Page 47 - Tale of Transformation

Artifacts of Culture Change Categories and Items
Outcomes
Naturally occurring, unplanned positive outcomes have been experienced by many homes that have made these concrete changes, top on the list being reduction in turnover.
Turnover in nursing homes is high and has traditionally been high. Industry statistics show turnover to be 100% for CNAs, 66% for RNs/LPNs, 50% for Directors of Nursing and 25% for Administrators (IOM 2001).
Culture changing homes have experienced the opposite. Turnover at Providence Mt. St. Vincent reduced from 50 to 22% from 1992 to 2003. Big Fork Valley, formerly Northern Pines Communities, adjusted turnover rate declined from 52 to 13 % with the implementation of communities from 1999 to 2000. The communities celebrated 100% retention of all employees in all positions during the first 6 months of 2000, only three months after transition (Culture Change Now Vol. 1, 2001). Apple Health Care, a small privately owned nursing home chain having implemented culture change practices since 1997, experiences overall staff turnover rates at 30-40% compared to national rates as high as 70% (Ronch and Weiner, 2003). “Substantially reduced staff turnover” was documented in a three year study of two Rochester, NY culture changing homes (Dannefer and Stein, 1999, 2002, reported in CC for LTC, 2003).
In her studies of low and high service quality nursing homes, Susan C. Eaton has documented that for the traditional low-service quality model, aide turnover in usually exceeds the 100% industry annual average and reports that industry informants estimate turnover to cost $4000 per nurse aide (or three months’ wages) and has a negative impact on care. “The relationship of turnover to patient care is clear and well documented: higher turnover interrupts continuity of care and is associated with lower patient care outcomes (Harrington 1996 as reported by Eaton, 2000).
Although workforce stabilization was not the objective of Meadowlark’s embarking into a culture change journey in 1997, it is one of its significant - and early – outcomes with staff turnover plummeting from 80 percent to 30 percent in the first year and holding that range ever since (Wagner, 2005).
Retention translates into increased efficiency. Retention leads to better quality outcomes. Better quality outcomes lead to lower costs on average $13.50 less PPD and an annual savings (90 residents/day) of $440,000 (Rantz, 2003).
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