Teamwork Carries the Day During Pandemic | https://www.providermagazine.com/Articles/Pages/Teamwork-Carries-the-Day-During-Pandemic.aspx | Teamwork Carries the Day During Pandemic | <p>During the pandemic, it hasn’t been unusual to see a director of nursing (DON) in the kitchen, human resources staff making beds, maintenance staff picking up or dropping off employees, and administrators feeding patients. There’s an “e” in teamwork, and in the past year, that’s stood for “everyone helps everyone else.” <br></p><p><img src="/Issues/2021/April/PublishingImages/Oguin.jpg" alt="Jennifer Oguin, RN, DON" class="ms-rteImage-3 ms-rtePosition-1" style="margin:5px;width:144px;height:177px;" />As Jennifer Oguin, RN, DON, at Trinity Care Center in Round Rock, Texas, says, “My title went out the window. When it comes down to it, we are a team that pulls together without even asking. People just jump in and do what needs to be done. It’s embedded in our culture.”<br></p><p>Teamwork has taken on new meaning during the pandemic. Facilities have implemented new strategies for communication, collaboration, and innovation. Transparency, resilience, and empathy are not buzzwords but essential elements of daily work life.<br></p><p>Getting past the pandemic and the politics of 2021 calls for renewed efforts to focus on the residents and what it takes to keep everyone safe and engaged, as well as building and strengthening cultures that will weather any storm or crisis. </p><h2>Head of the Class: Education Moves Up<br></h2><p>Team education has always been essential in post-acute and long term care. However, during the pandemic, it’s taken on a new level of urgency. It’s also been more challenging, as guidance, recommendations, and clinical evidence regarding COVID-19 have changed constantly. Keeping up with this has been challenging. <br></p><p>How challenging? Well, according to Ohio State University researchers, there have been more than 87,000 scientific papers alone on the coronavirus since the pandemic started. <br></p><p>“You have to communicate frequently and have one-on-one conversations,” says Oguin. “You have to discredit misinformation before it spreads and is embraced as fact.” At first, she says, people were often confused and frightened.<br></p><p>However, she says, “We have kept staff informed as new evidence and information arises. As they saw positive results from guidance and protocols, it lessened their fears and increased their confidence and trust.”<br></p><p>Keeping everyone on the same page when they are getting different information from several sources is “a constant battle,” Oguin says. “As the CDC [Centers for Disease Control and Prevention] put out new guidance, we were regularly updating protocols and recommendations.” <br></p><p><img src="/Issues/2021/April/PublishingImages/JBB.jpg" alt="Jeffreys Barrett, RN" class="ms-rtePosition-2" style="margin:5px;width:150px;height:192px;" />When change is this constant, it is important to acknowledge that it’s frustrating and challenging, she says. “You need to say, ‘We’re doing this, too; we’re there with you. We know this is new and different, but it’s the right thing to do.’ You need to have a team that trusts you, and this helps build trust.”<br></p><p>Jeffreys Barrett, RN, MHA, NHA, executive director of Wellsprings of Gilbert in Arizona, says, “Early on, there were some people who didn’t believe COVID was a real virus, and others who were terrified of it. I would post emails once a week and constantly communicate information we received from the CDC and department of health.”<br></p><p>At some point, he suggests, “You can only educate people until they stop listening. But you can build a level of trust between yourself and others and deal with what is happening without being bombastic or threatening.”<br></p><p>As the pandemic wore on and the holidays approached, team leaders wanted to ensure that staff resisted the urge to attend large parties and family gatherings. “We provided a lot of staff education leading up to the holidays talking about ways to safely celebrate with family and friends,” Barrett says.<br></p><p>Buster Peter, administrator of Park Bend Health Center in Austin, Texas, says, “Then we gave staff take-home kits with PPE [personal protective equipment], hand sanitizer, and other items. We got the most positive response we’ve ever gotten for a staff gift. They appreciated getting something that they needed.”</p><h2>Hiring for Character</h2><p><img src="/Issues/2021/April/PublishingImages/Buslovich.jpg" class="ms-rtePosition-1" alt=" Steven Buslovich, MD," style="margin:5px;width:145px;height:186px;" />Hiring during the pandemic was challenging. It was difficult to vet job candidates to determine if they’d be a good fit for the organizational culture. Yet, it’s important to communicate that “if you are devoted to the residents and this patient population, you will do everything possible to protect the resident,” says Steven Buslovich, MD, CMD, MSHCPM, a New York-based geriatrician and chief executive officer of software producer Patient Pattern. “If you’re doing it solely for the paycheck, this isn’t likely the place for you.”<br></p><p>Staffing is always challenging. However, Oguin says, “It is important to have a back-up plan in advance for how you will maintain adequate staffing in a crisis.” Cross-training can help, she says. Training everyone on basic tasks such as feeding, monitoring the dining room, making beds, and basic infection control can make it easier to enable people to fill in when there are shortages on the front lines.</p><h2>Nurse Aide Adaptions<br></h2><p>In many communities, “People stepped up and helped others,” says Alice Bonner, PhD, RN, FAAN, senior advisor for aging, Institute for Healthcare Improvement. “Nursing homes worked with area agencies on aging, senior centers, etc. Administrators and others connected with high schools and community colleges to help fill job openings. Everyone came together, and that made a big difference.”<br></p><p>During the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) waived the federal nurse aide training and competency evaluation requirements for newly hired nurse aides, with the exception of requirements that nurse aides be competent to provide needed services. CMS issued this waiver “to assist in potential staffing shortages seen with the COVID-19 pandemic.”<br></p><p>The American Health Care Association/National Center for Assisted Living stepped in to help by offering free eight- and 16-hour online courses for a temporary nurse aide (TNA) able to provide services and supports such as assistance with dining, ambulation, and other activities of daily living. After successfully completing the online training, TNAs then go through a competency evaluation by the provider before beginning work. <br></p><p>Currently, the program is permitted under special waivers, exceptions, or flexibilities for TNA roles in several states. To make the transition to become licensed/certified nurse aides/nurse aides included in state CNA/LNA/NA registries, TNAs need to complete additional certification requirements in accordance with federal and state regulations.<br></p><p>While this solution has filled a need during the pandemic, the National Association for Health Care Assistants (NAHCA) recommends that CMS reinstate the nurse aide training and competency evaluation standards as soon as possible, and no later than the end of March 2021.<br></p><p>NAHCA also suggests that the agency require that temporary nurse aides (those employed under the waiver) complete the training and competency evaluation set forth in federal regulations, since CMS has no authority to extend a waiver beyond a declared emergency period.<br></p><p>Elsewhere, callouts have been an issue. While these were problematic, Peter says, “We always put the safety of our residents and staff at the forefront. We recognize that short-term staffing strategies lead to long-term infection control success. We had nurses covering shifts as CNAs [certified nurse assistants], and we had people working double shifts. But we wouldn’t let people come to work when they didn’t feel good.”</p><h2>From Fear to Firefighters</h2><p>“Some people ran from the fire, but many were firefighters,” Buslovich says. “People with COVID often stop eating and drinking, and they need support and encouragement. We started systematic fluid hydration protocols, and anytime anyone went in the room, they would offer the patient a drink.” Everyone, including therapists, activity staff, administrators, and others helped hydrate and feed patients, he says.<br></p><p>“You might have one or two brave aides on a COVID unit with 20 residents. We don’t have the luxury of relying on them to adequately feed or hydrate everyone,” he says. “It takes a team to enable residents to recover from COVID and, whenever possible, stay out of the hospital.”<br></p><p>These types of efforts were significant, Buslovich says. “We have some of the frailest patients, yet our mortality rate has been remarkably low. Our teams have been a great commodity, and their efforts saved lives.”<br></p><p>Many team members made significant sacrifices to protect residents and co-workers. For instance, Buslovich says, “I moved out of my house and rented an apartment so staff could protect our families and be available 24/7 to the facility. We didn’t know enough about the virus early on, and you had to make a choice to fight the fire or stay back. This way, we could be present and available.”</p><h2>Small Fish, Big Pond</h2><p>One key to reducing turnover is to support staff when they get sick. “For staff who are out, it’s easy to feel like you don’t matter, like you’re a small fish in a big pond,” Peter says.<br></p><p>“When our people call in to staffing coordinators, they get a call from the administrator—not to find out when they’re coming back but to let them know we’re thinking about them and are genuinely concerned about their well-being. They appreciate that,” he says.<br></p><p>“The wheels would fall off without staff. We made sure we expressed appreciation for people’s efforts.”<br>Barrett agrees. “When people were out sick, we sent flowers and food from Door Dash. We made sure we covered people’s wages while they were out. We take caring for our people seriously. It’s not just lip service.”<br></p><p><img src="/Issues/2021/April/PublishingImages/JJG.jpg" alt="Jefferson Gerodias, RN" class="ms-rtePosition-2" style="margin:5px;width:150px;height:188px;" />Jefferson Gerodias, RN, BSN, director of clinical services at Wellsprings of Gilbert, says, “We took care of employees and their families. We sent them food. Other staff would go grocery shopping and leave them on the doorstep for families.” <br></p><p>Gerodias knows this from experience. He contracted COVID in January and was out sick for two weeks. “Every day I woke up to 50 text messages asking how I was doing. And my floor staff got together and brought me groceries.”<br></p><p>Bonner adds, “When people are out sick, managers can call and check on them. There should be a buddy system where colleagues check on each other. People who are out with COVID shouldn’t feel forgotten or unsupported.”<br></p><p>Moving forward, empathy is key. “You need to understand what everyone is feeling. Everyone has obstacles they are dealing with,” says Oguin. “While everyone is doing their best, you can’t expect them to always drop everything. Managers need to be flexible and understand that their employees are juggling lots of responsibilities and challenges.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></p> | Teamwork has taken on new meaning during the pandemic. Facilities have implemented new strategies for communication, collaboration, and innovation. | 2021-04-01T04:00:00Z | <img alt="" src="/Issues/2021/April/PublishingImages/0421-CS1.jpg" style="BORDER:0px solid;" /> | COVID-19;Workforce | Cover Feature | Joanne Kaldy | 48 | 4 |
Positive Culture Provides a Strong Foundation | https://www.providermagazine.com/Articles/Pages/Positive-Culture-Provides-a-Strong-Foundation.aspx | Positive Culture Provides a Strong Foundation | <p><span><img src="/Issues/2021/April/PublishingImages/Team-staying-warm.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:290px;height:306px;" /></span>Skilled nursing and assisted living providers have found that fighting COVID-19 has only underscored the importance of a positive company culture.<br></p><p>“The pandemic uncovered that we don’t always have a mutually supportive and reinforcing culture in nursing homes,” says Alice Bonner, PhD, RN, FAAN, senior advisor for aging, Institute for Healthcare Improvement.<br></p><p>“We have webinars and other programs telling people that we have to do better, but that’s not enough and not always the best approach.” She stresses the need to develop tools and resources to create and sustain a positive culture.<br></p><p>Then, she says, “We need to figure out how to get these into 15,600 nursing homes.”</p><h3>What Works</h3><p>During the pandemic when everyone was overwhelmed and staff were stretched thin, “The whole premise of our culture is that we treat everyone with respect and dignity,” says Paul Gerharter, RN, vice president of clinical services for Caraday Healthcare. “We make it clear that it’s okay to talk about family and life away from work.”<br></p><p>When staff feel like their managers understand what they’re going through and are empathetic, they are more likely to be engaged and embrace the organization’s vision. “It’s important for everyone to understand there will be bad days,” Gerharter adds. “We need to own up to mistakes, forgive people, learn, and move forward.”<br></p><p><img src="/Issues/2021/April/PublishingImages/DallasNelson.jpg" class="ms-rtePosition-2" alt="Dallas Nelson" style="margin:5px;width:165px;height:210px;" />One thing that has been crystal clear during the pandemic is, “You have to set up a culture of safety before a crisis hits,” says Dallas Nelson, MD, CMD, associate professor of medicine at the University of Rochester School of Medicine and Dentistry. “You need a system that shows you value employees, that they can bring up questions, fears, and concerns and be respected.” <br></p><p>She suggests that when this culture doesn’t exist, trust can suffer, and staff are hesitant to believe management has their best interests at heart. “You have to make staff feel safe before they can make other people feel safe,” she says.</p><p>In a culture of safety and trust, it is much more difficult for conspiracy theories, rumors, and misinformation to gain traction. This certainly doesn’t mean that management is always right or that leadership has all the answers.<br></p><p>“The idea that good leadership doesn’t change its mind is terrible,” Nelson says. “Changing course after new data come out isn’t a sign of weakness; it shows that leadership wants to do what is right for residents and staff. If you act like you know what you don’t know, you will lose trust, and people won’t trust you to keep them safe.”<br></p><p>“Those homes that have really transformed their culture to be more resident-centered and resident-directed had systems in place that helped them during the pandemic,” says Penny Cook, MSW, president and chief executive officer of the Pioneer Network. As a result of their cultures, they already had consistent staffing, effective ways to interact with families, and other elements that promoted engagement, <a href="/Articles/Pages/Transparency-Is-Telling.aspx" target="_blank">transparency</a>, teamwork, and empathy. </p><h3>What Can Help</h3><p>Culture change continues to be a significant opportunity for facilities, and it can be a “massive endeavor,” says Anna Fisher, DHA, CMDCP, CDP, director of quality and education for Hillcrest Health Services. However, it can be managed with the right tools, resources, guidance, education, and, of course, people.<br></p><p>For example, she says, “We were part of a pilot for the Artifacts of Culture Change 2.0, designed to help make a shift in culture and affect positive change.” Offered by the Pioneer Network, Artifacts is an internal implementation, inspiration, and self-assessment tool that shows assisted living and nursing homes a variety of beneficial changes they can make to increase resident autonomy, rights, and choice, as well as note their progress toward changing institutional culture. For more information, go to <a href="http://www.pioneernetwork.net/artifacts-culture-change" target="_blank">www.pioneernetwork.net/artifacts-culture-change</a>.<br></p><p>More than ever, making sure residents are part of culture change is key, Cook says. “I’ve talked to some communities during the pandemic where staff said relationships with residents helped them through it all.” <br></p><p>This power of reciprocal learning needs to be promoted more. For instance, Cook shares the story about how her 25-year-old son was stressed and exhausted, and a conversation with his grandmother boosted his spirits tremendously. “If residents know they have cheered up a staff member or made someone laugh or smile, that gives them a sense of purpose. We all need that,” she says.</p><h3>The Bright Way Forward</h3><p><span><img src="/Issues/2021/April/PublishingImages/Buslovich.jpg" alt="Steven Buslovich" class="ms-rtePosition-1" style="margin:5px;width:166px;height:210px;" /></span>Even though the business of post-acute and long term care is serious, there is a place for humor. “Humor is a huge part of our day-to-day life,” says Gerharter. “When we have our weekly calls, we laugh. We are in a serious business, but we want people to feel at ease.”<br></p><p>“We were at a low point prior to the vaccine,” says Steven Buslovich, MD, CMD, MSHCPM, a New York-based geriatrician. “Now I am seeing a lot more optimism and the vaccine changing our way of life. This is exciting. If we continue moving forward where everyone follows a plan, that is the best path to ‘normalcy.’ The virus will be around indefinitely, but we will have a new normal way of life, and we have learned much that will ensure the best possible teamwork moving forward.” <br></p><p>The pandemic has shone a light on areas of opportunity in the system, suggests Fisher, and providers need to use this information to refine their processes and create ways to continue dialogues they’ve started with other stakeholders.<br></p><p>“You can look at our current situation as the glass half-full or half-empty. Yes, the pandemic has spotlighted issues within the system that need to be addressed, but people should celebrate all of the remarkable things they’ve accomplished this past year.” <br></p><p>In the meantime, “You have to stay resilient, and some things you just have to let roll off your back,” says Jeffreys Barrett, RN, MHA, NHA, executive director of Wellsprings of Gilbert in Arizona. “We have to prioritize more than ever before, and as leaders, we need to let other leaders do their jobs.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></p> | Skilled nursing and assisted living providers have found that fighting COVID-19 has only underscored the importance of a positive company culture. | 2021-04-01T04:00:00Z | <img alt="" src="/Issues/2021/April/PublishingImages/0421-CS2.jpg" style="BORDER:0px solid;" /> | COVID-19;Culture Change | Cover Feature | Joanne Kaldy | 48 | 4 |
‘Start, Stop, Continue’ Lets You Listen, Learn, and Leap Forward | https://www.providermagazine.com/Articles/Pages/Start-Stop-Continue.aspx | ‘Start, Stop, Continue’ Lets You Listen, Learn, and Leap Forward | <p>The coronavirus pandemic has exposed gaps and problems but also innovations and opportunities for long term/post-acute care providers. The time is now to capture and nurture the great ideas and creative efforts, while doing away with outdated or unproductive processes or activities. This doesn’t have to be a time-draining, cumbersome endeavor. It can be as easy as start, stop, continue. <br></p><p>The Start, Stop, Continue framework is a fairly easy technique where managers and their teams can assess what processes, systems, practices, ideas, and programs are working and where changes are needed.<br></p><p>By identifying which of these things the team thinks should be started, stopped, and continued, the manager can pinpoint ideas for team-based action, change, and innovation that can be implemented quickly.</p><h3>Clarify Means</h3><p>To get started, make sure that the team members understand what should go on each list:</p><h4><img src="/Issues/2021/April/PublishingImages/start.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />START.</h4><p>These should be items that the team thinks would have a positive impact and contribute to better outcomes, teamwork, morale, engagement, and retention that aren’t already being used.</p><p>For example, staff may want to start more flexible schedules, make better use of technology, or a develop a better system to communicate or share information.</p><p><br></p><h4><img src="/Issues/2021/April/PublishingImages/stop.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />STOP. </h4><p>These include activities or tasks that aren’t helping the team achieve their goals and actually may be impeding their efforts. For instance, staff want to stop having so many Zoom meetings.</p><p><br></p><h4><img src="/Issues/2021/April/PublishingImages/continue.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />CONTINUE. </h4><p>These are things that have worked in the past and should continue to be part of the team’s workflow. “Continues” may include flexible scheduling, efforts to support staff during a crisis, or partnerships with local health departments and other stakeholders. </p><p>Ask everyone to submit one to two items for each category. Suggestions may be limited to each team’s work area (for example, clinical, administrative, operational) or open them up to recommendations about any aspect of the workplace.<br></p><p>Have an interdisciplinary, representative, and inclusive workgroup review the submissions, eliminate the duplicate ideas, and come up with a manageable list. The workgroup can develop specific action items in each area and send these back to the larger group to vote on the ones they think are most important and practical.<br></p><p>The workgroup then can involve the appropriate players to plan and implement each of the final stop, start, and continue actions.</p><h3>Extra Benefits</h3><p>While the pandemic and the fallout from it continue to place a burden on staff and leadership alike, this process can be done over a period of weeks, and the results can be powerful. Among the potential benefits:<br>● People will find that they have much in common and share some similar ideas. This can contribute to team building, engagement, and motivation.<br>● Staff are engaged and appreciate that their opinions are sought and valued.<br>● Problems, gaps, and other troublesome issues that are flying under the radar are brought to light and can be addressed early on.<br>● Ideas, thoughts, and concerns are captured while they are fresh in everyone’s minds. <br></p><p>Giving teams an opportunity to provide teamwork on a regular basis enables them to contribute and helps create a culture of trust, inclusion, and loyalty. <br></p><p>For more information, go to <a href="http://www.forbes.com/sites/groupthink/2016/02/02/start-stop-continue-tutorial/?sh=6dc19e412798" target="_blank">www.forbes.com/sites/groupthink/2016/02/02/start-stop-continue-tutorial/?sh=6dc19e412798</a>. ■<br></p> | New technique helps leaders and their teams easily assess their own programs for efficiency and success. | 2021-04-01T04:00:00Z | <img alt="" src="/Issues/2021/April/PublishingImages/0421-CS3.png" width="595" style="BORDER:0px solid;" /> | Management;Caregiving | Cover Feature | Joanne Kaldy | 48 | 4 |