A Thanksgiving Story

Three Thanksgivings ago we sat down at the extended table with our extended family and felt so incredibly blessed we could barely speak. My father had survived a small stroke; my husband’s father had survived a heart attack and bypass surgery. We didn’t expect to all be together that year, but we were.

A year later, my father was dead and my mother in the hospital, unable to join us for Thanksgiving dinner. We rushed, somewhat numbly, through dinner, avoiding the traditional recitation of blessings.

This year feels a little like that particular Thanksgiving, on a global scale. It’s hard to find things to be thankful for (if you actually open your investment reports). It can be frightening, as companies and individuals we have long looked up to for leadership are faltering – maybe even failing.

And yet. Today the sun shone through the piles of golden leaves. I walked to work the long way, savoring perhaps the last nice morning of the month, feeling healthy, alive and filled with thanks.

Today, we had a chance to help a whole group of individuals begin their journey to become caregivers and nursing assistants. We connected with business associates who are challenged but persevering; and several who are thriving.

My children are spread out all over the globe; one in India and one in Israel. They’re studying, volunteering, and traveling. They’re excited about their adventures and fully engaged in their work of growing into global citizens.

Our table will be a little lighter this year for Thanksgiving dinner. Our bank accounts and investment portfolios are certainly a lot lighter. But when I count my blessings this year – out loud – the list will be long.

Happy Thanksgiving.

Paddling Against the Current to Achieve True Culture Change

You’re on a raft in a swiftly moving river. Imagine that you’re not entirely happy with the direction this river is flowing – how do you change directions? Can you paddle the raft upstream against all the power of the rushing river by yourself?

If your community has been talking about “culture change” you may well be facing this same sort of challenge. Custom and habit are powerful forces, pushing against any effort you may be making to change direction.

Can you paddle that raft upstream by yourself? Not likely. But get your team involved, and you can push against even the swiftest moving currents.

How do you get your team involved? If you truly want to create a new culture of care in your community, you’ve got to get the entire team involved.

“Deep learning and cultural change are ALWAYS connected,” says Peter Senge, author of “The Fifth Discipline: the Art and Practice of the Learning Organization,” (Currency Publishing, 2006) and culture change consultant. According to Senge, culture change is “deep systemic change” – change that begins at the personal level of each employee in the community.

If you’re ready to make some changes, hand your team a paddle:

1) Start the discussion. To achieve culture change you’ve got to start talking about WHAT needs to change and WHY. It can’t be just your perspective – you’ve got to hear what everyone else has to say about this. Being clear about the WHY of change is every bit as important as the WHAT of change, too, so think it through carefully and make sure the WHY aligns with your mission and message.

2) Really listen. Sounds easy. It’s not. Really listening when you’ve begun the discussion means you may hear things that you think are working well may not be working at all out “on the floor.” Keep an open mind, while you’re keeping your ears open, too.

3) Create a culture of LEARNING. To change behaviors (culture), you’ve got to provide an atmosphere where learning is valued. “Learning is always about people knowing how to do something they couldn’t do before,” says Senge. Is your inservice training simply designed to meet compliance regulations? Are you repeating content month after month, year after year? Are you seeing employees learn to do something they couldn’t do before because of your inservices? If not, make a change in your approach to training to truly create a culture where learning and personal growth are valued. Furthermore, to make the transition from knowing to doing requires more than training; it requires leadership. You, as manager, must “buy in, role-model it and require it,” as Fred Lee (If Disney Ran Your Hospital) puts it, to see true culture change.

4) Keep it simple. Life is complex. Change is even more complex. To make change even more challenging, remember this rule: People always resist change. Especially if they don’t understand why they need to change.

5) Reward innovation. When your employees see that you’re serious about changing the way things have always been done, they may get excited about finding new ways to do things. Make sure you reward the excitement – give praise and public acknowledgment and watch other employees get on board. When staff sees innovation and change resulting in positive outcomes they will become advocates for even more change and innovation.

6) Have fun with it. Not surprisingly, the most effective change agents are ones that people enjoy. If you want to introduce a new approach or technology, you’ll be much more successful if it’s fun.

Changing your culture in any meaningful way is like paddling that raft against the current. It can be done, but only if everyone on the team is rowing together

How to break through the wall – creating success in times that feel impossible

On my daily walk to work I cross a bridge over the Willamette River. It’s not a wide river, but just upstream is a broad, powerful falls. The banks of the river are steep rock walls, dropping over 70 feet from the roadway to the water below. I’ve been walking over this bridge nearly every day for a year now. It’s my few minutes for reflection and planning; lately I’ve found myself thinking about the power of the water.

I see how the water, when it is focused into a narrow channel, can cut through what appears to be solid rock. The water that falls as a soft, blanketing mist much of the winter here in Oregon turns into a force that literally changes the landscape. It cuts its way cleanly through stone, over time.

As I consider that force, I think of two key concepts that I can apply to my work: focus and tenacity. It’s easy in any business to try something a time or two and then give up, looking for an easier way around an obstacle.

Obstacles like a poor economy, however, aren’t easy to get around. When the primary barrier to your success is money, from the client’s perspective, it can feel like a solid rock wall.

Whether you’re talking about a community that desperately needs census building to cover payroll and other costs, or, as in my business, a product that is needed but may not be considered essential to operations, the barriers can feel rock solid and impenetrable.

That’s when I start thinking about the river. It can’t break through a solid wall with a meandering stream. But when the force of the river is focused into a single, powerful jet of water, it can cut through almost anything – given enough time. That’s the second part of this principle – time and consistency. The Grand Canyon wasn’t forged in a single season, but it created a masterpiece over time with the focus and tenacity that is, itself a force of nature.

From my personal perspective, I’m encouraged by news articles like the one out of London that reports that 78% of human resources leaders are looking to online training to reduce their costs in accessing external trainers and resources and 57% are looking for ways to reduce the amount of time staff spend out of the office on training. This report shows a trend toward more companies looking at custom online training as a way to reduce their training expenses while still maintaining a competitive edge during tough times. Of course, this is exactly what our company has been promoting for the past two years, often feeling like we were running into that solid rock wall of resistance.

The expert quoted in the article concludes, "Now, more than ever, it is imperative to have a fully trained and knowledgeable workforce on hand to see you through these tough times but not at the expense of productivity. eLearning solutions such as virtual classrooms, web based training and mobile learning not only minimise the time employees spend out of the office, but they also allow employees to carry out training at flexible times, thereby reducing impact on their day-to-day work."

Ah, a little crack in the wall is suddenly appearing.

I believe I’ll focus and continue to be tenacious, and see if we can create a channel right through this barrier.

What’s your barrier? Take a lesson from the river, and break through it this winter!

Holiday Gift Ideas from my team to yours

Election is over: What’s next for senior care providers?

Let me first say this: “Whew!”

It was a long campaign. It wasn’t always pretty or nice. There was mud slinging on every side of every issue. Often it seemed that the strength of some people’s passion overruled their sense of basic human decency, not to mention a sense of decorum desirable in a prominent elected official.

We have big issues ahead of us in the coming years. We’ll need to put aside our partisan passions and tap into our passion for quality care for seniors and for the strength of this industry.

We’ll need to advocate for decent pay, training and benefits for senior care workers throughout the US, because if we don’t someone else will (carrying a potentially big stick).

We’ll need to work hard to continue to improve the quality of care provided in senior living communities from the inside out, rather than wait for increased governmental oversight and regulation.

We’ll need to continue to demonstrate not only the social benefits of senior care in our care communities, but also the economic benefits to a society that will soon be staggering under the mounting pressure of an aging population.

We’ll need to embrace technology and clearly recognize a generation of younger people who have felt – perhaps for the first time – the power of their voice and the strength of their vote. These young people were involved in a strong wave of technology-based communication that has changed the face of our society, probably in ways we won’t even recognize until some time in the future.

It’s a new day in America. None of the old problems are gone, but perhaps we can face them with new energy and new resolve.

Elections and the Economy – scare tactics and employee performance

I got an email yesterday that still has me a little upset. It’s allegedly written by the CEO of a large company, containing a memo he sent out to all of his employees about the upcoming election. He’s encouraging recipients to send the same memo to their employees as well.

I admit, I was curious and read on. The lengthy memo went into great detail about why employees should be concerned about a tax policy that makes their bosses pay more – it could cost them their jobs. The content deteriorated from there – significantly.

After a few deep breaths to get my blood pressure back under control, I thought about the message we send to our staff when we use scare tactics to try to change their behavior – and there are plenty of scare tactics on any side of the election and the economic issues being debated today.

One study, reported in an article titled “Fear as a strategy: effects and impact within the organization,” (Journal of European Industrial Training, 1998), found that “the use of punishment and fear in the organizational setting has proved to be ineffective and undesirable. Managers must try to create an environment and climate where employees can express their full potential and respond to difficult challenges by letting go of fear of failure, fear of change, or fear of risk taking.”

What does work?

Creating an environment that recognizes the value of the individual employee to the organization, not just the leadership or top management.

Investing in employees by giving them tools to learn and grow, to achieve their potential or climb a career ladder within your organization.

MyInnerView, in collaboration with the University of Minnesota and others found five “interrelated and predictive domains” of focus for providers:

• Consumer (resident and family) satisfaction (do consumers receive from frontline employees the level of care and service they expect, or more?)
• Employee satisfaction (Do employees feel they are heard, respected and valued?)
• Workforce stability (Does the company have programs in place that foster the retention of the best and brightest employees?)
• Clinical outcomes (Are problems quickly identified and addressed appropriately? Do frontline staff know what to report, as well as when, how and to whom?)
• Regulatory performance (Is compliance in all areas of the program a key focus for all staff?)

Every successful company will have plans, approaches and programs in place in each of these five areas. And they won’t be based on using fear as a management technique.

Systems key to building sustainable training program

Several times each year I spend time thinking about where I envision my company a year from now; five years from now. I find that doing this exercise often makes me adjust, even slightly, my priorities today if I’m going to be aiming my company in the right direction to reach those goals tomorrow.

Over the years, I’ve come to realize what all good managers know: it’s the systems that you have in place that will take you on your desired path to growth, not just the people.

I have to admit that I stutter a little even while typing this. I profoundly believe that we must invest in our people, and that the quality of our people makes the difference in the quality of our service, and our company’s very survival.

At the same time, I know that if either Wendy or Wayne (very key people in my company) leaves or becomes injured and can’t work, I need systems in place to continue the growth and achieve my goals. I can’t afford to have my company’s success or failure dependent upon any one person on my team - including myself.

When we’re working with new or prospective clients we often hear owners say, “The administrator I have in one building loves to do all her own inservices. I think we won’t use the aQuire training system in that building.”

In my owner/operator days, I had administrators who were excellent teachers and administrators who were excellent marketing representatives. I had administrators who never had a single citation during survey, but weren’t ll that great at teaching.

I knew that, without systems to support the individuals, my communities would never move forward. We’d always be fighting the battle of dependency on the person, and worrying about trying to replace the person with someone with the exact same skill set should - heaven forbid - they leave.

David Finkel, (Investor Fast Track) whose advice I always read and appreciate, says that one of the most important distinguishers to move your business forward “is to build a systems-reliant company versus a people dependent business. 90% of small businesses stay that way because they choose the latter--building a people dependent business.”

Finkel goes on to describe a highly successful, growth-oriented business as one “where the key know how for the business has be captured in processes, procedures, and systems that allow that business to get consistently great results with consistently good people.”

Three benefits occur when you move from a people-dependent to a systems-reliant company:

1) Your business becomes much more scalable. You can replicate your business more easily, and more quickly. Imagine the ease of adding new services or new properties quickly and easily.

2) Your business becomes much more stable. If a key employee gets hurt, for example, you no longer are vulnerable to loss of forward momentum or quality service.

3) Your business becomes much more valuable. If another operator can continue your business, with little interruption, the value of that business increases should you wish to sell or leverage the business.

Clearly, these benefits require a commitment to looking at all aspects of operations. It requires looking at the ways “we’ve always done things” and being willing to shake them up.
It will require an investment in a system that will, in the long run, produce a higher return on that investment.

In the area of staff training, a systems-reliant approach may result in a change in the status quo. It may require a financial investment. But your gain can be significant.

You can quickly and easily demonstrate full compliance with training requirements – for surveyors, investors, attorneys.

You can achieve consistency in training content and quality company-wide. Many people thought they’d achieved that with corporate training manuals, only to find that, once again, the use of the training manual was only as good as the person designated to use it.

You can set your company apart from the rest who only do traditional (read: “boring”) inservices, both in your hiring advantage and in your services delivery.

You can continue quality training uninterrupted, even with a change in key personnel.

Sustainability is a bit of a fad word today. But in the area of operational excellence, it's an element you can't afford to ignore.

Thriving in the Coming Workforce Crisis

You might not be currently experiencing a workforce crisis in your company or community. With the current economy many people are worried about job security. They’re not looking at the want ads so much as being thankful for the jobs they have.

But even today we have unfilled caregiving positions nationwide. And the gap between trained, prepared workers and the positions we need filled is only projected to widen in the coming years.

The Institute on Medicine recently released a report of their 2 year study into the affects of the aging of America on the health care and senior care workforce.

Their conclusions are pointed: “Unless action is taken immediately, the health care workforce will lack the capacity (in both size and ability) to meet the needs of older patients in the future,” says the Institute, in a report titled “Retooling for an Aging America: Building the Health Care Workforce.”

By 2030, the number of older adults will nearly double from the 2005 count, and will increase from 12 percent of the US population to nearly 20%.

Some of us are thinking – great! No more vacancies! We can even build more communities, and they will come!

But what about the staff? Who will be around to provide care in our very full communities?

It’s not like we have the problems of recruitment and retention solved in this field. In fact, many developers, owners and operators have been so focused on building and acquisitions it seems they’ve lost sight of the WHO: who is providing care; who is leading those who provide care, and who is caring for the people who provide care.

Focus on the WHO, and start positioning yourself NOW to become an employer of choice; a place where people will want to work, even when jobs are plentiful and hiring competitive. Here are some thoughts that can also help you position for success:

1) It’s all about training. Are you just skimming by with compliance training? Are you expecting your administrators, nurses, or others who are not educators by training or skills to train the people who will deliver your service? If you’re not investing in your front line folks, they’ll be looking for another employer who will. Provide the best training you possibly can, and then let current – and prospective - employees know that you’re willing to invest in their growth.

2) Who’s Leading the Team? One of the strongest reasons to stay in a job is having friends at the workplace. One of the top reasons to leave? A supervisor who doesn’t understand, support or lead. Look for leadership skills in people you’re hiring for supervisory positions; train for stronger leadership in existing employees.

3) Celebrate your Team. What do you do that is special for your employees? How do you celebrate their achievements, successes – how do you celebrate their birthdays and anniversaries? If you can’t list at least 5 things that you do that is unique and special, you’d better get busy. Your staff certainly will, with the want-ads in hand!

4) Invest in the Health of your Team. According to PHI, one significant factor to the upcoming worker shortage may be inadequate health care coverage for caregivers. It’s an incredibly expensive benefit, but the value may far exceed the cost of turnover for an employee group who recognizes the investment.

Watch this: the smartest companies in the field will be the ones who position NOW to become employers of choice. Then, when everyone else is advertising $1,000 hiring bonuses if you “come work for us!” they’ll be sitting pretty, with a strong, vibrant, well-trained staff.