Webinar: Accountability in Action, How an Eldermark Customer Maximized Staff Retention

 

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Webinar Transcript:

Mark Anderson (00:00):

All right, so team, does it look like we're ready to go.

Mary Frances Dahl (00:03):

Yep.

Patty Krueger (00:03):

Yep.

Mark Anderson (00:05):

All right. Thanks for your patience everyone. Really appreciate it. Welcome to today's Leadership Forum webinar. This is part of our leadership forum webinar series. We did take a couple of months off and we're back. Happy to have you with us today. Appreciate it. I'm your host, Mark Anderson, Chief Client Officer with Eldermark. My contact information is there if you want to contact me about anything to do with this webinar series, or for that matter, anything else at Eldermark, just let me know and I'll help you our connect you to the right person. Excited for our program today. But before we get started, just a couple notes about this webinar series. We put this series together back during COVID and continued it because this was designed to connect with leaders in senior living, among our customers and others to help this group learn about new technology solutions to share information and resources relevant to our work, and most importantly, to support each other in our work.

(01:07):

Just a couple of quick technology updates before we get to our topic today. Did want to reemphasize a couple things today that we are so excited about. ElderSmarts, this is our new analytics as a service offering a new data management system that can serve up for you, prescriptive and predictive analytics. We've created some wonderful template and custom content sets. If you're interested in learning more about ElderSmarts, let one of us know here at Eldermark. And then you've probably, if you're an Eldermark customer, you've been hearing a lot about Eldermark NEXT, this is our most advanced... our new user-friendly solution for senior living. Basically a remake of our current complete platform. Again, offering those important connections to the data that our customers are asking for around predictive analytics, analytics that you need to increase revenue, enhance your care, make your work simpler, and to create more meaningful resident outcomes in your good work and serving your resident customers.

(02:16):

Just a couple quick notes before we begin our presentation today. All of you'll remain muted during the presentation. As some of you have already been doing, please use that question feature on your webinar control panel to submit your questions to our presenters. We'll address all incoming questions as time permits and as they come in. You will get a link to the recording within 24 hours after we adjourn. So watch your email box for that. And you are welcome to contact myself or our presenters directly after the presentation. We always welcome that kind of interaction.

(02:51):

All right, so today's topic and presentation, Accountability in Action: How an Eldermark our customer maximize staff retention. Our guest presenters today are from The Waters from our friends at The Waters, we have Mary Frances Dahl, who's the Corporate Revenue Assurance Operations Manager at The Waters. And Patty Krueger, the Senior Director of Health and Wellbeing Compliance and Integrity. We met these two... well I've known you guys for a long time, but we came to learn about this accountability in action, this year of accountability at The Waters through an Eldermark colleague, their client success manager. And she said... This is Meg. Thanks Meg, for that. "The Waters is doing this really cool thing around accountability. You should check it out." And we did and it sounded great. So we invited Patty and Mary to a company meeting event back in August and the presentation was so good and so well received, we're like, we got to share this with the world.

Patty Krueger (03:55):

Oh, thank you.

Mark Anderson (03:55):

We got to share this with the world. And so this is part of that, this webinar today. So thank you Mary and Patty for being here today for your great work at The Waters and for senior living in general. I have been so excited about today. So thank you. Let's get going. It sounds like Mary's going to kick us off.

Patty Krueger (04:15):

Thank you for having us. We're excited to be here.

Mary Frances Dahl (04:17):

Thanks for having us, yes.

Mark Anderson (04:18):

Yeah, you're welcome.

Mary Frances Dahl (04:18):

So thanks for your patience. We had a little bit of technical difficulty. I'm going to blame it on the snow. We're coming at you from the frozen North and we had our second-largest snow storm on a Halloween ever on record yesterday. So we are very happy to be here and we're happy that the heat works.

(04:37):

Every year, The Waters has a focus on some aspect of what we want to work on as an organization. For instance, 2022 was the year of retention, 2023 has been the year of accountability. We started 10 years ago, we opened our very first community in 2013. And our founder was Lynn Carlson Shell. And she wanted to build a senior living way that took advantage of the hospitality industry and how hotels have become so successful, and resorts, in building thriving environments for their visitors. We wanted to build a thriving environment for our residents. So since 2013, we have now gotten to 13 communities and we're still growing. We have over 1600 resident apartments and over 2000 residents.

(05:38):

Now, why are we doing accountability this year? Well, when I first came here six years ago, we had eight locations and all eight were doing something different. I could not walk into a location and have an expectation of a process. And the EDs, our executive directors, were really given their communities and told, "Have at it, get going." It was very entrepreneurial and as we grew and grew and wanted to do some economies of scale, we found out that we need to dial that back a little bit and get some consistencies in here and some processes. Last year, we spent a lot of work in the years before, the last two years, on what do we want our organization to look like? What kinds of things do we want to become consistent in? So we rolled a lot of that out last year and this year, and we decided this year we would hold people accountable to what we were rolling out is new process and procedure and policy.

(06:38):

So Standards: The Waters Way. The definition is quality of attainment, an idea or thing used as a measure norm or model and comparative evaluations. So that's going to be very important in the upcoming slides and during this discussion. And the dahlia is our symbol. So you'll see lots of dahlias floating in and out as I go through this presentation, but it's really about making sure that we are presenting all of our staff, all of our residents, anyone that has anything to do with The Waters with quality and consistency.

(07:15):

So the key message for us is to write a reliable basis for people and their expectations. And I'm going to get more into consistency in just a bit. But we are a people industry. Everybody on this call is in a people industry. And we still should be able to give really great products and services with high quality and make sure that everybody is thriving. Thrive is a very big word that we use all the time. We want to make sure our residents have an environment to live in that is thriving as well as our staff.

(07:51):

So what do we want to do when we introduce a standard? Well, it needs to be measurable, and that needs to be an objective measurement. So anybody that has had to develop curriculum or been a teacher or a trainer understands that when you are developing something and you're training it, you need to be able to measure how well you did, how well they're doing, your trainees. So it needs to be measured. And then of it needs to be validated. I hope you've all heard the trust, but validate or a similar phrase. So we train it, we trust that it's going to be implemented, but we validate by measuring and testing. And we have to do that continually. You can't just train it and leave it. It's a living thing. And then well-maintained. We bring it up all the time, it's in every daily standup at every community, the different standards that we're rolling out. So we're never able to just forget it.

Mark Anderson (08:48):

So Mary, these standards, this was kind of like your foundational shared understanding that everything else else was built on across your teams? Because it sounds like you brought this all the way through all the teams, all the way to the daily stand-ups.

Mary Frances Dahl (09:02):

Yes. Yes. And it's everything from. We're going to concentrate on a few things today with clinical and operational, but it gets all the way into our restaurant, our servers, our uniforms, our expectations.

Patty Krueger (09:17):

We have standards for every department,

Mary Frances Dahl (09:17):

Standards for every department.

Mark Anderson (09:19):

So this truly penetrated the whole organization?

Mary Frances Dahl (09:21):

Yes. Yes.

Patty Krueger (09:21):

Yes.

Mark Anderson (09:22):

We're not just talking clinical services.

Mary Frances Dahl (09:24):

No, the whole organization.

Patty Krueger (09:26):

No, the whole organization.

Mary Frances Dahl (09:27):

And there's a bit of an analogy. I mean, people need to know what's expected of them. And you can't hold anybody accountable if you haven't trained them to what you're going to measure. What are you looking to be done?

Mark Anderson (09:42):

Well, not only do they need to, they kind of want to know,

Mary Frances Dahl (09:42):

Yes, people want to know.

Patty Krueger (09:43):

We have found they absolutely want to know. Yes,

Mary Frances Dahl (09:45):

Yeah, they want to know. I kind of make it be almost like when I was a school teacher, I taught junior high. And you have to set down rules and expectations for the student in the beginning so that they know what kinds of behaviors are acceptable, what is expected of them. And then there should be no surprises at the reviews, right, at the time for the test.

Mark Anderson (10:05):

True.

Mary Frances Dahl (10:06):

So if you define how your company acts, in turn, you're going to build trust in the brand. So consistency. We are what we consistently do. Excellence then, is not an act, but a habit. That's from our friend Aristotle. And I want to tell a little bit of a story. I know that I don't have an audience and we usually play to a live audience and I can't see you, but raise your hand if you've ever eaten at McDonald's. Raise your hand if you've ever had a Big Mac at a McDonald's. Raise your hand if you've had a Big Mac at a McDonald's in a foreign country. I have. So when I ordered a Big Mac on the [foreign language 00:10:58] in Paris at the McDonald's, I got the same Big Mac that I was used to getting in my hometown of White Bear Lake, Minnesota at the first McDonald's. And I was pleasantly surprised that I was able to get my hamburger in this foreign country. I was only 16. The only difference was I could get wine with that, which I did because I was 16 and in a foreign country.

Mark Anderson (11:25):

Of course.

Mary Frances Dahl (11:26):

But I still got the big map, and that's what my expectation was. That's what we're trying to go for. You walk into any Waters, while the accoutrements might look a little bit different, the way that you are going to be treated, the people aspect of it is going to be consistent. That's our goal.

Mark Anderson (11:44):

I love your restaurant analogy because I think everybody who's participating in this webinar today, if they've ever gone out to eat, and a lot of us have what we may call our favorite restaurant or one of our favorite restaurants. And why is it a favorite? Because it's consistently good.

Mary Frances Dahl (12:00):

Yes.

Mark Anderson (12:00):

It's predictably good. You know and you trust that when you go there, when you order that item, it's going to be tasty.

Patty Krueger (12:09):

It's going to be good.

Mark Anderson (12:10):

It's going to be good. Yes.

Mary Frances Dahl (12:12):

Yeah, it's all about the secret sauce.

Mark Anderson (12:14):

Yes.

Mary Frances Dahl (12:16):

But that's it.

Mark Anderson (12:16):

And we're going to learn all about your secret sauce today.

Mary Frances Dahl (12:21):

All right. Accountability is an assurance that an individual organization will be evaluated on its performance or behavior related to something for which it is responsible. So it's delivering on a commitment. And it goes both ways. As leaders, we are committed to be accountable to our staff. Our teams need to rely on us to be the stable force. We also need to rely on our teams to be stable for the residents. They're our frontline, but our residents need to know what's coming and they need to have an assurance that they're going to have consistency throughout their day, throughout their life. Our average age is 85 and at 85, it's all about habits. And they need to understand that they're going to have repeatable things during the day that they can count on and that we have to make sure that we're delivering on that. So accountability goes all the way around the world with us in our organization, and it's been a very good year for that.

(13:26):

Communication. This is the third standard. Our biggest communication problem, I believe, is a people as a humanity, is that we listen to reply. The whole time someone's talking to you, if you're only thinking about, what am I going to say next? You are multitasking at the worst form of multitasking because you need to be listening to understand what the person talking to you is saying. So this is something that we train on all the time. We have listening assessments. We have to listen to, understand and trust ourselves to have an appropriate reply. We call it active listening.

(14:11):

Communication standards. Leadership sets the tone and example for effective communication. Our executive directors are expected to ensure that communication is cascading out to the community. We want to be very transparent to everybody that walks in the door, from the vendors to the food deliverers, to the people that deliver the Amazon packages constantly, and I'm not plugging Amazon, I'm just saying we get hundreds a day, we need to make sure that we're communicating our story in the same way and that we respect people through communication. Every leader should also make an effort to greet, acknowledge, and know every team member in the community. And that can be difficult because you're already dealing with, our largest community has 175 apartments and 210 residents at this moment. So the executive director needs to know them, the 100 or so employees, and every family member that walks in the door to see a resident, they need to know. And that's very difficult. So we take great effort in knowing names and acknowledging.

(15:21):

So now we're going to have some numbers and statistics. I'm a numbers person, so I like this part of it. Did you know that 86% of leaders and employees blame the lack of effective collaboration and communication as the leading cause for errors in the workplace? Lack of communication. Have you ever said to yourself, I thought I told you that, or remember when I said? Well, let's make sure that we're doing it. That's why we repeat this every single day. We go through the standards. We have a form in our standup every single morning. Our communities have a standup from 9:00 till 9:30, or thereabouts, and they have a form that they go through. And our standards is one of the things that we go through.

(16:03):

Or did you know that ineffective company communication causes workplace anxiety? For 80% of US employees, that's based on the SoftActivity 2021 study, that was the beginning of the pandemic. Who needs to make things worse during a pandemic? So we need to try to cut anxiety out of our lives and we do everything we can to do that. Therefore, is it safe to state that improved communication can reduce employee stress? Yes. We have found that. People that know what's going on, are happier people. People that get surprised are not happy people, unless it's a birthday party surprise or something like that. Right? All right. So we increased productivity by making sure that we are transparent. Also, if we have bad news or news that isn't what somebody wants to hear, we give that as quickly as we give the good news. There's no reason to hold back on communication. You need to treat people like adults. You hired them for a reason.

Mark Anderson (17:11):

I really appreciate you mentioning that too. Because I think one of the most important things I learned early on in senior living from another leader was even if you have bad news, if you don't share the story, they will make up their own.

Mary Frances Dahl (17:27):

Oh, yes.

Mark Anderson (17:28):

And be careful of what that might be. Take control of the story by being transparent and you being the first one to tell it

Mary Frances Dahl (17:36):

Yes.

Mark Anderson (17:37):

Yeah.

Mary Frances Dahl (17:38):

And tell as many people at the same time so they hear the same thing.

Mark Anderson (17:41):

Yes.

Mary Frances Dahl (17:42):

Our demographic of our residents, they love to make up stories and they love to read into things and we try everything we can to make sure that we're giving them an honest account. We give out a weekly newsletter to all of our communities on the state of the community, the COVID numbers. We had a water break. We are called The Waters, and we have had some water breaks. But it's being transparent and communicating. And yes, exactly.

(18:17):

Through this year alone, in the first three quarters, we have actually dropped 10 points in our turnover rates with our employees. So we started the year at 25% of turnover, which it's a terrible rate. That means you're losing one in four people. And we're down to 15%. So that's a 10 point improvement. And we also have a much better system about exit interviewing and stay interviewing. So our HR department as part of our standards, has gone out to all of our communities and just, they'll just sit in the common area room, let the employees know they can drop in, and they do what's called stay interviews. So they're asking them, "How's it going? Do you see any improvement that you would like to see?" And also, don't bring me just problems. Bring me your idea of a solution. Get people to own the solutions and get involved. And I'm sorry if I'm talking really fast, I tend to do that because in Minnesota in the winter, we talk fast, we stay warmer that way. Okay?

(19:27):

Okay. Water standards, these are all of our standards. I know this is a bit of an eye chart. These are our top standards. And for instance, we have interview and hiring standards. We have interview sheets with questions on specifically for each position that we hire for. And we do multiple person interviews for everything that we interview. And we are at the point where we will interview and do right there on the spot, ask for employment. And we will give them a verbal and we will give them a formal offer letter at the interview level for a frontline person. So that has really been helpful because we can turn around an opening very quickly. Standup, I already talked about that. Our managers on duty and our first impressions, we have a standard around that. So the managers on duty on the weekends, there's an expectation. The executive directors and the department leader one-on-ones, they're weekly or biweekly, and there's a standard form that they go through.

(20:37):

The health and wellbeing standards of operation. Patty will get more into that. The touchtown resident and team member is a closed circuit TV system, and we give it to all of the users. The residents have a channel, that is The Waters channel for that community. And then we broadcast a different channel for the staff and the staff rooms. And that's just another way to communicate, communicate, communicate. SPLASH is our journey for getting a prospect to a resident. And it can be a month or it can be a two-year journey because this is a very big decision for all of our residents and we have now made that a consistent journey for everybody. And we have a daily staffing meeting. We have checkbooks that we use through PayScan and Yardi. Our department heads are responsible for their budgets. They help come up with their budgets, they own their budgets. Their discretionary spending is put into a checkbook as they get their invoices that they then approve. So everybody knows where they're at at any given moment in their budget on any day.

(21:53):

General orientation and competencies. Patty goes into a lot more about the competencies. That's her area. But we have an orientation that is standard throughout the company for all new hires. We have culinary standards. We have executive chefs at all of our communities. We have a daily retain review. Retain is a system we use for retention for our employees. Community rounding, that is in nursing. Monthly department meetings every single month. All the concierge staff comes in for a two-hour meeting. And we can do activities. Some people do escape rooms. We need our departments to feel like teams, and then we need our community leaders to feel like a team. And we do everything we can to try to make that happen.

(22:37):

We have a weekly communication, I already mentioned. Financial forecasting, our NOI plans, variance reports that we talk about at a leadership level all the time. We have our SLC CRM standards for how they navigate those prospects. As we all know, anybody that's been sales and marketing, we have a lot of competition. And so we have a very standardized way that we handle our prospects to move them through the journey. And then we have a Pinnacle satisfaction survey that happens. Every single resident gets a survey on how we're doing twice a year by a company called Pinnacle.

(23:16):

So I'm going to talk a little bit about operational things that I do, and this is all found in Eldermark. And I look at these things and I audit these things at the community level monthly. And one of the biggest things I use is the monthly revenue report. And I'm not going to read all of this, but it basically goes through all the lines of business that I can bill. And it's not just my recurring billing, it's my incidental billing. It's my one-off billing. It's my maintenance billable to residents. It's my restaurant billing. So this is something that I use constantly.

(23:54):

In addition to that, the aging is very important. And this is an actual aging from an actual community of ours that I ran about two weeks ago. And we had, as you can see, our total aging was in the negative. That means it was a credit. That means we have a lot of people paying ahead. That's what I want to see. But my goal is to have less than 2% of any of my aging total be over 90 days. And it is pretty aggressive, but we do it, I'm pretty proud of it.

(24:29):

Quarterly reviews. In our portfolio, we have our move-in reviews where we review all the new move-ins since the last review. We have service agreements and health and wellbeing pricing, and that's making sure that it's appropriate based on their current service agreement and what's in Eldermark. Rent increases are done timely and accurate. Billable maintenance, I test about 25% of the sample of all the closed maintenance tickets and I will go talk to the environmental services managers at the community level about any descriptions that look like it should have been built. Okay? Because I don't know about you, but our environmental services managers have the kindest hearts of any of the leaders. And if a resident stops them in the hall and says, "Please, will you come put my shelving unit together for me?" Nine times out of 10, they used to go do it and not put any ticket for it. But our residents actually, they're happy to pay for that service. They expect to be charged for that service. It's just difficult for our environmental services managers to actually charge for it. But that's something that we do.

(25:41):

Obviously on the food plans, we have declining food plans so that they start out with a dollar amount and they spend that through the restaurant. If they hit that dollar amount by the end of the month, then they start building chargeable food. And the checkbooks I talked about. Credit card reconciliation, everybody loves that. All of our communities have house credit cards that they use, and we have strict rules around reconciliation for that. And then the demographics and the reporting around move-ins and move outs. We want to know why people are moving in. We want to know why people are moving out. And we constantly want to improve.

(26:21):

And that's it for me right now. I'm going to turn it over to Patty for clinical.

Patty Krueger (26:26):

Thank you, Mary, thank you very much. Mary has all the fun. I get really into the data and the metrics. So I'm going to talk a little bit about that for you today. So as we talk about our standards of consistency, accountability, and communication, we rely on that data and those metrics to let us know how we are doing in all of our communities. We especially use that for our quality assurance process improvement. And our Eldermark dashboard has so many of those touch points for us just to ensure that we are accountable throughout the clinical teams. So at a minimum, certain metrics are reviewed at a regional level daily, and the expectation of the communities is that they review theirs multiple times throughout the day. As you can see, I can monitor data from all of the communication through all the communities, through the executive view. I can monitor the clinical data as well as the emergency response system that we have, and operational data, ensuring that all of the communities are accountable to those standards.

Mark Anderson (27:28):

And by executive, Patty, you mean you can see-

Patty Krueger (27:31):

I can can see all the communities.

Mark Anderson (27:33):

... all your communities' data merged together?

Patty Krueger (27:34):

Yes. I can go in individually or I can see everybody. And I like to see the communities as a whole to do a comparison and to watch for trends. So I do monitor the assessments to ensure compliance. Of course, with regulation, we all love our regulation. We have communities in three different states. So we are very fortunate that all of that is run through in our assessments report so we are in regulation with all of those states. The dashboard icon is where we pull our data and again, ensure that our quality assurance metrics are accounted for.

(28:11):

So when I look at the assessments, I do look at the assessment trends, assessments by statuses, and the score changes as all of these allow us to determine our staffing levels and if they are appropriate and determine our acuity levels as well. The operational metrics. Give me an overview of the communities and how they are all performing clinically.

Mark Anderson (28:37):

And maybe you're going to get to this, Patty, I think you will, but so you've got all this data across the company and then you can go to each community. How much of this trickles down to your daily standup, for example? Are you going to-

Patty Krueger (28:54):

I'll just answer the question really quick for you right now. It does trickle down because on our daily standup standard form, we do talk about hospitalizations, we talk about LOAs, we talk about move-ins, we talk about assessments that are past due. We also talk about our Notify, and that is our emergency response system because we monitor it so closely.

Mark Anderson (29:15):

So these data reports, they're not only, of course used as a leadership management tool, this is all coming right down to the frontline staff?

Patty Krueger (29:24):

This comes right down to the frontline staff. I know when I go into communities and assist with some of the department meetings, I actually bring up my computer and I show them some of the trends. They want to know this information, so we are very happy to give it to them.

(29:38):

So operationally, we do need to know our occupancy rates per community and the trending that we are seeing. So we do take a look at that. And as you all know, we need occupancy in order for us to operate our communities. Hospitalization rates, it's also important, that provides insight into our acuity levels within the communities. Now, our missed services that you see in that column right there, it's a metric, but I particularly watch close for quality assurance purposes for sure, but also to ensure that the services are actually completed. And then it just generates the revenue. As you can see down there, it looks like we missed a few of those services. Most often that is somebody, they have completed the service, they just have not hit the confirm button yet. So that is why we monitor that on a daily basis. It's an expectation that our directors of Health and Wellbeing go in and look at those missed services every single day.

Mark Anderson (30:37):

So I don't want to get you too off track, but we are hearing more and more at Eldermark from our customers that the words quality assurance or quality assurance performance improvement or QAPI.

Patty Krueger (30:49):

Yes.

Mark Anderson (30:50):

For those people who've been in the business long enough, those are nursing home words.

Patty Krueger (30:54):

They are nursing home. [inaudible 00:30:56], we call it QAPI.

Mark Anderson (30:55):

However, but looking at the acuity of the assisted living resident and where that's come to and where it continues to go is a higher acuity. And so we're seeing these traditionally skilled nursing practices find their way into assisted living, importantly because they serve an important role. Can you speak for just a moment about a little bit explaining about linking accountability with quality assurance-

Patty Krueger (31:27):

Oh, I can.

Mark Anderson (31:29):

... so that our participants can, for those that may not be as familiar, connect those dots? And then how this data is working generally to truly stick to that accountability culture that you've built? It's kind of a lot there, but.

Patty Krueger (31:43):

Yeah, it's a lot. I'll just kind of walk through our process. Again, The Waters has a standard for our QAPI. So all communities, regardless of the state that they're in, have the same QAPI quality measurements that we have. For instance, we do watch our hospitalization rate on our QAPIs. We do look at our pendant response time, our emergency response. We look at that. We look at our average number of alerts that come through. But what we're most interested in that is our response time and how long it's taking us to get to a resident in a true emergency. We look at those that are out on LOAs just for emergency relocations and where they're going to be. We have resident satisfaction of our meals on our QAPI.

(32:28):

We do look at it quarterly. We pull our metrics from Eldermark, most all of them actually from Eldermark into that QAPI. And then it is a team within each community that sits down, collaborates. And they have to determine their three top action plans, I guess, action points, I guess. And if their average response time has increased, maybe gone from... Our communities actually do really, really well with this. But if we see that a community is up to maybe four minutes now in average response time, maybe that would be their goal to get down. With that being said, I do send out reminders and I will come in and take a screenshot of the data and the metrics that I see out to the communities just so that everybody is aware that we are holding them accountable for some of this.

Mark Anderson (33:18):

And all these data points that you're relying on, I mean, you have to rely on good data management, good data entry practices. So it's kind of an observation of mine from before and today is that whatever you've done with this accountability culture, you are seeing quantity and quality of data management that you've probably never seen before? Is that a fair observation?

Mary Frances Dahl (33:45):

[inaudible 00:33:46].

Patty Krueger (33:46):

Yeah, absolutely. Absolutely it is. We do have a daily huddle form. In the old days, it used to be called report between shifts, a shift change. And on that huddle form, we do have, again, some of these data points and metrics on that for the teams to discuss just so that we are transparent and everybody knows.

Mark Anderson (34:10):

So that's this benefit of trickling this data down through the whole organization and then that daily standup being that transparent, that awareness of everybody as to how what they document affects what you're sharing?

Patty Krueger (34:26):

Oh, absolutely.

Mark Anderson (34:27):

Must be motivating the team in some way to document better. Yes?

Patty Krueger (34:33):

Yep, yep, yep.

Mark Anderson (34:33):

Great.

Patty Krueger (34:34):

And we want to ensure we're capturing all these services as well.

Mark Anderson (34:37):

Yeah. Thank you.

Patty Krueger (34:38):

Oh, you're welcome. And then from a risk management perspective, it really is vital that we monitor our incidents and ensure the safety of all, of course, who reside with us. That's our top concern, ensuring safety for sure. And from that, we have an obligation to investigate and assess and look at such factors as environmental medications, if there's a functional, something that we could improve on or if it's a cognitive decline just to develop our strategies to mitigate anything going forward. So we have these screens, we can hover over them, we can see what these are. We are able to select what we want. And we do discuss our falls with our communities on a monthly basis.

Mark Anderson (35:23):

So this graph is going in an impressive direction.

Patty Krueger (35:26):

It is, isn't it? I don't know what happened last March.

Mary Frances Dahl (35:30):

Yes, that's the right direction for this kind of thing.

Patty Krueger (35:34):

That's the direction that we want.

Mark Anderson (35:36):

For March. I'm going to give you the excuse of change of seasons is always hard on our residents.

Mary Frances Dahl (35:41):

It is.

Patty Krueger (35:43):

It's hard. It's hard.

Mark Anderson (35:43):

And so that's what we'll assign it.

Patty Krueger (35:47):

And now this is all of our 13 communities. Well no, probably 12.

Mary Frances Dahl (35:50):

12.

Patty Krueger (35:51):

12, yeah. And then again, part of our QAPI, as we just talked a little bit about, is our response time of our pendant calls, our emergency response system Notify. We really do want to make sure everybody is taken care of and we have really good average response times by the day. So this is all communities that you're looking at for a particular time. But I do look at this often. Well, I actually am in the dashboard, it's set at a regional role, once daily I'm probably in the dashboard 10 times a day just looking at metrics, seeing where people are. It really helps me just know if our staffing is appropriate, what our acuity is doing, and where the communities need additional support. So this screen is extremely helpful to have here because I am able to get all of this information. I'm able to look at trends.

Mary Frances Dahl (36:47):

And Patty looks like a beautiful, mild-mannered person, but she's our lion.

Patty Krueger (36:54):

I'm not really.

Mary Frances Dahl (36:55):

And she sends out reports to all the communities about where they're at with missed or not confirmed services, any of the metrics that she is responsible for measuring. And she uses a red line, and the longer the red line is the more work you can do to improve your situation. And nobody wants to be on a long red line on Patty's weekly reports. So what we also have just as a byproduct of our year of accountability and are being very open with all of our information, is-

Patty Krueger (37:34):

We have a little competition.

Mary Frances Dahl (37:35):

... We have some peer pressure going. Yes.

Patty Krueger (37:38):

We do.

Mary Frances Dahl (37:39):

And it's helpful.

Patty Krueger (37:40):

It is.

Mary Frances Dahl (37:41):

Gentle peer pressure can be very helpful. It's not bullying. It's just-

Patty Krueger (37:44):

No. My emails are very nice, but nobody wants a red line.

Mary Frances Dahl (37:48):

Nobody wants a red line.

Mark Anderson (37:49):

So they're competing for the shortest red line?

Mary Frances Dahl (37:51):

Yeah, they're competing.

Patty Krueger (37:51):

Or no, they want no line.

Mark Anderson (37:51):

Or no red line.

Patty Krueger (37:51):

They wand no line.

Mary Frances Dahl (37:53):

No line.

(37:57):

Okay. So on slide six I said measured, validated, and well-maintained. And right now I'm going to talk about the well maintaining part of making sure that we're holding people accountable. So we've figured out what we want our standards to be. We've trained our standards, we're measuring them. Patty and I are at the corporate level going around and measuring them, and we're validating, we're testing, and now we're going to talk about the well maintained. The mission of The Waters is to create a sense of community where everyone thrives. Everybody. Our leaders are paramount in achieving all of this, but our basic tenants, our teamwork, humility, responsibility, innovation, victories are celebrated and every moment matters. So when Patty sends out her red line report-

Patty Krueger (38:52):

With a nice email,

Mary Frances Dahl (38:54):

With a nice email. She emphasizes in that report the people that have no red line. So they want to be mentioned as having no red line. So she'll say, "Congratulations to ED S. Smith and to the director of Health and Wellbeing for having all of their services confirmed. This is great." Now she doesn't say, "But you people that have a long red line, better tow it."

Patty Krueger (39:20):

No, I don't.

Mary Frances Dahl (39:21):

Because they get the idea that they want to be in that first paragraph. They want to be celebrated. So it's basically a tenant of positive reinforcement. That's what we try to do.

Mark Anderson (39:34):

We have a question from the participants on who is the keeper of these standards, when you talk about, well-maintained? Is that a person?

Mary Frances Dahl (39:43):

No, we have a committee.

Mark Anderson (39:44):

Is that shared?

Mary Frances Dahl (39:45):

No, we have a committee.

Mark Anderson (39:46):

Who's the keeper? Your committee?

Mary Frances Dahl (39:48):

We have about 10 people at the corporate and the leadership community level that work on these and meet on these. The other thing that I'm going to talk about briefly in a little bit, but I'll just do it right now, is standards, process, procedure, policy is always changing. The only constant is change. We have got to be able to develop, move quickly, improve, go with the flow, change with technology, and constantly be looking at this. Just our SPLASH program alone that we rolled out for the first time two years ago has had significant changes just about every six months as we see things that we want to change, that we see new best practices.

Patty Krueger (40:32):

That's what I was going to say. New best practices.

Mary Frances Dahl (40:33):

New best practices. And then on the clinical level too, and operationally at the nonclinical clinical level, we also have to keep up with whatever our states decide to do. Those of you residing in the state of Minnesota that have an assisted living license know that, at least our lease before two years ago was about 40 pages. After the change of the Minnesota regs, our new lease is 93 pages adding in all of the new addendums and the requirements. And that's great for the residents because this demographic, the elderly, this is really the state being a stronger advocate for them. But it was very onerous for us to get in shape and change everything for that. So just understand that it's very much fluent, constantly changing.

(41:26):

So our Vice President of Operations, Heidi Elliott, I guess she would be the ultimate owner, to answer your question of the standards. And she sends out weekly tips. This is the well-maintained part. Okay? So she makes sure that everybody knows that we've got this in our sites. We're still looking at the standards. So this is the result of a survey that she sent out. This was weekly tip number two. We've got many weekly tips now being in November now. But she said most of you indicated that you are aware of and are using the leadership promise guide for difficult conversations. However, some responded on the standard survey that indicate that they were unaware of this promise. So we're constantly surveying our leadership too to make sure that if they attended a seminar that was a training seminar and they were multitasking and they missed part of it, I mean, who does that? So we're testing that and then we're revisiting it.

(42:27):

Performance conversations are never easy. Nobody wants to sit down and discipline one of their team. But it has to happen. It's part of accountability. We hire you to do a job. We want to pay you to do that job. We want to be able to bill for the job you're doing. So when you're not doing what you're supposed to do, we have to sit down and have difficult conversations. So we coach our leaders. And this was all in this weekly tip number two. We talk about how do we bring up the issue. So you want to seek to understand the issue and the problem first. This is a constant training on leadership. And I picked this one because this is one of the most difficult things for me to do when I have direct reports is having to sit down and talk to them about their areas of improvement. It's difficult.

(43:17):

So I'm not going to read through all these, but we researched what we want to do for our leadership promise. And the core issue is making sure that we have given the person that needs improvement, all the tools that they need to do their job properly.

Patty Krueger (43:36):

And to be successful.

Mary Frances Dahl (43:37):

And to be successful.

Mark Anderson (43:38):

Yeah. Well you're putting your money where your mouth is, so to speak, right, as leaders. You're like, look, we've got a new culture of accountability here. You have to do this-

Patty Krueger (43:50):

Yes.

Mary Frances Dahl (43:50):

Yes, absolutely.

Mark Anderson (43:50):

... to be a part of that.

Mary Frances Dahl (43:53):

And actually when we first started releasing the standards, I talked in the very beginning about some of our EDs where maybe mavericks because they ran it as entrepreneurs. But now we started introducing standards and consistencies and expectations and we lost some people. We lost some people that wanted to be able to do what they wanted to do on a daily basis. But it overall helped the organization definitely to develop these.

(44:19):

So that's it for our presentation. I have no idea what we're doing on for time.

Mark Anderson (44:23):

We're good.

Mary Frances Dahl (44:24):

But thank you you, Eldermark, for giving us the opportunity.

Patty Krueger (44:27):

Yes, thank you so much.

Mark Anderson (44:28):

Yeah, we really appreciate this, Patty and Mary, so much. I think, kind of rounding things out, great that we looked at some of the data points that help support your effort, that you're not just going on anecdotal stories or I heard. You're you presenting real time real data to your colleagues so that they understand where things fit based on those standards that you introduced. Really cool there. So we've got a number of senior living providers who are participating in the webinar today. Maybe we've got some that are thinking, "That accountability thing sounds like a good idea." What would be a couple pointers for them, where to start? Is it looking at the data? Is it just making the decision? I mean, not to go into too much detail, but you know what I mean? Just like where's a good place to start?

Mary Frances Dahl (45:26):

You can equate this a little bit to the old-fashioned gap analysis. So if you look at your processes and procedures, you look at how you're doing it today and look at where you want to be and have it be fairly measurable with line by line item. Have it be a process or a task or how do you want to do your collections? How do you want to do your billing? And how are you doing it now? How do you want to do it? And then line for line, what are you going to do to close the gap and get to the future? So it's a process design.

Patty Krueger (46:01):

It is.

Mary Frances Dahl (46:03):

You can use swim lanes, you can use... I mean there's a million different ways to actually develop process and procedure. The difficult thing is to then roll it out to the people who's changing the most. So it's a bit like we took eight, at the time, communities and did a merger and acquisition. And we took the best practices from all of them. We let them have their, say we had a committee that we formed and then we came up with what we wanted it to look like. And the most difficult was to get it out to the people that had the largest change to have. But it's a process improvement plan basically. It's a gap analysis.

Mark Anderson (46:42):

Well, and I love that you stretch out over a whole year. You alluded to creating new habits earlier on in what you were sharing, and we all know that in order to create a new habit, you have to repeat that over time.

Patty Krueger (46:59):

We do repeat.

Mary Frances Dahl (47:00):

Yes.

Patty Krueger (47:00):

Absolutely.

Mary Frances Dahl (47:01):

It has to be repeatable. But you also have to be open to change.

Patty Krueger (47:06):

But we have found that with the standards that we have, people want that. They want to know the data and they want to know what is expected.

Mark Anderson (47:17):

Yeah. Well, and I love the side benefit of the retention increasing and turnover decreasing for you.

Mary Frances Dahl (47:26):

That is one of our biggest goals Last year was our year of retention. As everybody on this call knows, it's very difficult to hire quality people. You used to have a job opening, you might have 15 to 20 applicants. Now we get one or two. And so we need to retain the people that we do hire and do train in to the positions. But yes, we have had positive improvement in that area as a side bite to this. Yep.

Mark Anderson (47:52):

Good. We've got just a comment from an attendee as we wrap things up and she says, "Thank you..." I won't name names, but I'll say this is a clinician out there in senior living that I happen to know. "Thank you for the very sensible approach in how to use the service minder data to track the day-to-day process. Great job."

Patty Krueger (48:13):

Thanks.

Mark Anderson (48:13):

So thank you for that comment.

Patty Krueger (48:14):

Thank you. Yes, thank you.

Mark Anderson (48:15):

Very much appreciated. Any other questions or comments as we work to wrap things up with our time? And again, apologies for the late start, but such great content today. We really appreciate it.

Patty Krueger (48:30):

Well thank you very much. Very happy to be here.

Mary Frances Dahl (48:34):

Thank you to be here.

Mark Anderson (48:34):

Are we able to do the poll or no? So how are we doing that? There it is. So before we end the webinar, a quick poll. If you would like Eldermark to follow up with you as a result of this webinar, any other things related to the content here, you can click yes on the screen and we will follow up with you after the webinar. Love to do that. We always love to connect with folks and we often get follow-up from attendees after these and that's always a lot of fun. All right, good. So answer the question. And then our next leadership forum webinar is the first Wednesday of December at 12:00 noon. Topic yet to be finalized. So watch for announcements about that coming up. Let's see, we have another quick question. Oh, just, thank you. Thank you. Okay, so one question before we end. Last question, how do you interview better to hire better? That's a whole nother webinar, but real quickly.

Mary Frances Dahl (49:43):

It is another webinar.

Patty Krueger (49:45):

Well, our HR team has developed the hiring standards from the first time they see an applicant to getting them in the door. Add to the questions.

Mary Frances Dahl (49:55):

Well and making sure that your interview questions are appropriate to the position and not just general stuff. And it's always nice to have multiple people in there. I interview for nursing all the time because I'm interviewing, looking for something different than Patty's looking for.

Patty Krueger (50:17):

What I'm looking for. I know [inaudible 00:50:18].

Mary Frances Dahl (50:17):

And then we collaborate after. So I think it's being prepared for the interview, being welcoming. Honestly, offering water or coffee, making them feel comfortable, making it be a non-anxiety ridden interview for the person that's applying. Taking them on tours. I can tell you that I'm so proud of The Waters. Our buildings sell themselves. People want to work there usually when they get in there. It was very difficult during COVID because we had to do everything on the phone, but now we're bringing them back in building. And being genuine, asking questions that you care about, but also having some fun.

Mark Anderson (51:00):

I'm going to add something just from my own background, if I may. And that is to your point about the standards at the beginning, one of the things, lessons that we learned during the nursing and staffing crisis in the late eighties, so that's how far back I go, but it was don't settle. Stick to your standards better to work without that position filled than to work with that position filled with someone who is less than adequate based on your standards.

Patty Krueger (51:30):

That is our philosophy.

Mark Anderson (51:33):

Right. But it's tempting when it is so hard to find good people.

Mary Frances Dahl (51:38):

It is very difficult.

Mark Anderson (51:39):

And it's like, oh, I've got two openings and I have two applicants. I guess I'll just hire these two people no matter what. Well, you don't want to do that.

Patty Krueger (51:48):

All the communities try very hard to hire the right people.

Mark Anderson (51:52):

So I just wanted to add that because again, getting to your standards thing, it's like stick to your standards. You're better off without it.

(52:01):

Oh, here's a question. "Do you have to be an Eldermark subscriber to be a leadership presenter?" You don't. So give me a call or email MAnderson@Eldermark.com. We have presenters in the Leadership Forum webinar series from everywhere, from various technologies to people who are just doing interesting things for the senior living business line. So yeah, we're all over the map. So long as the presentation is related to something to support leadership in senior living, yeah, we're open to anything. All right, well let's wrap things up. Again, thank you guys so much.

Patty Krueger (52:45):

Thank you for having us.

Mark Anderson (52:46):

Love having you as a customer. Love what you're doing. Thanks for sharing it with everybody. I really do appreciate it. Thank you very much.

Mary Frances Dahl (52:53):

Thank you.

Patty Krueger (52:54):

Thank you.

Mary Frances Dahl (52:54):

Stay warm. Happy November.

Mark Anderson (52:56):

Thank you attendees. And with that, we will close the webinar. Thank you.