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Is this any way to run an airline? - long-term care providers

Nursing Homes - May 1, 1996

Top companies' lessons for long-term care training

The story of the U.S. economy for the past forty years has been the shift from a manufacturing to a service economy, and those companies that have understood that this requires an entirely new approach to training front-line workers have met with resounding success. Companies like Southwest Airlines, Ritz-Carlton, Target Stores, and others have a great deal to teach the long-term care industry about developing a stable frontline workforce and creating a culture of success.

With some notable exceptions, training programs in long-term care derive from the old manufacturing model. Geared to teaching discrete mechanical skills, they treat the work of caregiving staff as a series of defined tasks. Often providers have taken a reactive stance toward regulations and have implemented training programs that amount to little more than "studying for the test," and which yield similarly disappointing long-term results. A look at how other industries have broadened their conception of training can be very instructive.

Perhaps at first glance an airline doesn't seem to have much in common with a long-term care provider, but look again. Both are very highly regulated industries. Both employ many workers who do not have college degrees. Both need to train employees to perform many technical procedures flawlessly. Both are in the business of taking care of vulnerable people (and who is more vulnerable than a traveler at 30,000 feet?).

Southwest Airlines, among the most successful companies in air travel, designed a training program that has been replicated, with modifications, throughout the entire airline industry. As a result of a study, jointly conducted by NASA and Boeing, that showed that up to 80% of aviation accidents are due to human error, Southwest set about revamping its entire training program. The NASA/Boeing study had concluded that most accidents are not the result of a lack of technical skill, but of poor teamwork, ineffective communication, fatigue and faulty decision-making. Some might find another area of similarity here between nursing homes and airlines.

At Southwest, training became Crew Resource Management, or CRM, and in response to the NASA/Boeing study, its scope was broadened to include team-building, communication, workload management and decision-making. They decided that the entire crew, including both ground and flight personnel, with the pilot as crew leader, would be considered the "job performer," not just the individual. Not only has the airline's safety record remained flawless since the inception of the program nearly 25 years ago, Southwest has enjoyed other dividends as well, including better employee morale, reduced turnover, greater customer satisfaction and loyalty and, of course, increased profits.

Similarly, Ritz-Carlton became the acknowledged leader in the hospitality industry by fashioning a training program based on the idea that the front-line worker is the most important person in the entire organization. Horst Schulze, COO of Ritz-Carlton, sees training as an investment, not an expense. "You are more important to customers than I am," he tells employees. Of their training program he says, "We are developing people who can become much better contributors."

Again, there are parallels between industries. Both hotels and nursing homes are almost entirely dependent on the performance of their frontline workers. In both industries, the point of contact between the entire structure of the organization and the customer is the frontline employee. Both industries are plagued by the frustrating and costly problem of recruiting and retaining employees - in the hospitality industry, the average annual turnover rate is nearly 100%. Regrettably, both industries are often plagued with the same counter-productive attitude toward turnover: Many hoteliers, like many nursing home administrators, use the fact of turnover to scoff at training, i.e., "Why should I spend money training people who are just going to leave anyway?"

As it happened, in addition to improving customer service and therefore increasing profits, the Ritz-Carlton program significantly reduced turnover. In fact, as the program evolved, stabilizing the workforce became a primary goal. "Today in the hotel industry, the employee has a choice of jobs," says Schulze. "Pragmatically, we want to hold on to our employees because changing one is very, very expensive." Certainly, this is also true of the long-term care industry. One rule of thumb many service industries apply to measure the cost of employee turnover is that replacing an employee costs four times the monthly salary of the position. Ritz-Carlton's experience indicates that even a longstanding retention problem will respond to a comprehensive, people-oriented training approach.

Target Stores, a middle-market retail chain, experienced a 30% decrease in staff turnover after completely revamping its training program. Their approach, a training program called Fast, Fun and Friendly, is based on a model developed by Walt Disney Productions, the undisputed front-runner in the service sector when it comes to innovative training. Fast, Fun and Friendly focused on team-building, customer service, and another area that nursing homes grapple with - work readiness, including literacy. Target made a commitment to developing the workforce it wanted. It invested in employees' development - and Target is among the fastest growing retail companies in America.

These and similar programs are built upon several important concepts they hold in common:

1. Training must be ongoing - "a process, not an event." Single events, such as seminars or off-site training sessions or instructional videos, are excellent for introducing or refreshing ideas. But successful companies have learned that only ongoing training can change attitudes and behaviors. Ongoing training may be the most powerful weapon there is against turnover. It lets staff know that you are mindful of them even when there isn't a crisis. It speaks clearly about your commitment to invest in them as a resource.

2. Training must be designed from the employee's perspective. It has been said that the further you are from the front line, the less you know about what's really going on. Too many companies invest in training programs that are seen as extra work by employees, or in producing massive manuals that staff prefer to use for doorstops. Ask your staff what they need to know to work more safely, intelligently and proudly.

3. Training must be conducted in an atmosphere of respect. Treat your employees exactly the way you would like them to treat the residents. "The level of service our front line is willing to give a customer is identical to the type of service they perceive they're getting inside the organization," according to Southwest Airlines' corporate director of training, Jeff Sullivan. Horst Schulze's assertion that his frontline employees are more important than he to the customer is even more true in the nursing home. Everything depends on your frontline workers: survey results, liability issues, quality of care, image in the community, profitability.

4. Training is a two-way street. All the classroom training in the world, all the seminars, the on-the-job training, the inservices, are useless if employees are under so much stress that they can't take it in. Successful companies know that these days the worlds of work and family are interdependent, and employees who can effectively balance the demands of both are better performers (not to mention more grateful, satisfied and loyal).

5. Training must empower. Management consultant Ken Bruder of Kaiser Associates says that good training programs create well-rounded, competent frontline employees, each of whom is empowered to handle whatever problems come up. A Navy veteran, he compares good training to the kind submarine crews receive. "When you're underwater and something goes wrong, you don't have the time to go from one end of the ship to the other to find the person who's responsible."

Ritz-Carlton employees are not only empowered to solve problems, they are expected to. If an employee fields a complaint from a customer, he or she "owns" that complaint until it has been resolved to the customer's satisfaction. This doesn't mean that the employee has to act on his or her own, but he or she can't pass the buck, either. Anyone who has ever been told "Sorry, that's not my department," or "Wait while I go get my supervisor," can see the merit of this approach.

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