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Recipes for Staffing Transformations


Getting Started: Before you choose your ingredients and start cooking, it's important to examine the core elements of culture change as the foundation for your transformation. Core practices of choice,
relationships and creating home are the "ingredients" that are necessary for your implementation recipe and at the heart of any culture change implementation. We found some great resources to get
you started on examining these core ingredients in your organization. Choose one or more, but don't miss out on this most important preparation step. It's the KEY to your success!

Get Cooking with Your Staff: Once you've explored the core ingredients in your organization, it's time to get cooking. This is the opportunity to explore the supportive practices for your staff that will help maintain choice, relationships and creating home for residents. For the Staffing Transformations Toolkit, we have a few ideas to get you started. Some are easier and some are harder. Or, maybe,
you'll want to go a completely different direction. Just like browsing through a cookbook, these thoughts just may provide the inspiration that moves you forward in your planning process.

TOOL (Source) - Click link to connect to resource
A Case for Consistent Assignment (Provider)   Δ  Δ
Advancing Excellence Resources for Consistent Assignment (Advancing Excellence) 
  Δ  Δ
Artifacts of Culture Change (Centers for Medicare & Medicaid Services)  Δ 
Better Jobs Better Care (LeadingAge) 
 Δ  Δ
Engaging Staff in Individualizing Care: An Implementation Handbook Δ  Δ 
Champions for Care (Action Pact) Δ  Δ 
Coaching Supervision: Introductory skills for supervisors in home and residential care (PHI)   Δ 
Consistent Assignment – Excerpts from Institutional to Individualized Care Part One
(Centers for Medicare & Medicaid Services)
 Δ  Δ Δ
A Communication Map for Engaging Staff in Individualizing Care Δ  Δ Δ
Starter Toolkit for Engaging Staff in Individualized Care Δ  Δ Δ
Core Competencies in Medical Direction (AMDA)   Δ
Culture Change and Staff Education Modules (Kansas PEAK Nursing Home Initiatives) Δ  Δ Δ
Getting Better All the Time: A Guide for Nursing Home Staff (Cobble Hill) Δ  Δ
Getting Started (Pioneer Network) Δ 
Implementing Change in Long-Term Care: A Practical Guide to Transformation
(University of Wisconsin-Madison and The Commonwealth Fund)
 Δ  Δ  Δ
Meeting the Leadership Challenge in Long-Term Care (Farrell, Brady & Frank) Δ  Δ 
MDS 3.0 National Learning Collaborative Webinars (Pioneer Network) 
Nurse Competencies for Nursing Home Culture Change
(Hartford Institute for Geriatric Nursing and Pioneer Network)
 Δ Δ
Path to Mastery (Eden Alternative) Δ  
Pioneer Network Case Studies in Person-Directed Care (Pioneer Network) Δ  Δ Δ
Planetree and Picker Long-Term Care Improvement Guide (Planetree) Δ  Δ Δ
Staff Stability Toolkit (Healthcentric Advisors, formerly Quality Partners of Rhode Island)  Δ  Δ  Δ
Training Guide for Self-led Teams by LaVrene Norton, Action Pact Workbook 


We investigated the staffing transformation process and we found that no regulations prohibit these changes. In fact, many of these initiatives support the Federal Centers for Medicare & Medicaid Interpretive Guidelines for F-241 Dignity and F-242 Self Determination and Participation. Without regulatory barriers, the focus of change should be on the results for residents and staff. We've highlighted a few initiatives and documented examples of impact below.

Consistent AssignmentReductions in turnover, increases to longevity, and improved staff
satisfaction (Pioneer Network Case Studies in Person-Directed Care, 2011)

CNAs "permanent assignment" is correlated with high quality of life (Kane, Rosalie A., et al. Measures, Indicators, and Improvement of Quality of Life in Nursing Homes: Final Report. Submitted to Centers for Medicare and Medicaid Services. June 2004).

"Particularly for residents with dementia, continuity of relationship with direct caregivers is important" (Wunderluch and Kohler, editors. IOM Committee on Improving Quality in LTC. Improving the quality of LTC. Washington D.C., 2001).

Findings: Rotating staff made CNAs feel less valued for their skill, experience and knowledge of patients (residents). CNAs defined good care giving as based on the establishment and maintenance of good relationships with residents. CNAs felt any disruption to these relationships was detrimental to the quality of the care provided and the quality of residents' lives. (Barbara Bowers -  "Turnover Reinterpreted: CNAs Talk About Why They Leave" Journal of Gerontological Nursing Vol. 29, Issue 3, 36)
CNAs attend care conferences
Recent research has confirmed that facilities where CNAs participate in care planning have lower rates of turnover compared to facilities where they do not. (Eaton, Susan C. Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes. Phase II Final Report, 2001).
Self-scheduling of work shifts. CNAs develop their own schedule and fill in for absent CNAs. CNAs independently handle the task of scheduling, trading shifts/days, and covering for each other instead of a staffing coordinator
"There was concern that employees would not work as hard as to find others to cover their shifts once the incentive program ended. However, after a year of self-scheduling, there were no uncovered shifts by the CNAs. We also implemented self-scheduling for our nurses, and after nearly a year, there have been no uncovered shifts by our LPN/RN nursing staff…. Our experience indicates that nursing personnel who take pride in their work are less stressed, knowing that they will not be short-staffed. " (Self-Scheduling for Nursing Assistants: A Pilot by Donna Howard and Donna Blackburn, LeadingAge).
Reduction or elimination of agency staff
Significant reductions in costs for agency - $1.5 million decrease documented in Teresian House Case Study (Pioneer Network Case Studies in Person-Directed Care, 2011)

Measuring Results
We recommend that you access these resources for examples of tools and spreadsheets to measure
outcomes of staffing programs.

Staff Stability Toolkit (Healthcentric Advisors, formerly Quality Partners of Rhode Island)

Meeting the Leadership Challenge in Long-Term Care (Farrell, Brady & Frank)

Download Just In Time Toolkit - Recipes for Staffing Transformations