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Florida hospice improves all areas of organization
It may be popular these days for hospices to create a statement of their core values as part of a management and organizational exercise, but that’s just the easy part.
The real challenge is making the core values mean something and translating the mission statement into a quality improvement foundation for all that a hospice organization does, says Mary Lou Proch, BSN, MA, EdD, director of education at LifePath Hospice and Palliative Care of Tampa, FL. LifePath Hospice staff and administrators have successfully incorporated the organization’s core values into their jobs and goals, and the result has been rapid growth and lower employee turnover rates.
Patient census up, staff turnover down
"We have had tremendous growth, with patient [cases] increasing 200%," Proch says. "In 2002, we had a staff turnover rate of 38%, and our projected turnover rate for 2004 is 20%, so it’s gone down tremendously."
LifePath’s recent successes prove that if an organization is giving good service, referrals will increase over time, resulting in sustained growth rather than a one-time fluctuation, Proch says. And this growth directly coincides with the organization’s new focus on core values. "Up until 10 to 15 years ago, nobody understood the importance of having values articulated to the organization," Proch says.
Now many organizations believe that developing a list of core values and letting employees and clients know what these are is key to quality improvement and continued growth, she says. "The more employees see their organization’s core values at work, the more satisfied they are and the more it develops trust," Proch explains. "But if you say one thing and do another, then you destroy employee satisfaction."
When LifePath Hospice was undergoing major management changes, the organization’s administrators decided to identify the hospice’s core values and use these to guide the hospice, Proch says. An interdisciplinary team worked together to come up with five core values for the hospice, which are the following:
"We also have the core purpose of making the most of life," Proch says. Once the job of identifying core values was complete, the organization began the more difficult job of deciding what to do with these core values and making them a part of the hospice’s culture and mission.
Here’s how LifePath Hospice used core values to improve quality, employee satisfaction, and processes:
1. Get the word out.
The first step involves presentation, Proch says. "We put the core values in posters and talked about them at meetings," she says. "We knew it would take a long time to make sure everything was connected." The culture change resulting from getting the word out about core values took from 1998 to 2002, which is when the hospice began to integrate different systems with the core values, Proch explains. "We had the values and then thought about what else we could do to put them into practice," she says. "It has to get to a point where it’s subliminal and automatic; first we make a conscious effort of it, and then it gets into the subconscious."
2. Hire employees according to core values.
"We started hiring people according to the core values in late 2002, and that’s when we first saw a dramatic decrease in our staff turnover rate," Proch says. For example, the core value of working together to meet common goals essentially refers to teamwork, so hospice hiring interviewers ask potential employees to discuss the experiences they’ve had working with teams and the qualities they have that support teamwork, Proch explains. "We say, Tell me about the time you worked on a team, and what do you do to support teamwork?’ and their stories let us know what they personally do," she says.
Likewise, for the core value of honesty and integrity, an interviewer might ask the applicant: "I’m sure you’ve been asked to do something you weren’t comfortable with. How did you handle that situation?" Proch says. "What we’re looking for is the best fit; when someone’s personal values match organizational values, their job satisfaction goes way up," she says. "So if their answers don’t meet our standard, they don’t go past that interview."
Job applicants who pass the first round of interviews will then be assessed for their professional and personal skills with regard to their particular profession and their potential work with a clinical team, Proch says.
3. Evaluate staff according to core values.
The performance evaluation form now includes statements that pertain directly to the organization’s core values, with sections on job knowledge, quality, productivity, and compliance. The various sections include statements such as, "Makes good ethical decisions," Proch says.
Judging staff on more than their smile
"Every one of those values has a statement in the job performance review that supports it," Proch notes. "These include statements saying, Bases treatment plan on what patient’s families’ goals are,’ and Do you put the family first?’"
It’s important to have processes for keeping people accountable, because otherwise there won’t be behavioral change, Proch says. "Our performance review’s bar was raised last year, and it’s more outcome-based," she says. "It’s not just that you smile and are pleasant."
Staff outcomes also are measured at departmental levels, such as whether individuals are able to work with other departments to achieve organizational goals, Proch says. For instance, an employee who does her or his part to help the pharmacy department achieve its goals is supporting teamwork between departments. Likewise, the employee will be rated higher on the evaluation if she or he is perceived as being a person of influence who is asked to be on various committees, Proch says.
4. Develop a leadership education program using core values.
"We’re developing a leadership education program for the first-line supervisors and the second-line managers," Proch says. "The third line is the director’s level." If the hospice’s philosophy is that patients and their families come first, then the employees are the ones who must come first for managers, because the people they supervise are their clients, Proch says.
The crucial question for supervisors and managers is: "What are some of the outcomes managers would implement to support the core values?" Proch says. "We also distributed an employee opinion survey this year," she says. "There were 35 questions related to the immediate manager and also questions about job satisfaction."
Survey statements had responses on a one-to-five scale of agreement, Proch says. One survey statement is, "My immediate supervisor removes barriers that keep me from doing my job." Another says, "My immediate supervisor communicates effectively to patients, family, and staff if there is a problem."
The survey was distributed anonymously by a contracting company so employees were convinced that no one’s name could be traced back to the answers given or that a hospice manager could access the data and change it, Proch says. "We went the extra mile to make it appear completely anonymous and that no one can touch the data," she says. When the data results are distributed, administrators will make certain supervisors own the data and learn from what it says about their managerial skills, Proch says. The process is expected to identify managers who need extra training and to help others identify their strengths and weaknesses, she says.
5. Infuse training with core values.
The general orientation includes a presentation of speakers who are grouped under the core values, Proch says.
"We have checklists to make sure people can do these certain behaviors, and we have outcomes that can support these values," Proch says. "The checklists have some clinical skills and some are judgments, but we always have the employee demonstrate integration of our LifePath values."
The orientation period includes the employee’s first 30 days of work, so the checklist is completed by supervisors who can answer the questions, such as whether the employee puts families and patients first, Proch notes. "Besides evaluating how well someone does with the job skills, we look at their values," Proch says. "If you have a performance issue as far as the skills, we can always teach you the skills, but if we’re different on values, we can’t always do something about that."