December 23, 2013
Like most health care organizations, Signature HealthCare LLC wants to make its patients’ lives better. What’s different is that it is using spirituality as a primary tool to make that happen.
A provider of long-term care services in the Eastern and Southeastern United States, Signature’s organizational culture is founded on three pillars: learning, spirituality and intrapreneurship, or behaving like an entrepreneur while working in a large organization. The organization wants to “revolutionize the long-term care industry through a culture of resident-centered health care services, personalized spirituality, real quality-of-life initiatives, and stakeholder education and empowerment.”
As learning is a key part of fulfilling its mission, the Louisville, Ky.-based organization introduced a number of initiatives that affect its more than 14,000 employees in seven states. For instance, corporate officers take turns as certified nursing assistants, or CNAs, during service days, and Signature is implementing career development initiatives to enhance intrapreneurship.
Signature also teaches employees how to enhance their emotional and spiritual intelligence, which has improved empathy and quality-of-life metrics for its residents, said Mary McNevin, Signature’s chief learning officer. For example, its Serenity unit, which offers specialized care to individuals with Alzheimer’s disease and dementia, has a program that teaches employees how to better relate to people with cognitive disorders.
Signature’s career enhancement and learning initiatives related to emotional and spiritual intelligence increased its nursing retention rate to 77 percent, and halved turnover rates and terminations for all employees. Its efforts also earned it a designation as one of the Best Places to Work in Healthcare by Modern Healthcare magazine.
The Power of Emotion and Spirit In 2011, Signature developed an eight-week curriculum on emotional and spiritual intelligence, or EI/SI, which includes exercises to improve listening and conflict resolution skills. Each of the organization’s chaplains are trained as trainers, and they train caregivers.
To date, more than 150 employees have been trained on EI/ SI, with an aggressive rollout scheduled for this year. Caregiver empathy as measured by assessments before and after the classes increases 12 percent on average.
McNevin said creating a “spirituality department” and adding full-time chaplains has improved residents’ lives as well as working conditions for employees. “When dealing with people who sometimes are in their final places in our homes, and who are often searching for different things that they have not taken the time to consider before, we meet them at their point of need — when they need both hope and compassion,” she said.
Kyle Browning, chief financial officer at Signature’s Serenity division, agreed. He said many residents are searching for an expanded sense of purpose, and chaplains can help them with their personal discoveries.
“Most corporations would consider bringing spirituality into the workplace as an unacceptable risk,” he said. “Honestly, it was a tough sell in our own company, too. Looking back, it was one of the best decisions we’ve ever made.”
A year after chaplains were introduced, residents’ pain reports and the use of restraints plummeted, while measurements on activities of daily living, such as bathing, dressing and grooming improved.
In a recent survey, close to 90 percent of applicants said they applied because of the company’s corporate culture and approach. Residents’ family members also have expressed higher customer satisfaction in surveys.
Signature’s Serenity unit of 11 homes dedicated to residents with cognitive disorders also has specialized immersion training on what it’s like to be cognitively impaired. Stakeholders become engaged in what McNevin described as a true experiential learning event. Afterward there is a debrief where participants learn how they can influence better outcomes for residents.
To date, 94 percent of Serenity employees have received eight hours of specialized training on caring for people with Alzheimer’s and related disorders, and 88 percent have received 16 hours of this training. Signature plans to expand such training to all homes in 2014.
To assess results, Signature also used the Quality Of Life-AD, a measure developed by Dr. Rebecca Logsdon. Caregivers complete questionnaires augmented by resident interviews. Questions include: “How do you feel about your physical health?” “How has your mood been lately? “How about your living situation?” “How about your memory?”
“Across the nation, 68 percent of all nursing home residents have some level of cognitive impairment and 47 percent have been diagnosed with Alzheimer’s disease,” Browning said. “Through learning, we equip caregivers with abilities they need to deal with somebody with this level of cognitive decline.”
This year, Browning and his Serenity team have partnered with McNevin’s learning division to convert the dementia classroom-led training into self-paced, micro e-learning modules. On average, modules are 10 minutes long, which makes them easier to incorporate into a rigorous 24/7 health care setting with a consistent message.
Developing Careers and Intrapreneurship Signature is also enhancing its culture of intrapreneurship by offering continuous education to advance employee careers and promote engagement. CNAs can become licensed practical nurses, and then continue to be registered nurses. In 2013, the company introduced a talent management system by Marc Effron called Nine Box to identify its high-potential high performers.
McNevin said Signature wants to overinvest in these employees because “these people have a long runway. We’d like to track them along their career path and provide opportunities for them to grow and develop when the timing is right for them.”
The organization takes career development one step further by requiring that every corporate officer who comes on board become a CNA. Officers typically will be required to take clinical classes, a written state exam and a clinical exam to demonstrate skills. All leaders must take classes to become CNAs and work in that capacity at least one day per year. To date, 90 percent of regional and senior executives have completed or are completing their CNA certification.
“How do you lead people toward radical change if you have never walked in their shoes?” said Browning, who has been certified and served as a CNA. “The role of a CNA is the hardest job in the company. Experiencing this role firsthand makes you approach each decision differently. For example, when you are in the heat of the moment of delivering care and reach for a bag to put soiled linens in only to have it rip apart as easily as a hot knife through butter, you quickly realize the few dollars you thought you were saving in purchasing really has placed you in a loss position.”
Every administrator in Signature’s nursing homes also must attend CEO School, a weeklong session designed by Joe Steier, Signature’s president and chief executive officer. Steier instructs new administrators on the company’s unique culture and business model, the overview of the industry’s past and future, market trends, health care policy and leadership development. A similar program is geared to the company’s directors of nursing.
Browning said these initiatives should send shockwaves through the long-term care industry. “Nursing homes have a negative reputation,” he said. “We call them homes, but in many cases they are very large, resulting in an institutional feeling, and can resemble a prison-like setting when it comes to function. For example, residents are routinely told when to get up, when to eat, when to take a shower and even which activities they will be involved in and when they will participate in them.”
However, he said Signature’s founders saw it as their duty to restore dignity and pay respect to those who have given so much by working to change the landscape of long-term care. This revolution is taking place on an employee-by-employee basis, in part by having them explore what it’s like to be a nursing home resident.
“Our goal is to immerse the caregiver into the world of the resident through learning,” Browning said. “This builds the foundation for what ultimately results in a culture shift that changes the way care is delivered.”
Katie Kuehner-Hebert is a California-based journalist. She can be reached at editor@CLOmedia.com.
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