliness of our billing process, for which we relied upon timeliness of clinical documentation being returned and timeliness of it being entered into a computer database, and the timeliness of getting the bill out the door," Solecki explains. "And we saw an improvement in that."
Even in processes where there was no noticeable improvement, managers saw that there was less acrimony between departments and less of an us-against-them mentality.
6. Adjust program when necessary.
After some successful years of the formal leadership program, home health care managers decided it was time for some changes.
With the implementation of the prospective payment system, it became clear that staff no longer had time for the full leadership training program. Also, the agency now has to focus more on recruiting and retaining staff since there is an industrywide labor shortage.
"The challenge of the environmental pressures combined with our desire to more effectively deploy leadership development has caused us to rethink having leadership classes," Solecki says.
Currently, a team is looking at re-engineering the leadership development program and so a leadership course was postponed this year.
"That’s been met with mixed emotions," Solecki says. "We’re all a little melancholy, but also enthused about taking what we have learned and making it more broad-scaled and effective."
Future leadership training courses might involve brown-bag lunches, newsletter education, periodic fliers, voice-mail messaging, and other types of group, committee, and project team meetings that infuse leadership training in their goals.
"We’re looking at a number of vehicles because everybody is strapped for time; and because our mission is to put patient care first, we can’t add time to anybody’s day," Solecki explains. "So we have to be more creative and we’re trying to build in our desire and approach to train leaders in already-existing avenues, and that’s going to be a challenge for us."
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