Improve staff turnover, LOS, and bottom line
Turnover went from 30 to 10 percent
Training hospice leaders to be effective managers may be one of the most effective ways to improve a hospice's staff turnover rate, as well as make a significant difference on the bottom line, according to the experience of one Florida hospice.
"We have made a major investment in leadership training, and the investment has had a tremendous return in terms of almost anything you can look at," says Dale O. Knee, MHCA, president and chief executive officer of Covenant Hospice in Pensacola, FL.
Six years ago, Covenant established the Covenant Hospice Leadership Academy, with a focus on training the hospice's current leaders and developing future leaders, Knee says.
Within months of starting the academy, the hospice had an up-tick in its growth, and that growth has continued over the years, Knee says.
"We have taken the employee turnover rate from what was typical in health care, 25 to 30 percent [annually], and have reduced it to less than 10 percent," Knee says.
This reduction alone has important implications for a hospice's financial well-being, since to replace a high-performing hospice nurse with three to four years of experience requires an investment of $75,000 to $100,000, Knee notes.
"So if you reduce the nursing turnover rate from 25 percent to 12 percent, then you have, frankly, put money in the bank," he adds.
Another outcome of the leadership training is an increase in the hospice's length of stay (LOS), Knee says.
The average LOS has improved about 20 percent from the low 50s to an average LOS of 70-plus days, Knee says.
"The median has stayed steady at 48 to 50 days LOS, but our volume increased, and we have more patients," Knee adds.
The higher LOS gives hospice staff more time to do what they are intended to do, and it has positive financial ramifications, Knee says.
All of the ways the hospice measures these changes show that it is directly correlated to the leadership program, Knee says.
A year and a half ago, Covenant officials decided to extend their leadership training to outside the hospice by forming an alliance with the Studer Group, a national healthcare leadership and management development group, in Gulf Breeze, FL. The two organizations formed the Studer Covenant Alliance, which provides training to health care organizations nationwide.
"We are taking the same type of tools and models of the Studer group and bringing that to hospices throughout the country and into the end-of-life sectors through partnerships and consulting agreements of one-to-two years long," Knee says.
"Secondly, we're putting together leadership development institutes, and will have one in Las Vegas, NV in September, 2007," Knee says.
"The proceeds we gain through the Studer partnership we put into furthering our mission in terms of other funded and unfunded programs, including our children's programs and some other things we do," he notes.
The leadership courses are for anyone who is identified as being a leader or supervisor in the organization.
"This is anyone in the organization who has hire and fire authority," Knee says. "In our case, there are about 65 people we consider to be in the leadership academy of the core group, and they are required, as a function of their employment, to participate in that."
The hospice holds leadership seminars each quarter for two full days.
"All the leaders in the organization come together from all the different offices and receive training and have a good time," Knee says. "We have a party the first night — maybe going bowling together or seeing a movie together, and the two days are filled with learning more about various aspects of leadership and how you can learn and develop additional skills."
The Covenant-Studer Alliance includes training services for home health, long-term care, and hospice care. Also, there are specialized consultation services and an institutional concentration on end-of-life care.
The hospice's training program received the 2005 Award of Excellence in Internal Staff Education from Florida Hospices and Palliative Care, as well as the 2004 Award of Excellence for Community Education by the National Hospice and Palliative Care Organization.
The leadership development training follows a model called evidence-based leadership, Knee notes.
"You start with the foundation and put the whole leadership evaluation process into place, including very objective ways to hold people accountable," Knee explains. "First, you do an evaluation of all leaders and then identify what needs to be done in terms of leadership development, and that means creating a process to develop the skills they need."
Leaders learn how to select employees for hire, how to use key words at key times, and how to write thank-you notes to employees — even sending these to their homes. This process of recognizing employees' positive behaviors is called "rounding," he says.
The entire leadership training and organizational development process can be broken into these categories:
- Evaluation: finding out where the organization is and what's needed for improvement, including holding staff accountable;
- Development: coming up with a plan to help staff learn necessary skills;
- Alignment: bringing the organization into focus in terms of what's important, and identifying key leadership behaviors that are desired;
- Breakthrough: changing things and breaking through old practices to form standardization of improved practices and behaviors;
- Acceleration: improving the organization continually, creating fertile ground for staff to seek new ways to make the organization better, Knee explains.
"Acceleration is where the organization takes off," Knee says. "You see dramatic increases in growth and better ways of doing things efficiently, including doing all the things you've always wanted to do and could never understand why we couldn't get there and sustain changes."
Training sessions provide tools and concepts for improving leadership skills. For example, one segment focuses on how to identify and handle the high, middle, and low performers within the organization, Knee says.
Leadership trainers show participants how to identify the high, middle, and low performers, as well as answering these questions:
- How do you move low performers up to a higher category or remove them from the organization? "We give people specific skills in dealing with that," Knee says.
- What are interviewing techniques to determine whether someone will be a high, middle, or low performer?
- How do you start a conversation with a low performer?
"We know that a good percentage of a supervisor's time is taken up with having to deal with low performing issues," Knee notes. "I've seen estimates of 60 to 65 percent of a person's time dealing with personnel matters is dealing with low performers."
So the leadership program teaches leaders how to eliminate the time they spend on low performers, freeing them to spend more time boosting the performance of middle and high performers, Knee says.
"The other aspect to this is that high performers tend to lose respect for supervisors who tolerate low performers," Knee says. "So we identify high, middle, and low performers, and we continually praise and constantly re-hire high performers — on a monthly basis."
A quick answer to what constitutes as high, middle, or low performer is this analogy, Knee says:
"If you have a group of people in an office, and you let it be known that you will buy pizza a week from Wednesday, and then you come in with pizza, the high performers will stand up and cheer; the low performer will say, 'Have you got pepperoni?'" Knee says.
"The high performers are the ones who will do not only their jobs, but are looking for more work, and they'll give 110 percent to an organization," Knee says. "They're always looking for challenges."
When a supervisor gives a high performer a performance review, the last thing on the high performer's mind is making more money, Knee says.
"The first thing a high performer wants is more responsibility, asking themselves, 'How can I help the organization?'" he says. "The low performers are the ones who are always complaining, and they're the last ones interested in being a member of a team — they're the ones for whom you always have to look over their shoulder, and they're the ones who never get their documentation done either correctly or on time."
Through effective leadership training, not only will the organization be improved, but there will be greater retention of leaders because leaders want to feel they're being trained and supported, Knee notes.
"I'm a former hospital administrator, and I think it's very typical in hospices and all of health care that we tend to promote people into leadership positions because they were good clinicians," Knee says. "That's okay, but when you do that you also have an obligation to help that outstanding clinician who has leadership potential to become a great leader."
There's another benefit to providing leadership training and enforcing the management skills that are taught.
"In every community, the word gets around," Knee says. "We have more and more people apply to us, and when we ask why they chose Covenant Hospice, we've heard increasingly in the last year and a half that they've heard about the leadership academy and they've heard that we don't tolerate low performers."
This reputation brings more high performers to the door, and an organization can become an employer of choice in health care, Knee adds.
Need More Information?
- Dale O. Knee, MHCA, President, Chief Executive Officer, Covenant Hospice, 5041 North 12th Ave., Pensacola, FL 32504. Telephone: (850) 433-2155
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