Customer Second—Staff First

Pacific Care and Rehabilitation Center’s philosophy for leadership “Customer Second—Staff First” may seem counter-intuitive to patient-centered care. Yet the AHRQ Nursing Home Patient Safety Culture Survey scores for this 100-bed skilled nursing facility located in Hoqiuam, WA are among the highest in the nation. What leadership practices led to such positive staff perception of organizational learning (98%), teamwork (86%), supervisor expectations and actions promoting resident safety (89%) and feedback & communication about incidents (98%)? A surveyed employee declared, “Management is top notch and wonderful to work with.” Here are a few ways in which the management team is highly visible, supportive and actively sets expectations for standard processes, transparency and a culture of safety.

• Use of technology. The administrator Michael Clegg purchased radios with headsets for all nursing staff to decrease noise from overhead pages and to make it easier for staff to communicate. Staff reports it is easier to get assistance with tasks and has decreased stress levels. Use of radios raises the level of accountability for all. Ken Nelson, RN, Staff Development Coordinator, describes crunch times when many may ask for help at one time, “If an aide asks for help and is met with silence, an emotional tension is created. Leadership will step in to support the team. Without the radio, I might not recognize a problem until it is too late and someone bursts into tears.”
• Guardian Angel program with checklists. All managers are assigned to a resident as a guardian angel. When they visit their resident weekly, each angel uses an evaluation checklist customized for non-clinical or clinical employees. Checklists cover items like infection control, clutter, personal care and emotional well-being. The administrator reviews these checklists and follows-up with any concerns.
• Briefs. In addition to the morning manager “stand-up” meeting typical of most nursing homes, the entire nursing staff holds a brief around the nursing station at the start of every shift. The Director of Nursing or Nurse Manager (day shift) or charge nurse (evenings/night shift) facilitates these 5-10 minute briefs to help the teams prepare logistically and mentally for the shift. To ward off tunnel vision focused merely on a list of tasks, the brief starts with the mission statement and a staff tribute “Moment of Truth.” They discuss expected discharges and admissions, significant change of resident conditions, staff changes or absences and other critical information. Julie Wakefield, RN, Director of Nursing, explains, “We want to focus them on our broader mission as well as brace and encourage them for the day.”