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Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere
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Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere

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Successful communication can be the factor that “makes or breaks” the interdisciplinary team in the SNF, and is the difference between a workplace you WANT to be in and a workplace you HAVE to be in! …

Successful communication can be the factor that “makes or breaks” the interdisciplinary team in the SNF, and is the difference between a workplace you WANT to be in and a workplace you HAVE to be in! The presentation details how effective communication skills, both within your own department and with other departments, can positively affect clinical outcomes and customer satisfaction in the SNF. Learn valuable techniques that will engage staff from all departments and disciplines with the vision of the organization, pulling the team together to work toward a common goal—excellence and the highest level of customer satisfaction. The presentation discusses workplace bullying and demonstrate techniques to eliminate this stressful and team-crushing problem. Key strategies for using the employee annual evaluation as an evidence-based tool for discussion of accomplishments and areas with opportunity for improvement is highlighted. Learn strategies for successfully managing difficult employees and learn how good communication can be the ultimate team-building exercise.

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  • I believe that this quote speaks to the positive outcome of good communication so eloquently. When a person leaves an interaction with you they may not remember the particular details of the conversation. What they will take away is the memory of how you made them feel during the interaction. People often judge you based on how you make them feel.
  • Sound familiar?
    Have you ever worked here?
    These are statements that frustrated and unhappy employees may make. During todays presentation we will explore some strategies to communicate with your staff more effectively. This will increase their satisfaction, and that satisfaction will trickle down to your customers.
    How does it affect customers? (transition to next slide)
  • If our employees are frustrated and angry our customers will notice. Your front line staff spends more time with your customers than anyone else.
    It is a worthwhile time investment to communicate effectively with your staff. It will make your customers experience better. Employee retention and employee loyalty will increase. Your organization will develop a good reputation as a nice place to work and a nice place to live.
    Effective communication has numerous benefits (transition to next slide)
  • Connect with others—when others learn that they can trust what you say (ie, what you see is what you get) and that you can guide them toward doing a better job and therefore having their own personal success.
    Express what you really mean—you will be able to tell your employees honestly what you need from them in order to have success for the whole team. This may not necessarily jive with their own personal interests, so you will need skills to persuade them to give up their personal gains in order to contribute to the gains of the collective. This takes a lot of skill!
    Navigate challenging situations—you need to practice these skills in smaller-stakes situations so your skills are honed when the larger challenges come along.
    Build better relationships—when a staff member realizes you are willing to bear with them feeling angry at you in order to tell the truth (and thereby benefit the organization) you will earn their respect that you are willing to sacrifice your own personal interests in favor of the organization. This builds respect. Talk about my family members who will tell me the truth even if they know I am going to get mad at them for what they said. This shows a true respect for a person—being willing to risk them being mad at you so you can help them to succeed as an employee.
    Earn respect and loyalty of your team—see above point.
  • Connect with others—when others learn that they can trust what you say (ie, what you see is what you get) and that you can guide them toward doing a better job and therefore having their own personal success.
    Express what you really mean—you will be able to tell your employees honestly what you need from them in order to have success for the whole team. This may not necessarily jive with their own personal interests, so you will need skills to persuade them to give up their personal gains in order to contribute to the gains of the collective. This takes a lot of skill!
    Navigate challenging situations—you need to practice these skills in smaller-stakes situations so your skills are honed when the larger challenges come along.
    Build better relationships—when a staff member realizes you are willing to bear with them feeling angry at you in order to tell the truth (and thereby benefit the organization) you will earn their respect that you are willing to sacrifice your own personal interests in favor of the organization. This builds respect. Talk about my family members who will tell me the truth even if they know I am going to get mad at them for what they said. This shows a true respect for a person—being willing to risk them being mad at you so you can help them to succeed as an employee.
    Earn respect and loyalty of your team—see above point.
  • Your staff are always watching you and your behavior can be a big influence on their behavior. As you communicate with them, be conscious that you are modeling the communication behavior you would like them to have with each other and your customers.
    Last bullet—this is not to say that staff will always feel good after they interact with you. Maybe it is a heavy-duty discipline session where behaviors need to be addressed. But many staff will base their judgement on how they see you day-to-day, and if you address their concerns adequately and follow up with them.
  • Non-verbal communication can’t be faked. You can learn to modify it in yourself and read it in others, but there will always remain some aspect your own that you are unaware of or is involuntary. Think of an excellent poker player—they know how to read others and how to school their own reactions, but somebody always comes along who can figure out their “tell”.
    You may be familiar with advice on how to sit a certain way, steeple your fingers, or shake hands just so in order to appear confident or assert dominance. But the truth is that such tricks aren’t likely to work (unless you truly feel confident and in charge). That’s because you can’t control all of the signals you’re constantly sending off about what you’re really thinking and feeling. And the harder you try, the more unnatural your signals are likely to come across. And that just makes both parties feel really awkward!
    This is why it is so important to manage and lead others well. So your communication will be sincere, both verbal and non-verbal. Please don’t misinterpret my use of the word “sincere”. What I mean is, when your staff is well managed and has the vision of the organization they will be less likely to want to pay attention to the small stuff that kills an organization like gossip and backbiting. You as a manager are key to setting that tone and by doing so you will be less frustrated with your staff and less likely to send negative non-verbal communication to them that they may respond negatively to.
  • Talk about playing with your cell or checking email while someone is talking to you. When did this officially become socially acceptable and not incredibly rude? If you set clear parameters with staff about how to approach you with their questions and concerns and are not afraid to be honest with them when they are over the top you will not feel as though you have to “dodge” that staff member who always has a complaint.
    Pretend that at the end of the conversation you are going to get a quiz on what was said. This may keep your mind from wandering off to the next meeting you need to attend or the next deadline that must be reached.
  • Talk about Ronald Reagan, known as the Great Communicator. His speech about “The Evil Empire” is famous—those behind the iron curtain who heard him speak knew that the leader of the free world saw their plight
    His summary of strategy for the cold war: “We win, they lose”.
    “Mr. Gorbechev, tear down this wall” was deleted from his speech numerous times, and he kept putting it back in.
    As Reagan himself used to say, he wasn't successful because he was a great communicator. He was a strong leader because he communicated great things.
  • Many behavior problems stem from an inability of the patient to express themselves—leading to frustration—leading to bad behaviors.
    “What we have here is failure to communicate.”
  • There is a reason why solitary confinement is punishment.
    Non-verbal communication and tone of voice is more important than the words spoken (“nice shirt”) We will talk more about non-verbal communication later in this presentation.
  • Patient at Aug Conv who was a Catholic School Dorm Mistress—swore like nobody I have ever seen.
  • Comfort and reassurance—but do not be condescending.
  • Use the quick exit when needed…when you come back they may not even remember your last interaction…fresh start!
  • “My family hates me and has left me here and will never come and get me ever again!”
    Dealing with the facts may not be effective—how do you prove that the family does not hate them? What if they do hate them? Maybe they will be in a car crash and really never come back.
    Deal with the emotions…”I can see you are upset. It must be frightening to be staying in a place you have never been before. I am ______and I have been here a while. Let me show you how things go here/where your room is/where we eat/etc.”
  • Customer service is one of those phrases that gets thrown around a lot. Because we use it so much it almost makes the meaning of it innocuous. We all like to talk about it and then it becomes one of those catch phrases that everyone says, but nobody can really “nail down” if we are doing it. Customer service can’t be defined by what you may think it is in one particular moment, it has to be defined by the entire organization and then everyone follow the model. It is not a relative term up for individual interpretation.
    If you were to google customer service you would come up with 100 definitions—all different and all the same. This is a paraphrase of many of the definitions that I found in my research and I think it sums it up nicely.
  • Trust and loyalty—the patient and their significant others come to trust you when you do what you say you will do and don’t try to do what you cant. Meaning, if they have a problem with something that is not your responsibility or authority you refer them to the person who can help them the best. Show you are interested in their issue and then help them to the person who can best address that issue if it is not you. Loyalty to you coworkers means not throwing others under the bus when there is a complaint but instead work with the patient to get the best and quickest resolution to the problem. This will inspire loyalty for the facility from the customer.
    Sacrifice and serving—We cant forget that our jobs are service. We are providing a service that the customer is paying for. We need to provide that service.
    Do what you say you will do—People will sometimes “overpromise” to attend to something that is not in their scope of duty, and then they can’t provide the service. The best way to avoid this is to know what you are responsible for and know when you are not qualified or authorized to do something…and if that is the case help the customer to the person who is the most qualified to take care of that particular issue.
    Customer needs first—again, we are here for service.
    Dignity is extremely important. The definition of dignity is “Dignity—the state or quality of being worthy of honor.” Everybody, from the highest ranking dignitary to the person with the lowest social standing all want to be treated with dignity. And when we know we are not being treated with dignity we react in a negative manner toward the person who is not giving us that respect. If you take nothing else home from this presentation
    If you asked any organization (healthcare, business, food industry…anything) they would agree that these are some of the goals of good customer service. The elusive issue becomes---how do we practically apply these noble principles into our daily operations? When we are working short? When the power is out? When a visitor is causing a scene at the nursing station?
    These scenarios are precisely why a “quick fix” learning seminar is not the final answer, because…
  • We have seen how important the family member’s input is on the QCLIs. What you should take away from this is that you are always being watched and observed by the residents and visitors in your facility.
    What kind of impression are you making?
  • We have seen how important the family member’s input is on the QCLIs. What you should take away from this is that you are always being watched and observed by the residents and visitors in your facility.
    What kind of impression are you making?
  • Facial expression—smile, smile, smile. Someone with a serious or angry facial expression is harder to approach and people may approach that person with more of a negative tone, simply based on your facial expression.
    Your appearance and attire—be certain you are following dress code and your appearance is neat and clean. Family members judge how we will care for their loved ones based on how we care for ourselves. Hairdo, jewelry and fingernails should be appropriate for a nursing home environment.
    Your posture—slouching, leaning up on the wall, standing with hands on hips all give the impression of a negative attitude or not wanting to be at work. I am the worst offender at the hands on the hips thing because I spend a lot of time with my head bent over medical records so I stand like that to stretch my neck and shoulders out. I have to be careful of my posture because I don’t want to come off condescending or domineering.
    Your speech and inflection—as I demonstrated earlier, your tone of speech and how you say something is much more important than the words that you use. However, careful choice of kind words, when paired with the proper tone, is the best combination.
    Your overall attitude—If you really hate your job you are not fooling anyone. Everyone who works with you knows it and all your patients know it. If you are a negative and miserable person you spread that like perfume (or the opposite of perfume) everywhere you go. Is that what you want to smell like?
  • Telling someone you can’t help them will only frustrate them more. But, you are not expected to do everything for everyone. If what they are asking for is out of your role you need to direct them to the person who will be able to assist them with their problem or complaint.
    Nobody is expected to do everything. But if you can’t do something direct the customer to the person who can help them. Don’t just leave them hanging with a “that’s not my job” kind of attitude.
  • If someone approaches you angrily for no reason…take a moment to consider it. You may not deserve to have been approached with an angry tone. You may have nothing to do with why the person is angry. It could be totally not your fault.
    BUT, if you approach them back with an angry, defensive, or condescending tone you are setting the tempo for the rest of the conversation. They are only going to respond back to you more angry, and then you respond to that, and on and on.
    For example: It is change of shift and you have just taken responsibility for the floor. Mrs. Jones approaches you and says: “My mother got no breakfast today and she is starving. I told them that she needs two pairs of socks because her feet get cold and I just walked in to find her barefoot. On top of that her favorite pajamas are missing and I told you all that I would do her laundry. I bet someone stole them. This is the worst place I have ever seen. Nobody here does anything, you all just sit around.”
    That is a load of negativity to take when you have just walked in! If you respond back to her in an angry and defensive tone, pointing out that she has no idea if breakfast was eaten because she wasn’t there, that the patient takes off her own socks every day, and that the pj’s are in laundry due to her mom’s incontinence…You will have answered the issues but inflamed the situation.
    Better script: “I can see that you care very much for your mother and want her to be comfortable. Those are all important issues. One of my responsibilities is to see that she is clothed properly, so I will make sure she has socks on right now. Then let me take you to my supervisor ________ so she can help you with these other important issues.”
    To be successful in these difficult situations it is imparative that you have knowledge of the chain of command (A system whereby authority passes down from the top through a series of executive positions or military ranks in which each is accountable to the one directly superior).
  • Sub-standard level of care has been a hot topic in the news lately. Medicare is increasing their audits and facilities must respond with higher quality documentation to show what they are doing for the patient.
    Employee dissatisfaction affects the residents. If employees are dissatisfied this will get passed on to our residents. Im not talking about abuse here, I just mean a low-level feeling of anger or angst that is communicated through body language or off-handed comments that the residents are exposed to.
  • Comment that “quality care” is not an easily quantifiable term, because most people have a differing opinions. Segue into next slide…
  • As a result of the Affordable Care Act, CMS released a 5 part action plan (which will be outlined on the next slide) to improve nursing home safety and quality. This program has a 3 part aim, which is outlined in this graphic.
    The CMS Nursing Home Action Plan is based on CMS’ Three-Part Aim for improving U.S. healthcare.
    The Three-Part Aim comprises three objectives:
    1. Improving the individual experience of care;
    2. Improving the health of populations; and
    3. Reducing the per capita cost of care for populations.
    CMS describes its Action Plan as having themes outlined in the action plan that will guide our efforts to continue progress in improving nursing home safety and quality.
  • CMS’ strategy consists of five interrelated and coordinated approaches, each of which addresses one or more of the Three-Part Aim objectives – those five approaches are listed on this slide:
    Enhance consumer engagement
    Strengthen survey processes, standards, and enforcement
    Promote quality improvement
    Create strategic approaches through partnerships
    Advance quality through innovation and demonstration
    The Action Plan also addresses 5-star program, Culture Change, Care Transitions, The Inappropriate use of Antipsychotics in Nursing Homes, Advancing Excellence in America’s Nursing Homes campaign, to name a few.
    These programs put emphasis on quality care and demonstrable communication between the disciplines in a nursing home, as well as upward towards administration and regional consultants, and even higher to owners and stakeholders.
    One could make the correlation that good communication can have the outcome of higher quality care.
  • This is an example of regulatory mandate regarding communication in a LTC facility. Communication is not just important to ensure that we have good relationships with co-workers, it is also part of our every day lives in a regulated field. Although LTC is currently more regulated than an ALF, we can see that patients in an ALF are remaining in their homes for treatment while sicker and sicker, and returning home after a SNF stay even sooner than before.
    Talk about Dawn in an ALF as a med technician and giving morphine for the first time.
  • One of my biggest frustrations as a CNA was that I knew these patients, and somebody else was making facility rules. Now please keep in mind I was 18, and like many 18-year-olds I knew everything.
    So that motivated me to become a nurse, where I would have influence on all these decisions being made. Again, my own interpretation of my nurse power was far greater than actual application. I still felt like decisions were being halfhazardly made all around me, and I did not have sufficient enough influence on the overall picture. My own inflated sense of self-worth continued, but I had made some bad mistakes by this time and had learned how to speak to people without getting written up.
    So finally, there I was, in management. Now…I would have the influence I desired. Now…I would be making these mighty decisions that seemed so random to me before. And boy, was I ever going to improve things! Lo and behold, I discovered that there was a reason for all those “crazy management decisions”. Hmm. Who would have figured.
    Thankfully, time and experience has taught me a valuable lesson of humility.
    But it has also taught me that it is important, to the extent possible, to include all levels of the nursing home in decision making or care planning. Once of my biggest frustrations as a care planner was the feeling that I was writing them in a little box, and that my plans were not being used (again, with the humility here). What I have learned is I was doing it wrong. You need to get input about how it is actually done before you can write a care plan that says how you do it. After all, is it a plan of care for you, or a plan of care for the resident?
  • Assertiveness is a positive aspect in a manager. Don’t confuse it with jerkiness—this definition does not mean running over everyone or bashing them in with the rules. It means a calm and confident air that can be trusted to be working for the good of the organization.
    Many managers lack assertiveness, and therefore the tail wags the dog in their department.
    An assertive manager is able to communicate in such a way that they can lead people to do things they may not want to do, and like the fact that they are doing it.
  • Ultimately, you can’t control your employees will. If they do not want to go in the direction established by your organization you cannot force them to go. But, you can clearly set expectations that apply to all that wish to stay in your organization, and hold the employee to them. They can then choose for themselves if they wish to continue with the organization or move on to another that better meets their needs as an employee. Either way is a win—the employee embraces the vision of your organization or they find another organization that has a vision they can be comfortable in.
    The only thing that is not an option is staying in your organization and not complying with the expectations set forth for all employees.
  • One technique we use with patients who behave in ways we do not like is setting clear expectations, have a meeting with the patient to express those expectations, and then quickly and consistently follow up if the expectation is not met. This methood is still appropriate for our employees.
    Setting a clear expectation of what is acceptable and what is not acceptable behavior is the best way to get the behavior that is desired. Often times these employees have good skills on the floor, it is their interaction with coworkers that needs to be addressed. The clearer you are with your expectation, and the better you follow up on incidences, the more you can decrease the incidences of this behavior.
    Assertiveness is not workplace bullying—we will talk about that topic shortly.
  • Managers must make clear what expectations they have, especially regarding work performance and comportment. You don’t have to be a general barking orders at the team, but you do have to make your expectations clear. Your staff cannot read your mind, and when left to figure things out for themselves you may not like how they get things done.
    Its important that it is clear what will not be tolerated for behavior. Big things are easy—things that should be common sense like coming to work on time and compliance with company drug policy. Some things are not as easy, such as staff-to-staff behavior. It is important as a manager that you clearly communicate what the organizations stance is on issues and hold staff accountable for that standard.
  • Many mangers really struggle with the confrontation of speaking to an employee about their behavior—and cope with that by avoiding the conversation.
    I know that this was an area that I really struggled with as a new manager. I was very young when given my first management opportunities and lacked the maturity that comes with the life experiences of becoming more comfortable with your own self and not needing to define my self by what others thought of me. I would avoid and avoid and avoid these types of situations until they rose to a ridiculous level, then I would respond with all the frustration that had been growing as the situation mounted. The results of those conversations were not positive!
    One of the best things I learned from my mentor is that conflict and confrontation can be healthy. Speaking to someone immediately when they are not meeting expectations—rather than letting that resentment or anger build (or even just a mild annoyance)—is an extremely healthy and effective way to deal with others.
    BTW, this works in your personal life, too!
  • As a manager it is also your responsibility to protect other employees. If one employee is consistently able to get away with bad behavior that often interferes with other employees rights or ability to work their job in peace in the most successful way possible. Sure, the person who is creating the problem may leave eventually. But, it is more likely that others will be forced to work around this person, which causes a morale drain for others.
    Worst case scenario: the good employees get fed up an leave. Nursing aides who see co-workers providing poor care to residents they may become disaffected, frustrated, and angry.
    Your staff will respect you more if there is a standard that everyone is held accountable to. Letting some get away with behaviors while others cannot is unfair. Your staff will trust you more, and be more effective and happy employees, when the same standard is held for all.
    In our business, happy and content employees will take care of our customers better and will give a better overall impression of our organization. This will attract more quality employees and will attract more customers.
    Remember--You are the role model. Your staff will be watching your behavior. When you see staff in your organization engaging in behavior that is inconsistent with the values or vision of the organization, it is important to address that behavior. It is important for others to watch facility leadership in regards to this.
  • Tell the story of Nichole, the worst DON in the universe. Ever. Period.
  • Satisfying the desire for compensation doesn't have to mean paying astronomical salaries. The salaries at Zappos.com, the online shoe store, are well below market rates (only about $23,000 annually for the average hourly employee), yet the company still manages to inspire almost cult-like loyalty from its employees with its free-spirited corporate culture and dedication to molding its entry-level hires into managers [source: Inc.].
    Compensation doesn't have to be monetary. It can come in many forms: stock options, extra time off or even a drink out with the boss.
    You can satisfy the need to bond by creating a corporate culture that's based on mutual respect and support. Instead of making employees compete against one another -- which creates a cutthroat environment in which people willingly step on their co-workers to get ahead -- reward employees as a team to encourage camaraderie.
    To satisfy the third need, you must have transparency. The company's goals and the employee's responsibilities should be obvious from the moment a new person is hired. Everyone's job should be very clearly delineated, and each employee should understand how his or her individual piece fits into the bigger picture.
    Finally, employees should be recognized for every contribution they make to your organization. Whether that reward comes in the form of a promotion, salary increase or just a round of applause at a company event, it's still recognition.
  • Different companies call performance objectives different things:
    Responsibilities
    Duties
    Results
    Outputs
    Targets
    Results Requirements is a concrete description of a result that you expect from any employee who holds the job. For example for a salesman to make $10,000 per quarter.
    Behavior Requirements is a description of how you want employees to behave while getting their job done. Behavior requirements often reflect the values of the company. These will relate back to customer service expectations.
  • Developmental goals are based on:
    Weak spots in the employee’s overall performance that the employee should improve on
    Strengths that the employee should nurture and develop
    Skills that will help job performance
    Also do not try to change the employee through their goals. If they truly hate and are not good at public speaking (for example) don’t make them have a developmental goal to speak in front of 1000 people.
    Be realistic. Don’t place so much on the employee that they cannot succeed. This can lead to failure, burnout, and low morale.
    Be measureable in your goal. Use a fair method of measurement.
  • A performance log can be very informal. Include:
    Concrete details
    Be accurate and don’t exaggerate
    Don’t use slurs or inappropriate comments. This log may be aired in the courtroom.
    Don’t use language that could be misconstrued as discriminatory
    Avoid personal attacks. Concentrate on the behavior, performance, conduct, and productivity
    Make each entry complete so anyone reading it could understand what happened
    Stick to job-related incidents.
    Include any kudos the employee earns.
  • Prior to the evaluation meeting gather up the information and fill out the forms. Then spend some time using critical thinking skills to determine how the information represents the employee, overall. You can’t trust your gut here—you have to gather and review all the documents first, then make your determination.
  • Blame: don’t blame the employee if things are going badly or take credit for yourself if things are going well. If the employee is not performing well look critically at the circumstances. If the fault lies with you, take responsibility. Your employee will respect you for that.
    First impressions: good or bad, may color your impression. Good employees with a bad first impression may feel discouraged that they cannot seem to get past it! Conversely, those you like well should be evaluated with the same standards
  • The old saying about nurses eating their young.
    Because it can occur in a variety of contexts and forms, it is also useful to define workplace bullying by the key features that these behaviours possess. Bullying is characterized by (Einarsen, 1999; Keashly & Harvey 2004; Lutgen-Sandvik, 2006):
    Repetition (occurs regularly)
    Duration (is enduring)
    Escalation (increasing aggression)
    Power disparity (the target lacks the power to successfully defend themself).
    Attributed intent
    With some variations, the following typology of workplace bullying behaviors has been adopted by a number of academic researchers. The typology uses five different categories.[11] [12]
    Threat to professional status – including belittling opinions, public professional humiliation, accusations regarding lack of effort, intimidating use of discipline or competence procedures
    Threat to personal standing – including undermining personal integrity, destructive innuendo and sarcasm, making inappropriate jokes about target, persistent teasing, name calling, insults, intimidation
    Isolation – including preventing access to opportunities, physical or social isolation, withholding necessary information, keeping the target out of the loop, ignoring or excluding
    Overwork – including undue pressure, impossible deadlines, unnecessary disruptions.
    Destabilisation – including failure to acknowledge good work, allocation of meaningless tasks, removal of responsibility, repeated reminders of blunders, setting target up to fail, shifting goal posts without telling the target.
  • Transcript

    • 1. Communication & Coaching: A Nurse’s Guide to Creating a Harmonious Atmosphere HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Beckie Dow, RN, RAC-MT Director of MDS/Nursing Program Development
    • 2. Speaker Bio Over 20 Years Experience in Long-term Care Clinical and Reimbursement Accuracy in Assessments Quality Assurance Activities Interrelation between MDS, Care Planning, QA, and Clinical Excellence at the Bedside AANAC Master Teacher Copyright © 2013 All Rights Reserved 2Harmony Healthcare International, Inc.
    • 3. Communication & Coaching: A Nurse’s Guide to Creating a Harmonious Atmosphere Disclosures: The planners and presenters of this educational activity have no relationship with commercial entities or conflicts of interest to disclose Planners: Elisa Bovee, MS, OTR/L Diane Buckley, BSN, RN, RAC-CT Beckie Dow, RN, RAC-MT Keri Hart, MS CCC, SLP, RAC-CT Kristen Mastrangelo, OTR/L, MBA, NHA Christine Twombly, RNC, RAC-MT, LHRM Presenter: Beckie Dow, RN, RAC-MT Copyright © 2013 All Rights Reserved 3Harmony Healthcare International, Inc.
    • 4. Communication & Coaching: A Nurse’s Guide to Creating a Harmonious Atmosphere Disclosure Speaker: Beckie Dow, RN, RAC-MT Director of MDS/Nursing Program Development The speaker has no relevant financial relationships to disclose The speaker has no relevant nonfinancial relationships to disclose 4Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
    • 5. Communication & Coaching: A Nurse’s Guide to Creating a Harmonious Atmosphere Criteria for Successful Completion Complete Sign-in and Sign-Out on Attendance Form Attendance for entire session Completion and submission of speaker evaluation form. Copyright © 2013 All Rights Reserved 5Harmony Healthcare International, Inc.
    • 6. Program Objectives The learner will be able to discuss the positive impact of clear communication to address areas of improvement on staff members and customers The learner will be able to articulate the positive impact of a cohesive clinical team to promote staff and customer satisfaction The learner will be able to list three techniques to better communicate with a cognitively impaired elder Copyright © 2013 All Rights Reserved 6Harmony Healthcare International, Inc.
    • 7. Program Objectives The learner will be able to give examples of workplace bullying, and offer techniques to eliminate bullying in the workplace The learner will be able to describe how proactive communication with co-workers and employees can stop the cycle of miscommunication and create a more harmonious workplace for staff and customers Copyright © 2013 All Rights Reserved 7Harmony Healthcare International, Inc.
    • 8. “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel” -Maya Angelou Copyright © 2013 All Rights Reserved 8Harmony Healthcare International, Inc.
    • 9. Frustrated Employees Say… “Management doesn’t care about us” “They never get rid of bad employees; they just get away with everything” “We always have to deal with the fallout, and they get to go home” “If I speak up and then nothing changes, why should I even bother?” Copyright © 2013 All Rights Reserved 9Harmony Healthcare International, Inc.
    • 10. Frustrated Employees Say… Your front-line staff spends the most time with your customers They are, essentially, the face of your organization Effective communication with your staff can increase employee satisfaction, which will influence customer satisfaction Copyright © 2013 All Rights Reserved 10Harmony Healthcare International, Inc.
    • 11. Communicating Well… Copyright © 2013 All Rights Reserved 11Harmony Healthcare International, Inc.
    • 12. Communicating Well… Good communication is a powerful tool that can help you to: Connect with others Express what you really mean Navigate challenging situations Build better relationships Earn the respect and loyalty of your team Copyright © 2013 All Rights Reserved 12Harmony Healthcare International, Inc.
    • 13. Communicating Well… The way you listen, look, move, and react influences the listener It shows whether or not you care, if you are being truthful, and how well you are listening As a manager or caregiver, your staff and patients will often base their opinion of you on how they feel after they interact with you Copyright © 2013 All Rights Reserved 13Harmony Healthcare International, Inc.
    • 14. Communicating Well… When non-verbal communication supports verbal communication you will increase trust, clarity, and rapport When non-verbal communication does not support verbal communication you will generate tension, mistrust, and confusion Copyright © 2013 All Rights Reserved 14Harmony Healthcare International, Inc.
    • 15. Communicating Well… Be sensitive to someone’s physical response to your communication This non-verbal communication can offer you valuable clues as to their true response to your words Be aware of the non-verbal communication you are displaying, so others do not misinterpret your meaning Copyright © 2013 All Rights Reserved 15Harmony Healthcare International, Inc.
    • 16. Communicating Well… Non-verbal communication can be modified and controlled…to a point Even the best communicators do not fully eliminate all non-verbal communication By managing your staff effectively, you will decrease your own frustration and be able to communicate better Copyright © 2013 All Rights Reserved 16Harmony Healthcare International, Inc.
    • 17. Communication Ability for the patient with Dementia Dementia can gradually diminish a patient’s ability to communicate Patients with Dementia have increased difficulty expressing their thoughts and emotions—and more difficulty understanding them in others The ability to communicate is a basic need Copyright © 2013 All Rights Reserved 17Harmony Healthcare International, Inc.
    • 18. Communication Is… Sending and receiving messages How we relate to one another An important part of our relationships A way to express who we are More than talking or listening About attitude, tone of voice, facial expression, and body language Copyright © 2013 All Rights Reserved 18Harmony Healthcare International, Inc.
    • 19. Changes in Communication Difficulty finding the right words Using familiar words repeatedly Inventing new words to describe familiar things Easily losing train of thought Difficulty organizing words logically Copyright © 2013 All Rights Reserved 19Harmony Healthcare International, Inc.
    • 20. Changes in Communication Reverting to speaking a native language Using curse words Speaking less often Relying on gestures rather than speaking Copyright © 2013 All Rights Reserved 20Harmony Healthcare International, Inc.
    • 21. Help The Patient Communicate Copyright © 2013 All Rights Reserved 21Harmony Healthcare International, Inc.
    • 22. Help The Patient Communicate Be Patient and Supportive. Let the person know you are listening and trying to understand what is being said. Show Your Interest. Keep good eye contact and show the person you care about what he or she is saying. Copyright © 2013 All Rights Reserved 22Harmony Healthcare International, Inc.
    • 23. Help The Patient Communicate Offer Comfort and Reassurance. If the patient is having trouble communicating, let them know it is OK. Encourage. Have the patient continue to try to explain his or her thoughts. Give the Patient Time. Let the patient think about and describe what he or she wants. Copyright © 2013 All Rights Reserved 23Harmony Healthcare International, Inc.
    • 24. Help The Patient Communicate Don’t Interrupt. Gently stop a rambling thought in a respectful manner. Avoid Criticizing or Correcting. Don’t tell the person that they are incorrect. Try to find the meaning in what they are saying. Avoid Arguing. If the patient says something you disagree with, let it go. Copyright © 2013 All Rights Reserved 24Harmony Healthcare International, Inc.
    • 25. Help The Patient Communicate Offer a Guess. If the patient uses the wrong word or cannot find a word, try guessing the right one. If you understand what they mean you may not have to give the exact word. Be Careful Not to Cause Frustration Encourage Non-Verbal Communication. Pointing or gesturing to clarify what is being said. Copyright © 2013 All Rights Reserved 25Harmony Healthcare International, Inc.
    • 26. Help The Patient Communicate Limit Distractions. Find a quiet place. The surroundings should always support a person’s ability to focus on his or her feelings. Focus on Feelings, not Facts. Sometimes the emotion being expressed is more important than what is said. Look for the feelings behind the words. Tone of voice and actions may provide clues. Copyright © 2013 All Rights Reserved 26Harmony Healthcare International, Inc.
    • 27. A Challenge For You: Consider the following scenario: A confused resident approaches the nursing station. “I would like my hair done today,” she requests. The nurse replies, “No, you can’t get your hair done. The hairdresser is only here on Tuesday and Thursday.” Copyright © 2013 All Rights Reserved 27Harmony Healthcare International, Inc.
    • 28. A Challenge For You… Avoid the following words for 24 hours: No Don’t Can’t Won’t Not Copyright © 2013 All Rights Reserved 28Harmony Healthcare International, Inc.
    • 29. What is “Customer Service?” An expression of human decency which creates mutual benefit for the customer and service provider A series of activities that enhances the customers feeling that the product or service meets their expectations Copyright © 2013 All Rights Reserved 29Harmony Healthcare International, Inc.
    • 30. What is “Customer Service?” Creating an atmosphere of trust and loyalty Sacrifice and serving Doing what you say you will do Putting customers needs first Treating others with dignity Copyright © 2013 All Rights Reserved 30Harmony Healthcare International, Inc.
    • 31. First Impressions… Copyright © 2013 All Rights Reserved 31Harmony Healthcare International, Inc.
    • 32. First Impressions… Residents and family members have the opportunity to observe you and how you interact with all residents. What kind of impression are you making? Copyright © 2013 All Rights Reserved 32Harmony Healthcare International, Inc.
    • 33. First Impressions… People generally form a first impression of you in 3-5 seconds This first impression will influence how residents and family members perceive you will provide care A poor first impression is often difficult to change Copyright © 2013 All Rights Reserved 33Harmony Healthcare International, Inc.
    • 34. First Impressions… What influences a first impression? Your facial expression Your appearance and attire Your posture Your speech and inflection The overall attitude you display Copyright © 2013 All Rights Reserved 34Harmony Healthcare International, Inc.
    • 35. First Impressions… Identify your role--let the patient and family member know what you are responsible for, and direct them to the person responsible for their other requests Don’t try to do what you do not have the capability or authority to do, because if you fail, the patient will feel more insecure Copyright © 2013 All Rights Reserved 35Harmony Healthcare International, Inc.
    • 36. Ownership of a Task Not Acceptable She is not my assignment Her nurse is on break She is not here. Call back tomorrow Acceptable I am happy to help you I can assist you I will give her a message that you wish to speak to her. What is your name and contact information? Copyright © 2013 All Rights Reserved 36Harmony Healthcare International, Inc.
    • 37. Ownership of a Task How you respond to an initial request sets the tone for the remainder of the interaction At times, customers will approach you in an angry way even if you don’t deserve it It is important to always respond kindly and courteously to a request or complaint Copyright © 2013 All Rights Reserved 37Harmony Healthcare International, Inc.
    • 38. Communication and Meeting Government Initiatives Two themes are common in today’s debate about the long-term care industry: Many patients receive, or are at risk for receiving, sub-standard level of care Long-term care employees may be dissatisfied with work environment or job duties which will affect residents Copyright © 2013 All Rights Reserved 38Harmony Healthcare International, Inc.
    • 39. Communication and Meeting Government Initiatives Employee turnover is a serious concern for all levels of the health care industry Retention of valuable employees is essential for patient satisfaction and financial stability Increased governmental attention to “quality care” in healthcare Higher customer expectations Copyright © 2013 All Rights Reserved 39Harmony Healthcare International, Inc.
    • 40. What is “Quality Care”? Each person may define quality care differently, based on personality, values, culture, etc. Common themes: Treat patients with dignity and respect Patient involvement in decisions Control of ones own life Physical and emotional needs met Copyright © 2013 All Rights Reserved 40Harmony Healthcare International, Inc.
    • 41. The CMS Nursing Home Action Plan: A Three Part Aim Copyright © 2013 All Rights Reserved 41Harmony Healthcare International, Inc.
    • 42. The CMS Nursing Home Action Plan: Five Approaches Enhance consumer engagement Strengthen survey processes, standards, and enforcement Promote quality improvement Create strategic approaches through partnerships Advance quality through innovation and demonstration Copyright © 2013 All Rights Reserved 42Harmony Healthcare International, Inc.
    • 43. The Regulatory Aspects of Communitation--F280 “The care plan must be prepared by an interdisciplinary team that includes the attending physician, an R.N. with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident’s needs, and, to the extent practicable, the participation of the resident, the resident’s family, or the resident’s legal representative [42CFR483.20(k)(2)]” Copyright © 2013 All Rights Reserved 43Harmony Healthcare International, Inc.
    • 44. A Bottom-Up Approach to Communication Valuing direct caregivers input in patient care policy decisions Care planning becoming more relevant to the patient Care plan more closely represents patients status and is better individualized to the patient Copyright © 2013 All Rights Reserved 44Harmony Healthcare International, Inc.
    • 45. A Bottom-Up Approach to Communication Encouraging input from front-line staff may increase their acceptance of policy change…or at least their understanding Feeling valued increases employee satisfaction and retention Opens up dialog about other topics Copyright © 2013 All Rights Reserved 45Harmony Healthcare International, Inc.
    • 46. A Bottom-Up Approach to Communication Truthfulness with employees is a key aspect of caring for employees Telling employees what they need to hear, which may not be what they want to hear, is a necessary first step This may cause the manager discomfort at first, but is a skill that needs to be practiced Be ASSERTIVE! Copyright © 2013 All Rights Reserved 46Harmony Healthcare International, Inc.
    • 47. Assertiveness “Disposed to or characterized by bold or confident statements or behavior” --Merriam Webster dictionary Copyright © 2013 All Rights Reserved 47Harmony Healthcare International, Inc.
    • 48. Assertiveness Assertiveness is not forcing others to do what they do not want to do Assertiveness is clearly pointing the way for the team to go, and inviting others to take that journey with you Anyone can force compliance, but a manager encourages commitment Copyright © 2013 All Rights Reserved 48Harmony Healthcare International, Inc.
    • 49. Assertiveness Assertiveness is… Clearly communicating expectations Following up Coaching and encouraging Having the same standard for everyone Assertiveness is not… Bullying Manipulating Intimidating Forcing compliance Threatening Copyright © 2013 All Rights Reserved 49Harmony Healthcare International, Inc.
    • 50. Assertiveness Many managers struggle with employee behavior that is not in line with the organizations vision It is up to the manager to set clear expectations regarding behavior and follow up The clearer expectations are, the easier it is to address problem behavior Copyright © 2013 All Rights Reserved 50Harmony Healthcare International, Inc.
    • 51. Effective Communication An effective manager will: Set clear boundaries and expectations Practice accountability Honor your staff’s rights Choose your battles carefully Deal with problem behavior swiftly and fairly Copyright © 2013 All Rights Reserved 51Harmony Healthcare International, Inc.
    • 52. Boundaries and Expectations Managers who do not clearly define boundaries and expectations are just asking for trouble Don’t expect your employees to be mind readers Communicate what you expect—and what will not be tolerated Copyright © 2013 All Rights Reserved 52Harmony Healthcare International, Inc.
    • 53. Accountability Managers must hold staff accountable when they do not meet expectations It can be uncomfortable for some people to have this type of confrontation These behaviors will rarely resolve on their own, without coaching or discipline Copyright © 2013 All Rights Reserved 53Harmony Healthcare International, Inc.
    • 54. Accountability Remember—it is your job as a manager to consistently hold staff accountable Holding those who engage in bad behavior accountable will create respect with other employees Having the same standard for all creates an atmosphere of trust Copyright © 2013 All Rights Reserved 54Harmony Healthcare International, Inc.
    • 55. Honor Staff Rights Staff members should be able to expect that they will be treated fairly at work and have an appeals process available to them Staff should also be able to expect equity in how they are treated and spoken to by peers and managers Copyright © 2013 All Rights Reserved 55Harmony Healthcare International, Inc.
    • 56. Choose Your Battles Some areas are not available for debate, such as patients rights, regulatory mandates, etc. Other areas may be more flexible and may provide an opportunity for collaboration on a small topic that makes a big difference Copyright © 2013 All Rights Reserved 56Harmony Healthcare International, Inc.
    • 57. Choose Your Battles Psychology Today says there are four things that motivate employees Desire for compensation and material things Need to bond with others and feel they belong Need to make sense of the environment Desire to defend their accomplishments Copyright © 2013 All Rights Reserved 57Harmony Healthcare International, Inc.
    • 58. Performance Evaluations The cost of employees who do not perform as we expect them to is hard to quantify Consider time, money, lost productivity, and lower morale The most effective management technique is preventing performance problems proactively and addressing issues quickly and decisively Copyright © 2013 All Rights Reserved 58Harmony Healthcare International, Inc.
    • 59. Performance Evaluations Performance Evaluations will enable the manager to: Examine each employee as an individual Evaluate strengths and weaknesses Reward employees who perform well Provide continuous feedback Be better aware of the needs of your staff Copyright © 2013 All Rights Reserved 59Harmony Healthcare International, Inc.
    • 60. Performance Evaluations Performance Evaluations will enable the manager to: Reduce legal risk by ensuring that each employee feels they are treated fairly Identify and deal with problem behaviors Create valuable employees Lay the foundation for formalized discipline and/or termination Copyright © 2013 All Rights Reserved 60Harmony Healthcare International, Inc.
    • 61. Performance Evaluations Performance Evaluations will enable the manager to: Provide legal protection for the employer in the form of documentation that supports repeated attempts to correct behavior Provide a consistent and objective framework for all employees, so that no one employee feels “singled out” Copyright © 2013 All Rights Reserved 61Harmony Healthcare International, Inc.
    • 62. Performance Evaluations Performance Objectives Performance objectives identify what you expect from the employee and give the employee something to strive for Job Requirements are what you want the employee to accomplish and how you want the job performed Result requirements Behavior requirement Copyright © 2013 All Rights Reserved 62Harmony Healthcare International, Inc.
    • 63. Performance Evaluations Performance Objectives Developmental Goals are individualized for each employee These goals should directly relate to the employees job to prevent spending time and assets on developing a skill that does not benefit your company Only a few goals are needed to be effective Copyright © 2013 All Rights Reserved 63Harmony Healthcare International, Inc.
    • 64. Performance Evaluations Observe and Document Be mindful of employee performance throughout the year, not just in the weeks leading up to their performance evaluation Having an entire years worth of documentation about performance will paint a fairer picture of performance Copyright © 2013 All Rights Reserved 64Harmony Healthcare International, Inc.
    • 65. Performance Evaluations Keep in Touch The annual evaluation should not be the only opportunity for feedback Six months—checking in halfway Brief review of progress to goals thus far in the year Provide an opportunity for the employee to give feedback Copyright © 2013 All Rights Reserved 65Harmony Healthcare International, Inc.
    • 66. Performance Evaluations The Annual Evaluation Preparation is key in giving an effective performance evaluation Use objective data—numbers, facts Use subjective data—customer complaints or compliments Draw conclusions and summarize your conclusions on the Evaluation Document Copyright © 2013 All Rights Reserved 66Harmony Healthcare International, Inc.
    • 67. Pitfalls of the Evaluation… The “Blame Game” when things go wrong First impressions clouding future performance Liking those who like you Judging an employee based on one aspect of their performance Copyright © 2013 All Rights Reserved 67Harmony Healthcare International, Inc.
    • 68. Pitfalls of the Evaluation… Calling everyone “average” Placing more weight on recent events Stereotyping employees Reviewing based on fear—softening the evaluation Avoiding the evaluation Copyright © 2013 All Rights Reserved 68Harmony Healthcare International, Inc.
    • 69. Progressive Discipline Benefits of Progressive Discipline: Allows managers to intervene and correct employee behavior at the first sign of trouble Enhances communication between manager and employee Helps managers achieve higher performance from employee Improves employee morale and retention by demonstrating rewards for good behavior and consequences for bad behavior Copyright © 2013 All Rights Reserved 69Harmony Healthcare International, Inc.
    • 70. Progressive Discipline Benefits of Progressive Discipline: Avoids expensive replacement costs Ensures consistency and fairness in dealing with employee problems and Lays the ground work for fair, legally- defensible employment termination for termination of employees who cannot or will not improve. Copyright © 2013 All Rights Reserved 70Harmony Healthcare International, Inc.
    • 71. Progressive Discipline Steps of Progressive Discipline: Coaching Verbal Warning Written Warning Termination The disciplinary response should be appropriate and proportionate to the employee’s conduct Copyright © 2013 All Rights Reserved 71Harmony Healthcare International, Inc.
    • 72. Coaching At the first sign of an issue, sit down with the employee to discuss the issue “What can you tell me about…” Allow the employee time to explain Give the employee your perspective and offer guidance on correcting the issue Copyright © 2013 All Rights Reserved 72Harmony Healthcare International, Inc.
    • 73. Coaching Plan your coaching sessions The goal is to correct the issue and lead the employee on the path of improvement Don’t be emotional or threaten further action Stay positive and encourage the employee that you have confidence they can correct this issue Copyright © 2013 All Rights Reserved 73Harmony Healthcare International, Inc.
    • 74. Coaching Clearly explain what the issue is and what negative effect the issue is having on the company The purpose of this meeting is to discover the underlying issue and find a resolution that works for all Clearly outline what will be expected for future behavior Copyright © 2013 All Rights Reserved 74Harmony Healthcare International, Inc.
    • 75. Coaching Follow up with the employee even if the problem is resolved After 2-3 face-to-face coaching sessions with no resolution to the problem the discipline will progress to the next step Copyright © 2013 All Rights Reserved 75Harmony Healthcare International, Inc.
    • 76. Verbal Warning A verbal warning serves as notice to the employee that this issue is serious and must be corrected A verbal warning is a written warning that has no signatures The employee is placed on notice that if the issue is not resolved it will lead to further disciplinary action, up to and including termination of employment Copyright © 2013 All Rights Reserved 76Harmony Healthcare International, Inc.
    • 77. Verbal Warning If you have not already done so, contact your Human Resources (HR) department They are experts and can provide guidance Keep a written record of your conversations with the employee, including the coaching sessions Copyright © 2013 All Rights Reserved 77Harmony Healthcare International, Inc.
    • 78. Verbal Warning Be specific about deadlines for improvement, along with a timeframe for the next meeting Example: “You are expected to be on time for work each day, which means no later than 8:05 am. In two weeks we will meet again to follow up on your performance.” Copyright © 2013 All Rights Reserved 78Harmony Healthcare International, Inc.
    • 79. Verbal Warning After 2-3 verbal warnings the discipline will progress to the next step The employee will be aware of the consequences of their actions should they choose not to change By this time, you have had 2-3 coaching sessions and 2-3 verbal warnings Copyright © 2013 All Rights Reserved 79Harmony Healthcare International, Inc.
    • 80. Written Warning All interactions up until this point should be documented in the employee file Do not document after the fact Keep your HR department informed of the progression Written warnings are serious Copyright © 2013 All Rights Reserved 80Harmony Healthcare International, Inc.
    • 81. Written Warning As with the verbal warning, give specific details of what aspect of the employees behavior must change Provide a timeframe for follow up Include language stating that if the issue is not resolved further disciplinary action will be taken This action may be up to and including termination Copyright © 2013 All Rights Reserved 81Harmony Healthcare International, Inc.
    • 82. Written Warning The written warning should be signed and dated by the employee and manager If the employee refuses to sign, write “Refused to Sign” on the document A separate Performance plan may be written to outline goals and timeframe for improvement of the employee This is helpful when dealing with multiple issues Copyright © 2013 All Rights Reserved 82Harmony Healthcare International, Inc.
    • 83. Written Warning Continue to coach the employee, and stick to the timeframe for improvement outlined in the written warning If the issue remains unresolved, issue a second written warning that contains a specific timeframe for improvement Copyright © 2013 All Rights Reserved 83Harmony Healthcare International, Inc.
    • 84. Written Warning At the end of the established timeframe for improvement issue a Final Written Warning A Final Written Warning is open-ended Example: “You are expected to be on time for work, which means no later than 8:05 am. If you are late even one more day your employment will be terminated.” Copyright © 2013 All Rights Reserved 84Harmony Healthcare International, Inc.
    • 85. Progressive Discipline Progressive discipline is not intended to punish or demoralize Progressive discipline is intended to be fair Progressive discipline invests the employee in the improvement strategy This increases the likelihood of follow through and employee improvement Copyright © 2013 All Rights Reserved 85Harmony Healthcare International, Inc.
    • 86. Progressive Discipline Progressive Discipline can improve morale and foster feelings of employee loyalty Treating employees fairly and with respect Enhances communication Avoids expensive replacement costs Lay the groundwork for a fair, defensible employment termination for employees who cannot or will not improve Copyright © 2013 All Rights Reserved 86Harmony Healthcare International, Inc.
    • 87. Why Progressive Discipline is Difficult for Some Managers Don’t want to be a “bad guy” It is uncomfortable to confront others Don’t want to deal with an angry, hurt, or critical employee Fear of conflict Desire to be liked Fear of retaliation Copyright © 2013 All Rights Reserved 87Harmony Healthcare International, Inc.
    • 88. Why Progressive Discipline is Difficult for Some Managers Reasons to “do it anyway”: Helps employees improve Gives you the personal satisfaction that you have done all you could as a manager to help this person improve Gives legal footing that a termination was just and fair Promotes morale of team as conflicts are dealt with fairly and equitably Copyright © 2013 All Rights Reserved 88Harmony Healthcare International, Inc.
    • 89. Progressive Discipline The goal of the Progressive Discipline process is for the employee to change their behavior to meet your company’s standards. Copyright © 2013 All Rights Reserved 89Harmony Healthcare International, Inc.
    • 90. Termination Termination of employment is not simply a disciplinary measure Termination is a representation of the failure of the disciplinary process The behavior of the employee has not changed, despite numerous warnings Or, the initial offense was egregious (stealing, workplace violence) Copyright © 2013 All Rights Reserved 90Harmony Healthcare International, Inc.
    • 91. Termination Have the termination document prepared before the meeting Be brief when disclosing the contents of the document to the employee Have the employee sign the document Stand up to signal the meeting is over Copyright © 2013 All Rights Reserved 91Harmony Healthcare International, Inc.
    • 92. Workplace Bullying Workplace bullying might be becoming more prevalent—or we may be identifying it more often Bullying can lead to decreased productivity and decreased morale A good environment for patients, staff, and guests must be bully-free Copyright © 2013 All Rights Reserved 92Harmony Healthcare International, Inc.
    • 93. Workplace Bullying Bullying: The use of persistent aggressive or unreasonable behavior against a coworker or subordinate Can be covert or overt May be difficult to identify because the bully may stay within established rules and policies of the organization No universally accepted definition Copyright © 2013 All Rights Reserved 93Harmony Healthcare International, Inc.
    • 94. Workplace Bullying Statistics 13% of workers state they are currently being bullied 24% of workers say they have been bullied in the past 12% have witnessed workplace bullying 49% of workers affected by workplace bullying Source: 2007 WBI-Zogby Survey Copyright © 2013 All Rights Reserved 94Harmony Healthcare International, Inc.
    • 95. Dealing With Workplace Bullying First step is to have a no-tolerance policy for bullying—positive workplace culture starts from the top! Consider progressive discipline for the bullying individual Investigate complaints of bullying per your facility procedure Take all complaints seriously Copyright © 2013 All Rights Reserved 95Harmony Healthcare International, Inc.
    • 96. Final Thoughts Patients, staff, visitors, and customers always want to be treated with dignity People respond more positively when they feel they are heard and were dealt with honestly Good communication is not a luxury— it is a necessity to providing good care Copyright © 2013 All Rights Reserved 96Harmony Healthcare International, Inc.
    • 97. Questions/Answers Harmony Healthcare International 1 (800) 530 – 4413 Bdow@harmony-healthcare.com www.harmony-healthcare.com Harmony Healthcare International, Inc. 97Copyright © 2013 All Rights Reserved 97Harmony Healthcare International, Inc.
    • 98. Harmony Healthcare International Have you Considered a Customized Complimentary HARMONY(HHI) MEDICARE PROGRAM EVALUATION or  CASE MIX ANALYSIS for your Facility? Perhaps your facility has potential for additional revenue  Assess your facility against key indicators and national norms  Email us at for more information RUGS@harmony-healthcare.com Analysis is cost & obligation free Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved 98Harmony Healthcare International, Inc.

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