Innovative operational practices with real results
In the best-seller Good To Great, author Jim Collins describes Wells Fargo’s approach to developing its management team. In the 1970s, then-CEO Dick Cooley “began building one of the most talented management teams in the industry,” Collins writes. “Cooley foresaw that the banking industry would eventually undergo wrenching change, but he did not pretend to know what form that change would take. So instead of mapping out a strategy for change, he and chairman Ernie Arbuckle focused on ‘injecting an endless stream of talent’ directly into the veins of the company.”
It wasn’t until 1983 that Wells Fargo’s journey to “great” began, but the foundation had been laid long before. When the banking changes came, Wells Fargo weathered them better than any other bank, thanks to the team assembled by Cooley.
In studying the Best of the Best Award entries, it’s also interesting to consider where the great ideas originated. The senior living business has seen tremendous change—and the great ideas coming from senior living providers continue to change the way providers do business. Who knows what these ideas—generated by talented people—will lead to. What will come next? Do you have the right team in place?
And, what makes an operational practice great?
The winning operational practices in the ALFA 2007 Best of the Best Awards range widely from creative initiatives launched at individual communities to sweeping, companywide sea changes. But virtually every winning idea involves rethinking “tried and true” practices that, over time, can start to seem tired and stale—practices that, like the paradox of bureaucracy, can stall the very progress they are meant to make. Consider the following business challenges:
- How do you market to family caregivers leery of being marketed to?
- How do you breathe new life into a community’s sluggish sales and marketing effors?
- How do you move past routine activity offerings to truly motivate residents to keep learning and improving themselves?
- How can you get beyond the “trial by fire” tendency, and train new executive directors more intelligently?
- How can you encourage worker safety in such a way that virtually every associate will clamor to achieve it?
- How do you rethink the role that a senior care residence plays in the larger community so that the outside world comes to know and appreciate it in an altogether new way?
They’re all tricky questions in need of creative approaches by creative people. The 2007 winners clearly had the right teams in place to make positive change occur. Take a look at how nine companies tackled these challenges. And then hold up your company’s own “tried and tired” practices to the mirror.
Like many California-based companies over the past 15 years, Silverado Senior Living had seen steady and significant increases in workers’ compensation claims and costs. Despite efforts to keep safety on the forefront of employees’ consciousness, the frequency and subsequent costs of claims each year was reaching alarming levels. Meanwhile, continuing challenges in recruiting and retaining frontline workers threatened to undermine the consistency of safety training and practices.
Fast forward 12 months, and Silverado’s total workers’ compensation costs in 2006 decreased by more than 150 percent from the previous year, and by 350 percent when compared with the average total cost per year since 1999—despite significant increases in the number of employees and communities during that period. When the time came to renew workers’ comp insurance, carriers vied for Silverado’s business, and the company enjoyed a substantial refund from its existing insurer.
The key to Silverado’s turnaround success is an innovative safety incentive program that seeks to award prizes and gifts to every associate who demonstrates an ongoing commitment to safe practices. “We looked at countless safety award/incentive programs. Most of these programs only awarded a small fraction of the employee pool, which is not what we wanted,” Frank Russo, director of risk management, said in nominating the program for a Best of the Best award. “We felt that we would much rather pay our employees than pay claims.”
Through the “Safety Star” program, every active associate receives 10 safety stickers for every month they don’t have a workers’ compensation claim, and additional stickers for demonstrating a specific act of safety or for other sanctioned activities such as receiving training or having good attendance. Each sticker is worth about $1 toward their choice of jewelry, clothing, toys, electronics, and other awards in a 100-page catalog.
Silverado also established “SSL Safety Star of the Month” at each community to honor employees who demonstrated particularly outstanding safety performance, and a large trophy rotates every 30 days to the “Safest Community of the Month.”
In addition to improving safety and consistency and reducing claims, the new program is proving a financial winner. “We forecasted it to cost $105 per year for each employee. An average Medical-only claim costs around $1,250 and an average indemnity claim costs around $11,000. So if this program can eliminate just a handful of claims a year, it will prove to be cost efficient,” says Russo.
In recent focus groups, the Safety Star program also was cited as having contributed to an increase in job satisfaction. According to Russo, some frontline employees even saved up their stickers to buy toys and holiday gifts they couldn’t afford otherwise. “It would be an understatement to say the program was an instant hit,” says Russo. “The reaction of our caregivers was amazing. They could not believe that ‘even they’ were going to receive recognition and awards, too.”
Winner: Five Star Quality Care Inc.
Best of the Best Strategy: Marketing Initiative
Just One More
When Five Star Quality Care Inc. decided to do a campaign to attract more admissions to 35 underperforming communities, it could have set a single mandatory occupancy goal and issued top-down pressure for every community to meet it or else, but that’s not quite what it did. The company could have focused on sales and on closing deals, but it chose not to.
Instead, the big company adopted a strategy aimed at boosting the underpinnings of the “little things” that each community should be doing to position itself better and attract more sales. In the end, the marketing campaign, dubbed “Just One More,” succeeded in drawing 77 move-ins in 90 days last year, a 50 basis point improvement that brought in an estimated $2-2.5 million in annualized rent. As importantly, it helped jumpstart the marketing and sales departments in those communities.
“What we frequently find in a community off the mark in occupancy and sales is that they’re often not doing the little things, the ‘blocking and tackling’” that will bring more customers to their doorstep, says Doug Harper, corporate director of business development for the Newton, Massachusetts-based company. “The expectation was that at a minimum, we would generate measurable increases in occupancy and incentivize properties to do the little things they need to do to drive sales.”
While there is nothing new about encouraging basic marketing —such as hosting events and requiring the sales staff to achieve a minimum of phone-outs to prospects—Five Star Quality Care demonstrated a certain level of trust in the capability of the associates in the field to help the company turn around sluggish statistics. While the corporate office did provide a threshold of actions that communities must, at a minimum, agree to do, each community met with its regional team to devise its own “contract” with its own strategies.
For example, one region of continuing care retirement centers (CCRC) added an incentive rewarding the sales staff for successfully converting any resident who came in for a short-term skilled nursing stay to assisted living or independent living after rehabilitation.
Rewards ranged from special recognition and rankings on all communities scoring 95 percent occupancy or greater, to rewards for undertaking marketing initiatives, to progressively larger monetary rewards for every new sale that results in a net increase in residents.
The credit for accomplishments rests with the local communities who made their own efforts work. “What made people in the field excited was the recognition that this is not an edict. We did not roll out an ironclad program,” says Harper.
“We’re a company that’s grown fairly large and fast purely through acquisitions,” he adds. “What works at Morningside in Cleveland, Tennessee, isn’t in any set of circumstances going to work in a big CCRC in New Jersey.”
Winner: Sunrise Senior Living
Best of the Best Strategy: Marketing Initiative
Pick up a copy of Sunrise magazine in a local doctor’s office and the glossy cover draws you in with a smiling woman looking confident and capable. Splashy ads tout the likes of Lancome Paris and diamond jewelry. Various sections cover the range of expert advice that readers of women’s magazines have come to expect—health, nutrition, emotional, financial, and legal. But look more closely and what really commands attention is the fact that the magazine targets family caregivers.
“It’s a very, very soft sell,” says Jamison Gosselin, director of corporate communications for McLean, Virginia-based Sunrise Senior Living, which produces the new magazine. “It’s very far from a marketing magazine and more toward a general interest publication.”
Within its 60 pages are articles that seek to educate, entertain, and inspire that beleaguered, underserved demographic—women ages 40 to 64 who are caring for aging parents. Thus, squeezed between gardening advice and “8 tricks to stay organized forever” are articles by experts on “How to say ‘No’ without the guilt” and “Inner Strength” (“Get in touch with yours”) and “Loving a parent with Alzheimer’s.” There are ads for Ford Mobility Motoring, emergency call systems, and The American Diabetes Association.
And Sunrise Senior Living, of course. According to Gosselin, the magazine helps Sunrise court an audience that may already be dealing with the emotional side of caring for parents and needs to know about the intricacies of senior care options, but isn’t quite ready to be overtly marketed to. “The challenge we saw was trying to address various emotional and informational needs without hammering them over the head with marketing,” he says. About 600,000 copies are printed in the United Kingdom, where it is produced, and distributed to Sunrise communities, family members, referrers, and leads.
Measuring any quantitative benefits of Sunrise will take time because the magazine is still new (the third issue was due out last month) and because it is a softer, longer sell. But so far, the buzz from the field is good. It clearly helps Sunrise advance its brand and reputation, while readers are passing the magazine along to friends who need it, says Gosselin. “A lot of doctors don’t want marketing materials in their offices anymore, but they will take something like this,” he adds.
Winner: Brandywine Senior Living
Best of the Best Strategy: Technical Innovation
Whether it’s the COO considering a change in the company’s operations, an executive director mulling over staffing levels, or a nurse monitoring individual residents’ care, better decisions are made when the available information is up-to-date, accurate, and complete. But is there a single commercially available data-tracking system for senior living communities that can track it all?
Brenda Bacon, for one, gave up the search two years ago and had her company come up with its own. “We did look at a lot of tracking systems and there are a lot of excellent features,” says the president and CEO of Mount Laurel, New Jersey-based Brandywine Senior Living Inc. “We could not find a tool that measured to the level we wanted, in real time, in a way that was actionable.
“We didn’t just want a retrospective of last month’s data. I want to know right now what’s going on out there,” she adds.
Bacon’s impatience paid off about 18 months ago with the development of the proprietary Assisted Living Virtual Information Network (ALVIN), which aims to be the ultimate multi-tasking operational measurement tool. From the moment a relationship is started with a prospect, a computer profile is launched for the potential resident that will track his/her profile throughout the sales courtship, initial move-in assessment, and ongoing care monitoring, right up until move-out. Access to ALVIN is available across departments, which can lead to more individualized attention and consistent care.
Individually, communitywide and companywide, ALVIN enables the coding of prospects (as hot, warm, cold), and of the care level of residents. At any time, Bacon can call up summary pages that trend the acuity levels at any given community, as well as census levels, resident demographics, the progress of sales and leads, staffing levels, and so on, which can lead to better operational decisions. For example, if the total acuity level score suddenly spikes at a particular community, staffing can be augmented to meet the higher demand. “It’s about making sure we’re capturing the service needs of the building, that we’re charging appropriately, and staffing appropriately,” says Bacon. Likewise, at budget time, Brandywine can project staffing and other costs based on the tracking of acuity levels and not just census.
Bacon attributes the software’s success to the fact that the operational team sat down with the internal information technology team to hash out what would be truly useful and user-friendly. “When you’re working with an outside IT company…they might not ‘get it’ as much as my guys do,” she says.
Winner: Brookdale Senior Living
Best of the Best Strategy: Performance Management
Dining Services Training & Internships
For about 10 years, Brookdale Senior Living has had an international internship program that accepts young professionals currently enrolled in their last year of culinary or hotel school. “We get incredibly talented people from European hotel schools,” explains Joska J. W. Hajdu, senior vice president of dining services.
The students round out their skills at some of Brookdale’s 547 communities, while contributing their own enthusiasm and talent. However, after that, most return to their home countries to finish school. Only a few end up returning to work at Brookdale, where they generally excel in dining and hospitality management.
Meanwhile, Brookdale noticed an undertapped source of potential management talent already in its own communities. The Chicago-based company needed a way to develop domestic kitchen and hospitality associates who showed particular promise for leadership positions. “Some employees wanted the opportunity to flourish,” says Hajdu. “It may just be a waiter who wants to become a manager.”
Thus was developed a new management training program, somewhat parallel to the international program, that is open to Brookdale associates who are nominated for their excellent performance and management potential.
The domestic program is 18 months—eight months longer than the international internships. To begin, participants go through a week of in-depth training at the company’s Chicago headquarters, followed by three weeks of intensive, hands-on training at a Brookdale partnership community. After that, participants are assigned to a Brookdale community for varying lengths of time, from a few days to a few weeks. Associates fill in for dining service line positions, and as they master skills and show exceptional performance, they are assigned to higher-profile roles.
Following the success of its pilot version, the new domestic program has enjoyed tremendous interest within Brookdale. The domestic program often has more applicants than it can accommodate. “We get the absolute best-trained managers out of the program. I literally get communities fighting over the graduates they get,” says Hajdu.
Between the international program and the domestic version, the quality and consistency of dining services has risen, and with it, resident satisfaction. “You’ve got this team of experts that are constantly out in the field.”
That’s a great position for any company to be in, particularly in a business where staffing shortages are frequent. One of the interns or trainees can fill in when a key manager is missing. “We are growing and developing our own talent,” says Hajdu. “We can create our own flow of candidates.”
Winner: Benchmark Assisted Living
Best of the Best Strategy: Performance Management
Executive Director in Training Program
A few years ago, Benchmark Assisted Living would initiate a new executive director by having her shadow an existing executive director for a few months. While that process gave a decent look at what the business was like from the director’s chair, it also had its limitations.
If a new hire happened to be trained in a community with a strong sales program, he or she would get a strong foundation in sales, but not in that community’s other, weaker areas. This reality made for a steep learning curve when new hires assumed their new posts. “It was more [trial] by fire,” explains Jessica Cunningham, learning and development manager. “You were just being pointed in the direction, but you didn’t get your legs under you for understanding the business.”
Thus was born Benchmark’s intensive new Executive Director in Training (EDIT) program. After a month spent learning about assisted living at the corporate headquarters in Wellesley, Massachusetts, incoming hires rotate through several communities, six weeks at a time, gaining experience in the different departments. Along the way, they absorb differences in leadership styles, culture, and people, while completing self-guided modules in finance, sales, and so on.
Only after running that gauntlet do EDITs shadow a particular executive director for a period of about three months. By that time, the program participants have a strong sense of all facets of the business, and have the added benefit of being a known quantity to the company as well. The candidate is paired with an executive director who seems a good match for rounding out his/her skills, before moving on to assist the director of operations at another community for a few weeks. The whole training program can take up to a year to complete.
The program has the advantage of being very flexible as to both the personality and the experience level of a new hire. Internally promoted hires are able to forgo aspects of the training with which they already are familiar, and Benchmark creates a pipeline of highly trained, invested executive directors. “They’re learning it from the front end, instead of having to fix things later,” says Cunningham.
“Ours is a structured development plan designed to the particular person. We can adapt it to the needs of the business and that person,” Cunningham says. “Internally, folks who were developed the old way, a number of them have commented they’re jealous.”
Winner: Emeritus Assisted Living
Best of the Best Strategy: Clinical Quality
Brain Health Initiative
Recent research suggests that the brain has a greater capacity to keep learning in old age than previously believed, and that brain health responds positively to a healthy, active, mentally stimulating lifestyle. This is good news for anyone interested in slowing cognitive decline, and several senior living companies have seized the opportunity to offer their residents a computer-based course for brain fitness.
Now Emeritus Assisted Living is taking its collective “brain power” one step further by promoting brain health on all levels of the company—for residents, families of residents, staff, families of staff, executives, and the larger communities in which the residences operate. “Brain health is not just a computer program, it’s about making a cultural shift, a lifestyle change,” says Chris Guay, divisional vice president.
The Seattle-based company’s own interest in brain health started when neuropsychologist Paul Nussbaum Ph.D., a leading brain health expert, spoke on the topic at an AARP conference a few years ago. Emeritus, in partnership with Nussbaum, developed a program that offers education and activities in five critical brain-enhancing domains: socialization, physical activity, mental stimulation, spirituality, and nutrition.
So far, the company has adopted these brain-healthy activities into the daily life of 10 communities and the corporate headquarters. Under the program, recommended brain-healthy activities range from walking clubs to learning a musical instrument, taking time out for spiritual reflection, and eating more fish and walnuts. Several Emeritus buildings offered brain health fairs for the larger community that also resulted in inquiries, tours, and referrals. One Emeritus community committed to wearing pedometers at work with a goal of walking 10,000 steps a day.
“One of the things we’re battling in the senior living industry is we’re dealing with seniors sometimes who have given up and don’t think they can learn anymore,” says Guay. While practicing brain fitness through a computer program might have intimidated some 90-year-olds, he says, Emeritus’ own holistic approach is catching on. “Long term, it will help people age in place, better help the overall health of residents, better help the overall health of staff. It’s going to improve the energy level of the communities, the day-to-day energy of the community. “It’s our vision to improve quality of life for residents and staff, and down the road, if we really can improve our residents’ lives, we hope to see our length of stay and employee satisfaction really increase,” he adds. “That’s what we’re betting on.”
Winner: Carlton Senior Living/Carlton Plaza of San Leandro
Best of the Best Strategy: Clinical Quality
Diabetes Intervention & Education
In 2004, Carlton Plaza of San Leandro, California, realized that one of every 10 move-outs were needlessly lost to skilled nursing because the 152-unit independent and assisted living community was not structured to handle residents with diabetes. Carlton Plaza had a licensed vocational nurse on board, but was not otherwise prepared to meet the needs of that disease.
Something clearly had to be done. “Definitely, diabetes is on the rise in the country. I didn’t feel we should turn away people just because they have diabetes,” says executive director Nancy Randhawa. As a result, Randhawa formed a task force to create a diabetic management program. “With just a little bit of knowledge, education, and training for the staff, we are able to manage, and assist the residents in managing,” their diabetes, she says.
Through the program, the community partnered with physicians and health-care providers to learn about medical intervention and treatment. They increased their health-care services for diabetics, changed their traditional three-meal dining schedule to five diabetes-friendly meals plus a nighttime snack service, introduced more physical fitness programs, and started monthly support groups for diabetics.
That turned out to be just the beginning. Physicians and families started to seek out Carlton Plaza for assistance and information for older persons who have diabetes. Randhawa saw an opportunity to expand the residence’s role in the larger community, by offering much-needed public health education about diabetes. In March of 2005, the residence—conveniently located just across the street from city hall—presented the city of San Leandro with the first annual diabetic convention.
About 150 people, including residents, family members, healthcare providers, and citizens, attended the convention, where they found a range of information, health checks, demonstrations, and speakers offered in partnership with health-care providers and pharmaceutical companies. “The first health fair just really spread the word…that we were doing something about diabetes,” says Shamila Chand, retirement counselor, who helped organize the effort. “People came in and said, ‘Oh my gosh, you’re a senior community?’”
The successes from the annual fair and ongoing diabetes management program are still being counted. The community’s diabetes support group attracts attendees beyond residents and family members, and the community has seen direct results in new leads and referrals, including an increase in referrals for diabetic seniors from health-care professionals and from competitors who are unable to help them. No residents with diabetes have been lost due to higher care needed since the last diabetes-related move-out in November of 2005, a date Chand remembers well. “I can remember the resident’s name because it was heartbreaking for me,” she says.
Winner: Kisco Senior Living/Woodland Terrace
Best of the Best Strategy: Residence Services
Transitional Student Volunteers
Woodland Terrace, a Kisco Senior Living community in Cary, North Carolina, has initiated a business partnership that won’t necessarily increase revenue, cut costs, or affect census. Yet the so-called “Innovations in Teamwork” has turned out to be a win-win of a different kind. In this case, it’s the residents and participants who profit.
Three times a week, Wake County high school students with slight to moderate disabilities arrive on school buses to spend a few hours helping out in the memory care unit. The volunteers arrive with a teacher/life coach who supervises them as they assist the staff and residents with simple jobs. They work in various departments, building career and life skills such as folding laundry, serving food, delivering mail, and interacting with residents and staff.
“We’re always open to try and partner with the community, to network with the community to help integrate our seniors,” says executive director Tom Ford. “We get to have volunteers, and they’re getting life skills and job skills.”
The program started last fall when a representative of the county school system approached Ford. After many conversations and a site visit, Woodland Terrace provided a list of seven tasks that the teenagers could assist with, and several high schools took up the invitation. Similar partnerships had already been successful at other area businesses, but this was their first opportunity at a senior community.
The community’s staff was at first a little apprehensive that the program would create more work for them, but the program soon became integrated into the daily life. Whenever a student sweeps a floor or scrapes a dish, it frees a caregiver to do more caregiving.
Residents have responded favorably. There are a fair number of teachers among them, and even more grandparents/great grandparents whose grandchildren live too far away for frequent visits. “This allows them to have that type of interaction,” notes Ford.
For their part, the students have learned career skills, but also that they can make a difference in residents’ daily lives, from remembering to smile, to sharing a walk, to helping to decorate the community for holidays. Students have been known to help residents back to their apartments or help a resident get a glass of milk, unasked. “Their kindness toward the residents, that’s not directly taught. It’s something they took upon themselves,” says Allison Hinz, a Garner High School teacher who works with the students.
Students and residents miss working together when school is on vacation. The program “gives our residents with Alzheimer’s some normalcy,” says Trudy Croxton, assistant wellness director, “and teaches students social norms beyond home and school.”
Whitney Redding is a contributing writer to Assisted Living Executive.
Contact information for members in this article.
• Brenda Bacon
• Shamila Chand
• Trudy Croxton
• Jessica Cunningham
• Tom Ford
• Jamison gosselin
• Chris Guay
• Joska Hajdu
• Doug Harper
• Nancy Randhawa
• Frank Russo
• Jeff Slichta
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