PHI's Coaching Approach to Relationship-Centered Care in Gerontology
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Gerontological Society of America
New Orleans — November 2010
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South-Bronx Headquarters
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Three roles:
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Model development
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Technical assistance
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Policy / advocacy
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State / Federal Strategy
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A suite of interventions designed to
build the “universal skills” necessary to
deliver relationship-centered care…
…driving decision making closer to the
consumer and her/his care partners.
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Active Listening
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Clear Communication w/o Judgment
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Self Reflection / Self Management
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Collaborative Problem Solving
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Participative Leadership
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Design:
Four-Year “R&D” Demonstration
Purpose:
“Break the cycle of instability”
Strategy:
Prepare nurses/managers to
become more effective supervisors
Funding:
$4.7 Million
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Intended Outcomes:
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Improve direct-care jobs
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Improve supervisory jobs
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Improve staff relationships
30 Provider Sites:
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Home care / nursing home
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Varying levels of intensity
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Interventions:
Executive Leader Seminars
Train the Trainer
Cross Functional Team Meetings
On-site Boosters
Peer Gatherings / Executive Leader Summit
Technical Assistance / Executive Coaching
Coaching Communication Training – DCWs
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Evaluation Activities:
Baseline Survey
Endline Survey
Turnover Data
Executive Leader Interviews
Trainer Interviews
Cross Functional Team Focus Groups
Supervisor Focus Groups
Direct-Care Worker Focus Groups
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Nursing Homes:
Beth Abraham - New York - 300 CNAs
Loretto Fahey - New York - 150 CNAs
Medilodge of Howell - Michigan - 150 CNAs
Fairview Beth Pike - Pennsylvania - 91 CNAs
Sterling - Pennsylvania - 90 CNAs
Loomis House - Massachusetts - 52 CNAs
Orchard Cove - Massachusetts - 38 CNAs
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Home Care:
Partners in Care - New York - 8400 HHAs/PCAs
Partners Boston - Massachusetts - 400 HHAs
VNA of Central Jersey - New Jersey - 200 HHAs
VNA of Indiana - Pennsylvania - 90 HHAs
CH&H - New Hampshire - 82 HHAs/PCAs
Keystone - Pennsylvania - 55 HHAs/PCAs
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{Retrospective Questions: n ≈ 240}C
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Nurse supervisors and leaders
reported
their time had been
freed
to focus on
other responsibilities:
Φ
25 supervisors reported an average of
three hours
saved per week following supervision training.
Φ
“As an executive director, I cherish the gift of
time. My staff have learned to work together to
solve problems at the appropriate level, leaving
me the ability to focus on strategic issues…”
~ Margaret Franckhauser , CEO, CH & H
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Coaching with consumers
and their families:
Φ
“Coaching promotes a feeling of mutual respect.
…trying to understand where people are coming
from, not making assumptions, applies not just to
staff, but also to patients and families.”
(supervisor)
Φ
“As soon as I said to [a very upset family member]
that I wasn’t sure what she was asking, so I wasn’t
sure how to help her, she calmed down…”
(nurse)
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Profound change –
initially individuals, then
entire organizations:
Φ
“Coaching Supervision has transformed the culture of
this organization. Relationships between our office-
based supervisors and home health aides are much
more positive…even the office is quieter.”
~ Marki Flannery, CEO, Partners in Care
Φ
“Coaching Supervision provided the educational
foundation for our culture change, which is all
about
relationships.”
~
Paul Hollings,
CEO, Orchard Cove
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Five “universal skills”
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Can be learned
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How to teach
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How to build capacity (teach teachers)
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How to sustain
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PHI's Coaching Approach aims to develop universal skills for relationship-centered care, emphasizing active listening, clear communication, self-reflection, collaborative problem-solving, and participative leadership. The Center for Coaching Supervision & Leadership engages in a four-year R&D project to enhance supervisory effectiveness, improve direct-care jobs, and foster better staff relationships across 30 provider sites. The program includes interventions such as executive leader seminars, train-the-trainer sessions, and on-site boosters, with evaluation activities like surveys and focus groups to measure impact.
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Presentation Transcript
The Coaching Approach to Relationship-Centered Care Gerontological Society of America New Orleans November 2010
PHI South-Bronx Headquarters Three roles: Model development Technical assistance Policy / advocacy State / Federal Strategy
PHIs Coaching ApproachSM A suite of interventions designed to build the universal skills necessary to deliver relationship-centered care driving decision making closer to the consumer and her/his care partners.
PHIsFive Universal Coaching Skills Active Listening Clear Communication w/o Judgment Self Reflection / Self Management Collaborative Problem Solving Participative Leadership
PHIs Center for Coaching Supervision & Leadership Design: Four-Year R&D Demonstration Purpose: Break the cycle of instability Strategy: Prepare nurses/managers to become more effective supervisors Funding: $4.7 Million
PHIs Center for Coaching Supervision & Leadership Intended Outcomes: Improve direct-care jobs Improve supervisory jobs Improve staff relationships 30 Provider Sites: Home care / nursing home Varying levels of intensity
PHIs Center for Coaching Supervision & Leadership Interventions: Executive Leader Seminars Train the Trainer Cross Functional Team Meetings On-site Boosters Peer Gatherings / Executive Leader Summit Technical Assistance / Executive Coaching Coaching Communication Training DCWs
PHIs Center for Coaching Supervision & Leadership Evaluation Activities: Baseline Survey Endline Survey Turnover Data Executive Leader Interviews Trainer Interviews Cross Functional Team Focus Groups Supervisor Focus Groups Direct-Care Worker Focus Groups
PHIs Center for Coaching Supervision & Leadership Nursing Homes: Beth Abraham - New York - 300 CNAs Loretto Fahey - New York - 150 CNAs Medilodge of Howell - Michigan - 150 CNAs Fairview Beth Pike - Pennsylvania - 91 CNAs Sterling - Pennsylvania - 90 CNAs Loomis House - Massachusetts - 52 CNAs Orchard Cove - Massachusetts - 38 CNAs
PHIs Center for Coaching Supervision & Leadership Home Care: Partners in Care - New York - 8400 HHAs/PCAs Partners Boston - Massachusetts - 400 HHAs VNA of Central Jersey - New Jersey - 200 HHAs VNA of Indiana - Pennsylvania - 90 HHAs CH&H - New Hampshire - 82 HHAs/PCAs Keystone - Pennsylvania - 55 HHAs/PCAs
Coaching Supervision uptake: % Reporting Often or Always Practicing Significance & Effect Size (low, medium, high) Before/After Questions Before CS training I held people accountable for doing their job well 63% p < .001 After CS training I hold people accountable for doing their job well Effect Size = .45, medium 88% Before CS training I practiced active listening at work 44% p < .001 Effect Size = .86, high After CS training I practice active listening at work 88% Before CS training I practiced pull back at work 34% p < .001 Effect Size = 1.01, high After CS training I practice pull back at work 82% {Retrospective Questions: n 240}
CCSL Supervision & Job Satisfaction Satisfaction Supervision Scale p = .040* Pre N = 1270 Post N= 1392 p = .004* Pre N = 1298 Post N= 1406 All Staff p = .039* Pre N = 1007 Post N= 1120 p = .003* Pre N = 1038 Post N= 1143 Direct-Care Workers
Increased efficiencies Nurse supervisors and leaders reported their time had been freed to focus on other responsibilities: 25 supervisors reported an average of three hours saved per week following supervision training. As an executive director, I cherish the gift of time. My staff have learned to work together to solve problems at the appropriate level, leaving me the ability to focus on strategic issues ~ Margaret Franckhauser , CEO, CH & H
Residents and clients Coaching with consumers and their families: Coaching promotes a feeling of mutual respect. trying to understand where people are coming from, not making assumptions, applies not just to staff, but also to patients and families. (supervisor) As soon as I said to [a very upset family member] that I wasn t sure what she was asking, so I wasn t sure how to help her, she calmed down (nurse)
One Sites Health Outcomes High Risk Residents with Pressure Ulcers Residents with a Urinary Tract Infection 18% 18% 16% 16% 14% 14% 12% 12% 10% 10% 8% 8% 6% 6% 4% 4% 2% 2% 0% 0% Orchard Cove National Average Trend Line (Orchard Cove) Orchard Cove National Average Trend Line (Orchard Cove)
Organizational transformation Profound change initially individuals, then entire organizations: Coaching Supervision has transformed the culture of this organization. Relationships between our office- based supervisors and home health aides are much more positive even the office is quieter. ~ Marki Flannery, CEO, Partners in Care Coaching Supervision provided the educational foundation for our culture change, which is all about relationships. ~ Paul Hollings, CEO, Orchard Cove
PHIsDistillation Five universal skills Can be learned How to teach How to build capacity (teach teachers) How to sustain
For more information, contact: Steven L. Dawson, President PHI SDawson@PHInational.org
