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2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes
October 07, 2008AMERICAN HEALTH CARE ASSOCIATION
Bradley N. ShiverickC.P.H.Q
Vice President and Chief Quality Officer
bshiverick@myinnerview.com
715-848-2713
Goals
» What is “quality” anyway?
» Organizational performance
» Satisfaction and loyalty
» 2007 national satisfaction report
» The importance of the workforce
Evidence-based philosophy
Evidence-based management calls for a paradigm shift in the approach to quality improvement: An appreciation of data, the ability to turn data into information and knowledge, and to use that information and knowledge to improve quality.
Turn plan into
action: improveprocess
Turn knowledge
into plan:apply new wisdom
to process
Turninformation into
knowledge:study current
process
Collect
data:ensure validity,
organize
Turn data into
information:benchmark, study
variation
Evaluate
outcomes:measurevariation
My InnerView’sevidence-
basedpath to quality
Collectdata:ensure validity,organize
Collect
data:ensure validity,organize
Turn data intoinformation:benchmark, studyvariation
Collect
data:ensure validity,organize
Turn data into
information:benchmark, studyvariation
Turninformation intoknowledge:study currentprocess
Turn knowledge
into plan:apply new wisdomto process
Turninformation into
knowledge:study currentprocess
Collect
data:ensure validity,organize
Turn data into
information:benchmark, studyvariation
Turn plan intoaction: improveprocess
Turn plan into
action: improveprocess
Turn knowledge
into plan:apply new wisdomto process
Turninformation into
knowledge:study currentprocess
Collect
data:ensure validity,organize
Turn data into
information:benchmark, studyvariation
Evaluateoutcomes:measurevariation
11
What is Quality, Anyway?
“The totality of features and characteristics of a product or service that meet or exceed
customer needs and expectations.”
Organizational Performance
Focus onWorkforceFocus onWorkforce
KnowledgeManagementKnowledge
ManagementProcess
ImprovementProcess
Improvement
Focus on CustomerFocus on Customer
StrategyStrategy
LeadershipLeadership
Organizational Performance
Focus onWorkforceFocus onWorkforce
KnowledgeManagementKnowledge
ManagementProcess
ImprovementProcess
Improvement
Focus on CustomerFocus on Customer
StrategyStrategy
LeadershipLeadership
Focus onWorkforceFocus onWorkforce
Focus on CustomerFocus on Customer
or loyalty?
Satisfaction …
When you don’t remember
anything, you’re satisfied!
Why look at
“Excellent”?
Loyalty is generated by memorable things
that happen that we didn’t expect.
These cause person to give score of
“Excellent,” not “Good.”
Frederick Riecheld: “The Loyalty Effect”
» To grow your business exponentially, you must get serious loyal relationships with your customers – Loyal customers are easiest customers to serve
– Long-term customers tend to spend more with you than new customers
– Happy, loyal customers purchase other products or services in company’s line
– Satisfied, loyal customers recommend company’s products or services
The Loyalty Effect: The Hidden Force Behind Growth, Profits, and Lasting Value ;Frederick F. Reichheld,
A loyal customer …
» Will recommend you to others
» Will give you the benefit of the doubt
» Will use you again
» Will enhance your reputation in the community
» Won’t sue you
“Research shows that, in most industries, there is a strong
correlation between a company’s growth rate and the percentage of its customers who are raving fans — that is, those who say they are extremely likely to recommend
the company to a friend or colleague.”
For My InnerView users,this is “Excellent”
For My InnerView users,this is “Excellent”
RECOMMEND
What is your recommendation of this facility to others?
What is your recommendation of this facility as a place to work?
… to receive care?
EXCELLENT GOOD FAIR POOR
The Importance of “Recommendation”» “Recommendation” is touchstone to determine
significance of your scores on all other items
» “Recommendation” score provides crucial information– Tells you loyalty of respondents
– Correlates to other quality outcomes:• All items in survey
• Occupancy
• Quality indicators
• Employee satisfaction
» That is why this question is used for Priority Action Agenda
» Those who are likely to recommend your organization to others are called “promoters”
» Why is willingness to promote your company such a strong indicator of loyalty and growth?
Frederick Riecheld: “The One Number You Need to Grow”
Frederick Riecheld: “The One Number You Need to Grow”
Because when customers recommend you,
they’re putting their reputation on the line.
They will take that risk only
when they are loyal.
“In most of the industries studied,
the percentage of customers who were enthusiastic enough to refer a friend or colleague — perhaps
the strongest sign of customer loyalty — correlated
directly with differences in growth rates among
competitors.”
Respondents
» 27,397 residents
» 118,985 family members
» 161,908 employees
» 4,116 (one in four) nursing homes nationwide
Source of data
» Largest private dataset of resident, family and employee satisfaction in nation
» From mailed resident and family surveys returned to third-party
» From self-administered employee surveys; mailed to third party
» Respondents rate facilities using four-point scale (excellent, good, fair or poor)
SURVEY RESPONDENTS
Figure 1 — “Facility count” is unduplicated total of facilities completing consumer and workforce satisfaction surveys.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
ConsumerDemographics
RESIDENT’S AGE
Figure 4 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
RESIDENT VISITED
Figure 4 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
LENGTH OF STAY
Figure 4 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
VISITOR IS ADULT CHILD
Figure 4 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Satisfaction
CONSUMER GLOBAL SATISFACTION
Figure 8Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
CONSUMER SATIFACTION
Figure 9 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
81%
QUALITY OF LIFE
CONSUMER SATIFACTION
Figure 10 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
QUALITY OF CARE
78%
CONSUMER SATIFACTION
Figure 11 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
QUALITY OF SERVICE
73%
SURVEY RESPONDENTS
Figure 1 — “Facility count” is unduplicated total of facilities completing consumer and workforce satisfaction surveys.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
EmployeeDemographics
EMPLOYEE’S AGE
Figure 5 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
JOB CATEGORY
Figure 5 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
LENGTH OF EMPLOYMENT
Figure 5 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
AGE OF NURSING STAFF
Figure 6Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
LENGTH OF SERVICE
Figure 7Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Satisfaction
WORKFORCE GLOBAL SATISFACTION
Figure 12Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
WORKFORCE SATIFACTION
Figure 13 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
TRAINING
60%
WORKFORCE SATIFACTION
Figure 14 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
WORK ENVIRONMENT
59%
WORKFORCE SATIFACTION
Figure 15–16 — May not total 100% due to rounding.Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
SUPERVISIONSUPERVISION
MANAGEMENT
46%
62%
Willingnessto Recommend
WILLINGNESS TO RECOMMEND
Figure 22Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Family
WILLINGNESS TO RECOMMEND
Figure 23Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Family
WILLINGNESS TO RECOMMEND
Figure 24Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Resident
WILLINGNESS TO RECOMMEND
Figure 25Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Resident and family
5.5%
6.0%
6.5%
7.0%
7.5%
8.0%
8.5%
Once yearor more
Every 3months
Oncemonth or
more
Once weekor more
Almostdaily
HOW OFTEN VISITED
Resident Family
WILLINGNESS TO RECOMMEND
Figure 17Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Workforce
DATABYTE
WILLINGNESS TO RECOMMEND
Figure 18Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Workforce
DATABYTE
WILLINGNESS TO RECOMMEND
Figure 20Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Nurses and nursing assistants
LENGTH OF SERVICE
4.0%
4.5%
5.0%
5.5%
6.0%
6.5%
Less than 3months
3 months -1 year
1-2 years 2-5 years 5-10 years 10+ years
Nurse Nursing Assistant
WILLINGNESS TO RECOMMEND
Figure 19Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Nurses and nursing assistants
BY AGE
Nurse Nursing Assistant
4.0%
4.5%
5.0%
5.5%
6.0%
6.5%
19 to 29 30 to 39 40 to 49 50 to 59 60 or older
WILLINGNESS TO RECOMMEND
Figure 21Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Nurses and nursing assistants
NationalTrends in
Satisfaction
FACILITIES WITH THREE CONSECUTIVE SURVEYS
SATISFACTION TREND
Figure 26Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Consumer2005 2006 2007
4.5
5.0
5.5
6.0
6.5
7.0
7.5
Quality of life Quality of care Quality of service Composite
3.0
3.5
4.0
4.5
5.0
5.5
6.0
Supervision Workenvironment
Training Management Composite
FACILITIES WITH TWO CONSECUTIVE SURVEYS
SATISFACTION TREND
Figure 27Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
All workforce2006 2007
FACILITIES WITH TWO CONSECUTIVE SURVEYS
SATISFACTION TREND
Figure 28Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Nurses2006 2007
3.0
3.5
4.0
4.5
5.0
5.5
6.0
Supervision Workenvironment
Training Management Composite
3.0
3.5
4.0
4.5
5.0
5.5
6.0
Supervision Workenvironment
Training Management Composite
FACILITIES WITH TWO CONSECUTIVE SURVEYS
SATISFACTION TREND
Figure 29Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Nursing assistants2006 2007
Factors DrivingSatisfaction in‘Best-in-Class’
Facilities
DATABYTE
DRIVERS OF CONSUMER ‘RECOMMENDATION’
Figure 32Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Figure 32Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
DRIVERS OF CONSUMER ‘RECOMMENDATION’
A Deeper Dive on “Drivers”
QUADRANT ANALYSIS: A DISCOVERY TOOL
MY INNERVIEW’S GOAL
Help providers achieve their quality targets
OUR APPROACH
Help providers:• Turn data into information
— discover patterns• Turn information into knowledge
— discover their roots• Turn knowledge into action
— plan, mobilize, act
QUADRANT ANALYSIS: AN EFFECTIVE TOOL
QUADRANT ANALYSIS: TWO KEY CONCEPTS
1. How residents, families and staff rate your care and services
Your average score on each item:1 – 4: “Poor” “Fair” “Good” “Excellent”
Rank order all items by average score:1 – 100: Lowest to highest ranking score
2. How much each item influences residents,families and staff to recommend to others
Correlate each item with “Recommendation:0 – 1: No correlation to strongest correlation
Rank order all items by correlational strength:1 – 100: Lowest to highest ranking correlation
1 ----- Lowest to highest ranking correlation ------ 100
Su
cces
ses
You have little control over customer expectations
Yo
u c
an m
eet
cust
om
er e
xpec
tati
on
s
C.
Secondary opportunities
D.
Primary opportunities
B.
Primary strengths
A.
Secondary strengths
Ch
alle
ng
es
1 -
Lo
wes
t to
hig
hes
t ra
nki
ng
sco
re
100
QUADRANT AND ACTION PRIORITIES
RESIDENT
FAMILY
Care (concern)by staff
Quality ofRN/LVN/LPN care
Respectfulnessof staff
17
13
2A B
SE
CO
ND
AR
Y S
TR
EN
GT
HS P
RIM
AR
Y S
TR
EN
GT
HS
4
7
103
198
155
FAMILYRESIDENT
1713
2
4
710
3
8
15
14
5
Competency of staff
14
195
Commitment tofamily updates
Safety of facility
17
13
A BS
EC
ON
DA
RY
ST
RE
NG
TH
S PR
IMA
RY
ST
RE
NG
TH
S
4
7
103
5
FAMILYRESIDENT
1713
4
710
314
Quality ofCNA/NA care
Choices/preferences
Responsivenessof management
Attention toresident grooming
Adequacy of staff20
1
C DSE
CO
ND
AR
Y O
PP
OR
TU
NIT
IES P
RIM
AR
Y O
PP
OR
TU
NIT
IES
16
14
12
9
2122
18
6
FAMILYRESIDENT
11
20
1
1619
12
9
2122
18
6
11
19
A BS
EC
ON
DA
RY
ST
RE
NG
TH
S PR
IMA
RY
ST
RE
NG
TH
SFAMILYRESIDENT
D
PR
IMA
RY
OP
PO
RT
UN
ITIE
S
19
Cleanlinessof premises
CSE
CO
ND
AR
Y O
PP
OR
TU
NIT
IES
DATABYTE
2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes
Figure 31Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
DRIVERS OF WORKFORCE ‘RECOMMENDATION’
Figure 31Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
DRIVERS OF WORKFORCE ‘RECOMMENDATION’
EMPLOYEE
1
17
13
2
SE
CO
ND
AR
Y S
TR
EN
GT
HS
SE
CO
ND
AR
Y O
PP
OR
TU
NIT
IES
PR
IMA
RY
ST
RE
NG
TH
SP
RIM
AR
Y O
PP
OR
TU
NIT
IES
16
47
10
3
8
15
14
5
12
918
6
11
A B
C D
EMPLOYEE
17
PR
IMA
RY
ST
RE
NG
TH
SP
RIM
AR
Y O
PP
OR
TU
NIT
IES
7
10
3
8
12
9
6
11
B
D
Adequacy of equipment/supplies
Communication by supervisor
Care (concern) of supervisor
Safety of workplace
Quality of resident-related training
Appreciation of supervisor
Care (concern) of management
Attentiveness of management
Assistance with job stress
EMPLOYEE
Understanding the Critical Importance of
The Workforce
Figure 30Source: 2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes , My InnerView Inc.
Relationship between consumer and workforce satisfaction
GLOBAL EMPLOYEE SATISFACTION
Bottom 10% Middle 80% Top 10%
CO
NS
UM
ER
SA
TIS
FA
CT
ION
7.9%
8.3%
9.0%
7.9%8.1%
8.7%
7.6%7.8%
8.5%
7.1%
7.4%
8.2%
7.7%7.9%
8.5%
6.0%
6.5%
7.0%
7.5%
8.0%
8.5%
9.0%
Globalsatisfaction
Quality oflife
Quality ofcare
Quality ofservice
Composite
50
60
70
80
Lowest Low High Highest
Source: Nursing home family and employee satisfaction surveys conducted in 2007 by My InnerView Inc.
Facilities with higher family satisfactionhave better work environments
< 54% 54% to 58% 58% to 64% > 64%
Mean = 68.0
EM
PL
OY
EE
EN
VIR
ON
ME
NT
SC
OR
E (
%)
FAMILY SATISFACTION
48
52
56
60
64
Lowest Low High Highest
Source: Nursing home family and employee satisfaction surveys conducted in 2007 by My InnerView Inc.
Facilities with higher family satisfactionhave better employee training
Mean = 57.1
EM
PL
OY
EE
TR
AIN
ING
SC
OR
E (
%)
FAMILY SATISFACTION
< 54% 54% to 58% 58% to 64% > 64%
Source: Nursing home family and employee satisfaction surveys conducted in 2007 by My InnerView Inc.
Facilities with higher family satisfactionhave better supervision
60
70
80
90
Lowest Low High Highest
Mean = 72.2
EM
PL
OY
EE
SU
PE
RV
ISIO
N S
CO
RE
(%
)
FAMILY SATISFACTION
< 54% 54% to 58% 58% to 64% > 64%
Source: Nursing home family and employee satisfaction surveys conducted in 2007 by My InnerView Inc.
Facilities with higher family satisfactionhave better management
50
60
70
80
Lowest Low High Highest
Mean = 66.5
EM
PL
OY
EE
MA
NA
GE
ME
NT
SC
OR
E (
%)
FAMILY SATISFACTION
< 54% 54% to 58% 58% to 64% > 64%
Source: Nursing home family and employee satisfaction surveys conducted in 2007 by My InnerView Inc.
Facilities with higher family satisfactionhave better employee global satisfaction
40
50
60
70
80
Lowest Low High Highest
Mean = 56.9
EM
PL
OY
EE
SA
TIS
FA
CT
ION
SC
OR
E (
%)
FAMILY SATISFACTION
< 54% 54% to 58% 58% to 64% > 64%
The Impact of Effective Leadership
DATABYTE
DATABYTE
Customer and Employee Satisfaction Surveys
The Mechanics
» Instrument
» Distribution
» Communicate
» Communicate
» Communicate
Using Your Results
» Comparison over time
» Comparison to peers
» Lowest “Excellent”
» Highest “Poor”
» Correlations
» The Critical Value of Comments
» Tells you how far ahead or behind you are by survey item, “in the race” for excellence
» What does it tell me?– Your average score
– Your percentile rank
– 90th percentile rank
– Range of scores by quartile
Comparison to Peer GroupPercentile Ranking
Quality ofCNA/NA care
Choices/preferences
Responsivenessof management
Attention toresident grooming
Adequacy of staff20
1
C DSE
CO
ND
AR
Y O
PP
OR
TU
NIT
IES P
RIM
AR
Y O
PP
OR
TU
NIT
IES
16
14
12
9
2122
18
6
FAMILYRESIDENT
11
20
1
1619
12
9
2122
18
6
11
Post Survey
» Identify Priorities for Improvement
» Root Cause Analyses
» Take Action
» Evaluate Effectiveness
» Communicate…
Thank you!
Questions? 715-848-2713