Chris Magleby, CSO of HCP, shares 5 proven strategies to keep your people past the first 100 days, and how you can save more than $58,000 per year in recruitment and retention expenses.
Chris Magleby, CSO of HCP, shares 5 proven strategies to keep your people past the first 100 days, and how you can save more than $58,000 per year in recruitment and retention expenses.
Linda Leekley (00:07):
Hi everyone. I am Linda Leekley, chief Clinical Officer at hcp.
Amanda Sternklar (00:12):
And I'm Amanda Sternklar, our director of marketing.
Linda Leekley (00:16):
And this is Vision, the podcast for leaders and forward thinkers in the care industry. And today we're gonna be discussing the proven methods that are guaranteed to help you retain more of your employees. And to do that, we're joined by our very arm chief strategy officer, Chris Magleby.
Chris Magleby (00:36):
Hi. Thank you. Sometimes, I'm honestly so excited to be here. This I saw, I've listened to a few of the podcasts and as soon as I started listening, I thought I gotta be a part of the club. So thanks for having me.
Amanda Sternklar (00:47):
We're happy to have you. Just a little bit of background from pulling weeds as a child at his father's nursing, nursing facility to heading up one of the leading research companies in the sector. Chris has spent most of his life in the senior living and skilled nursing industries. He lives in Salt Lake City with his wife and three children. And when not working, he can be found at a golf course, sporting event or concert venue. Thanks for joining us, Chris.
Chris Magleby (01:12):
Hey, you're welcome. Very happy to be here.
Linda Leekley (01:15):
Yeah. You, you know, Chris, you and I have spoken enough to times to that, that I know that employee retention is not just your specialty, but it's your passion. Yeah. Can you tell our audience more about your background and how you've dedicated your career to, to improving employee satisfaction and retention?
Chris Magleby (01:35):
Sure. I, one of the ways I like to kind of talk about this and, and, and my passion is to kind of tell a story of when I was a kid actually growing up, you mentioned that I grew up, my dad was running nursing homes as a kid. And so I would spend so much time at these different nursing homes. And one of 'em was in, or Utah, or nursing rehab. And he, he spent, he was an administrator there, probably longer than anywhere else. And so I was a kid, I'd go visit and one of my most vivid memories, well, lots of vivid memories, but I always got to hang out with the staff. I'd hang out in the, like, the nurse's lounges. One of the things I remember is that the vending machines only had Diet Coke. And so maybe nurses only drink Diet Coke, I don't know.
Chris Magleby (02:16):
But I always wanted like a, an orange crush or something like that when I was a kid, or a root beer that was the only diet Coke in the vending machines that the staff always was doing stuff together. They had this very close camaraderie. And even me as a child, I kind of got to experience some of that camaraderie. You know, they'd have their softball team, I'd go to the softball games, hang out with the, some of the staff that played on that. But one of the things that kind of left a lasting impression on me was the very first room when you'd, you'd walk into, you know, there's the front door, but we would always come in the side door from the parking lot. And the very first room when you walked into the, to this nursing home was a resident room. And the resident that lived there for my whole, every time I went there, her name was sissy.
Chris Magleby (03:05):
And Sissy couldn't really communicate very well. And she was, you know, bound. She was in her bed all the time, but she liked people. And so they would wheel her out every morning into her doorway that, so she's kind of in the hall, kind of in her doorway. And every time we would come into the facility, my dad would stop and hold his sissy's hand and ask how she was doing. And she couldn't really respond, but you could see her face that she really appreciated that. And that was the, that the atmosphere that they had there. Everyone was very caring and loving, and it was about this human connection. And, you know, s at my dad's Stan, he went on to found Pinnacle, which I was the c e o of for 12 years and, and was there for 20 years. And Pinnacle was kind of founded on that same principle, that taking a second to stop.
Chris Magleby (03:59):
And, you know, in this case, we're not holding people's hands, but, but we are letting them know that we care about them. And when you, you let the staff know how much you care about them, you let your residents, your patients know how much you care about them, you know, that is what created that great place to work. It's what created that great level of care is just that one-on-one connection. And, and so many of us are in healthcare because of that. We want to make a difference. We want to help people. We want to, you know, lift those around us up. And so for me, that type of camaraderie and showing people you care, that's what I'm very, very passionate about. And I think that's how we lift everybody up simultaneously.
Amanda Sternklar (04:44):
Fantastic. I think before we get too much further into this, we have to acknowledge the, the elephant in the room of, you know, we're here to talk about employee retention. We also have a product literally called Retain. We're not here to push this. We wanna make sure that we're sharing some really great information with everybody. But it is backed by all of the surveys and all the research that Chris, you know, you conducted with Pinnacle and, and we're continuing to conduct thousands upon thousands of employee surveys every year. I know because of that, you've developed a list of five proven strategies that are guaranteed to reduce employee and customer turnover. Can you talk about what those are?
Chris Magleby (05:24):
Yeah, let me talk a little bit about Retain, and it's kind of genesis actually. So, you know, for a long time we were conducting phone surveys for employees. We would do, we would talk to residents and family members over the phone. We talked to employees over the phone. And one of the things that we noticed was we would get some great feedback up front, but then after a while it was, it, it became hard to get the employees on the phone and it didn't seem to be the best way. Well, there was nothing wrong with the phone, but, but this continual outreach of, of phones based surveys, it, it didn't seem to have like a long shelf life. It, it, it only worked for a little bit and it worked great in the begin, you know, to get some of that feedback going. But these continual check-ins, we kept having our clients say, you know, I need a little more of a continual check-in with on my staff, make sure I know how they're doing.
Chris Magleby (06:17):
Especially the first 90 days, you know, everyone said, we just have so much trouble with staff retention the first 90 days. Can you do some new hire check-ins? Different things like that. And so we, we noticed that there was this, this problem and we wanted to see if we could fix it. So first we started doing some research into the problem. And what we found is that, yeah, all these anecdotes that we were hearing of, you know, people aren't staying during the first 90 days, you know, the data was backing that up. And we were seeing huge amounts of staff leaving. You know, as we started looking at the data, we were seeing a lot of, about 30% of staff was leading leaving before day 100. And so we started kind of crafting a solution. What, what could we do? And what we found was that if we did these really short kind of text message check-in surveys along their journey in those first 100 days, it was actually very effective.
Chris Magleby (07:13):
And so we started kind of building this new platform, which ended up being called Retain, that was based around this principle of, you know, checking in with our staff. We check in with them right when they're hired. We say, introduce ourselves. Hey, hey, hello, welcome. You know, they've asked us to check in, just make sure things are going okay for you. Then we'll check in at day 15, day 30, day 60 and day 90. And if we were able to get all of those touchpoints, we are able to kind of diffuse some of the big problems and keep these people around a little bit longer. Because one of the things that you see that's so interesting in our sector is you see this huge spike of turnover in the beginning, and then after about that 100 day period, it actually goes way down. And so what happens is people get into this job and they get into healthcare because they wanna make a difference because they care about other people because it's a rewarding job.
Chris Magleby (08:10):
But there's so much to learn. You know, we know this from some of our training products that we provide. You know, Linda, you've got a great career in healthcare. We know how how hard some of that training is during those first three months. And so for a lot of people that those, the, the scales start to get outta balance. Like the, the reward that you're getting from your job start, it sometimes doesn't feel worth it until you can get through that new hire orientation time and then the scales start to go the other way. And the reward that you're getting from performing this job, from caring about others, from having those type of sissy experiences that I was talking about that I had as a kid, they'll start to, to outweigh some of the difficulty because you work your way through that. And so we're able to check in with these people four times during their first 100 days.
Chris Magleby (08:59):
If they have a specific problem that needs to be addressed, well we are able to address it. So then we pair with that annual engagement surveys, exit surveys, anniversary reminders, birthday reminders, you know, all sorts of stuff that the software can do. Started to become a pretty powerful tool to help with employee retention. And as we were putting that together, you know, Amanda, like you mentioned, we ended up seeing, hey, these are five things that we can really help people understand. Five things that they can do to I improve, improve their employer attention. You know, especially in the last few years where the workforce crisis has been so hard for so many operators. I know so many like assisted living locations that are not at full capacity, even though they have a wait list to get in cuz they don't have enough staff. And I'm sure so many listeners and so many people attending today know that know that pain.
Chris Magleby (10:00):
You know, they, they may have more customers than they can service right now or, or more patients or more residents than they can service cuz they don't have enough staff members. And so if we can do any, whatever we can do to help, we, we wanna do that. And there's really, you know, you really have two options. One is to expand the hiring pool, you know, try to get out and find more people, try to recruit more people into the space. And I've seen a lot of that seems to be done at, at a state level or an association level. There's a lot of healthcare associations that are trying to help with that. Maybe get some laws changed, maybe reduce the amount of hours people need to have certain certificates where they're able to, or certifications where they're able to provide care. But one of the more efficient things that we can do is do a lot better at retaining the staff that we have.
Chris Magleby (10:49):
And so as we understand them as individuals, you know, I, everything always comes back to that individual understanding that that individual person's journey along their career, what they're trying to achieve, what their, their goals are and what, you know, what their road bumps are. Each person might have a little bit of a, a different road bump. You know, one person you'll learn through some of this systematic feedback that we provide is one person may have a hard time learning the, a new EMR and this's is hard for them. And, and coding things are different than than the last em r they were using. You know, another person may not have any problem with that, but they're really hoping for evening shifts, but they keep getting scheduled for the morning, something like that. Each person has a little bit of a different story. And so there, so there are some things that you have to do, you know, uniquely for each individual, but there are some systemic things that you can do across the board. And that's really what this plan we created was more of a strategy that you can implement that will systematically help you retain more of your workforce. So I'm, I'll kind of go over those five things, but I've just been talking forever. I don't know. Linda, you got something you wanna chime in, man, if you wanna say anything <laugh>?
Linda Leekley (12:04):
No, you're good. I think if you lay out in your five five still, that's, that's what, that was perfect Chris.
Chris Magleby (12:09):
Okay, cool. So the first thing that we suggest is, you know, we all kind of know that saying of the only thing that matters is what you measure. I think I'm butchering the saying a little bit, but people will do, you know, what their supervisors are measuring? People care about what we're measuring. So, so the first item on the step is you've got to create a strategy. And so we call it create a hundred day strategy. And I'm just, I'm gonna just reiterate something I already talked about. The first 100 days in post-acute care for employees is just critically, critically important. You see this a little bit in other industries, you will see that the turnover does spike a little bit during the first three months of employment. But for most other industries, the highest point of employee turnover happens at the year mark. And then it will go down a little bit and you'll see another spike at the two year mark.
Chris Magleby (13:06):
And then after that turnover starts to steadily decrease. We are unique in that we see the biggest spike of turnover happening in the first 100 days and then it starts to drastically decrease. And so, you know, by the time you get to the six month period, if someone's made it six months, their chance of turnover is very, very low. And so what we want to do is just really focus on the first three months, you know, those first 100 days of employment and kind of try to ferry people through this difficult time because we know by looking at the data that if they can get through that, chances of them sticking around long term are very, very high. And so the first thing that we want to do is create a hundred day strategy. We have to measure what our current 100 day, you can measure retention or you can measure turnover there, you know, the inverses of the same measurement and you've gotta set a goal on how to improve that.
Chris Magleby (14:10):
So before the pandemic, we were losing about 30 to 33% of our new hires to four day 100 since the onset of the pandemic and kind of the difficulty that that had, that had created in the healthcare system, we are now up to about 40% new hire turnover before day 100. So for anyone who's listening to the call, the first thing you wanna start doing is measuring of all the new people that I hire. And you can look at any timeframe. So you could say, okay, I'm gonna look at q1, everyone I hired in q1, did they make it a hundred days or not? And if they did make it a hundred days, you know, that's a a yes. You put them in the numerator, the denominators, how many people you hired, that's gonna give you a percentage. And so right now that benchmark is we are losing 40% before day 100.
Chris Magleby (15:04):
Or if you look at the inverse, we're keeping 60% of our new hires. And so, so that's kind of a benchmark that you can have. You can put that in the back of your mind or just say, this is what's going on across the nation. So if I'm keeping more than 60% of my new hires, you know, I'm out, I'm outperforming the average. If you're losing more than 60%, you're below the average. But no matter what you are doing, you need to measure that number and then create your strategy to improve that number and track your progress over time. So let me just see, I've gotten some notes here. Anything else I would, I would recommend on strategy one, create the strategy, measure how many employees stay through your first 100 days set goals to increase it. And then the other thing is highly, highly recommend.
Chris Magleby (15:51):
This is one of your team members needs to be assigned this measurement as one of their KPIs of how they're performing. And if someone will own this and you know, maybe you, you assign some type of year end bonus to it or something like that, somebody's gotta oversee this and have com you know, some radical ownership in trying to keep our employees through the first 100 days. We know how big of a, a return on investment you're going to get if you have somebody who is assigned to this to measuring this number, following the number and trying to improve it. So that's number one. Number two, oh yeah, go ahead.
Amanda Sternklar (16:29):
Go ahead. I just, I'd add to that something that we say internally, cuz I know it's such a big retention is such a, a big problem for so many organizations that I know the temptation is there to assign more than one person to this metric. So just to add to what you were saying, I know something we say internally is that if two people own it, nobody owns it. Mm-Hmm. So it would really kind of underline Chris, your point about making sure it is one person where this is their, their kpi.
Chris Magleby (16:57):
Yeah, absolutely. And you know, you're gonna have a lot of people maybe helping and different people are, are, you know, doing different responsibilities, but having one person own own it and reporting on it you know, having that number roll up as part of their, their their key performance indicators I think is very important. Yeah, well said. So create your measure how you're doing, create your goals, how you want to improve. And then the next thing is working on your onboarding and training process. And this is something I've spent a lot of time talking to different operators about what they're doing. And it's really interesting. One of the things that we just see all the time is because we're in this pinch where we don't have enough staff and like in a residential care setting or in a, you know, a skilled nursing or assisted living, we don't have enough DNAs on the floor and we don't have enough nurses.
Chris Magleby (17:53):
So as soon as we get someone new, we're put, we're bypassing part of the training process to put 'em out on the floor. And that creates a vicious cycle. One of the questions we ask and retain is, is how they rate their onboarding and training. And no question that we ask has a higher correlation factor to staff tenure than how they rate their training. So if they give an excellent score for the training they received, they're much more likely to have a long tenure with you. If they give a negative score, even if everything else is great, but they, they rate their training as poor, they have a very high likelihood of having a short tenure. And so just keep that in mind. You know, you really, I, I know it's hard because sometimes we need to, you know, in a home care setting, we want to get them, you know, out into the field.
Chris Magleby (18:44):
We want to, we have all these, these customers or clients that we want to take care of, but we don't have enough staff. And so we're, we're maybe skipping part of the onboarding stage or skipping part of the training to get them in the homes or, or in a, in a facility where we're getting them out on the floor maybe before they're ready. And that will create a vicious cycle. So you have to be very aware of that. I talked to a, an operator recently in the Pacific Northwest that they actually put a full-time trainer. Most organizations have a full-time trainer at the, at the organization level. So they have a trainer that, you know, all their facilities or all their agencies roll up into and they're, they oversee training. This particular operator decided to put a full-time trainer at a substantial cost. I mean, their salary is probably 60 to $80,000.
Chris Magleby (19:37):
It had to be you know, a someone who has some experience in nursing and someone who's ex has an experienced career. And then they've gotta provide some of the, you know, the training and some of the materials that go along with the training. And so, you know, in some of the locations it could have been up to a hundred thousand dollars expense per year to have these trainers on site. But they were spending so much money on agency and so much money on turnover that this became a good investment for them to have somebody who, and that person is that person that I'm talking about that could own the, the higher turnover metric. This is someone who's there to train the new folks and usher them through their first 100 days and, you know, make sure everybody's having a successful onboarding. So one of the things that I, just on a side note here, the number that we've always used, because sometimes you do to justify some of this stuff, you do need to have it affect the budget.
Chris Magleby (20:36):
You need to justify some of these expenses or some of these programs that you're putting in place. And so when, when you're looking at the cost of turnover, I think it varies quite a bit across the continuum of care. But the number that we generally use is about $4,000 per employee. So every time you lose someone, it's gonna cost about $4,000 to replace that person. Somebody who's, you know, in the, in the 12 to $20 an hour range, that's what you're going to, to spend. So if you're, you know, if you're losing a hundred people a year times that by 4,000 and you know, you can see how much money you're spending on turnover each year, you know, 400,000. And so I think the average in a skilled nursing setting, I think the average w was about 76 people per facility were turning over each year.
Chris Magleby (21:29):
The last time I checked, sometimes that by 4,000. And in a skilled nursing setting, you can see how quickly those, those costs add up. So if you can do something at a lesser cost to try to retain more of your staff, it's usually has a great roi. So, you know, working on that training process, whether you're investing in a trainer or just making sure people go through all of their training, one of the best things that you can do for training is ask the staff if it's good enough. Like that's really the, the only way that you can evaluate how good training is doing is by asking the staff. And that kind of leads me into the next item, which is systematic feedback. One of the things you've got to do in order to retain your new hires is check in with them regular regularly.
Chris Magleby (22:18):
And, you know, for our clients, that's where we come in and help through retain is, is we're going to systematically do this. And, you know, those are very casual check-ins. It's not designed to be a real formal employee feedback process. Maybe the employee engagement surveys that we would do each year are anonymous and they're a little more formal. These sys this systematic feedback where we're checking in with new hires that's less formal and it's kind of conversational and it's like, Hey, are you okay <laugh>, we know the job is stressful. Do you need anything? You know, that's that we end every check-in survey with that question. Do you need anything right now to be better at your job? Because each person's different. They might need something. You know, most people say, no, I'm okay right now, but every now and then, it's funny, I always tell the story cuz we, we would do it too internally.
Chris Magleby (23:08):
You know, we would hire, we, we hired a new software engineer once and he, he got a retained survey and he said, everything's great, but I don't have a garbage can near me, so I have to get up and walk the garbage every time I have to throw stuff voice, can I get a little garbage can, you know? And it's like that he, he's not gonna leave over something like that. But any little thing that we can do to, to help people, you'll hear all sorts of interesting little tidbits of just little things that people need sometimes to have major concerns in those first 100 days. And, and that will help. A lot of times they're asking for more training. That's one of the ma that's, I don't know if that's the most common like request that we see through these surveys, but it's certainly one of the most common is, Hey, I need more training with this, or I need more training with the E M R or how to use these, you know, the lift or, or whatever it could be.
Chris Magleby (23:55):
There's all sorts of things, but people are usually asking for help and, and more training. So yeah, when you get that type of feedback, it's really important to follow up. One of the things that I alwa people will ask me, how do I get more of my employees to participate in our feedback surveys? The number one thing you can do to increase the amount of employees participating in your surveys is to respond. Make sure you're responding to that feedback, thanking them for the feedback, taking action on it, letting them know what you're going to do. You'll receive a lot of different comments, but if you let the whole staff know how much you appreciate the comments and that you have a game plan and you're gonna try to improve, that's one of the best things that you can do to solicit more feedback. It starts to create that feedback loop.
Chris Magleby (24:42):
So anyway, so that's systematic feedback and how important that is. Checking in with your, your new hires regularly. Regularly, you know, we, we obviously would love to provide that solution and we can do it through retain, which does it through text messages. It's very friendly. This is, this is also something managers can do on their own. You know, if you have a smaller staff and you don't need to leverage technology yet, you can just schedule it so that managers are just saying, Hey, you know, checking in at day 15 30, 60 90 are, are you, are you doing well? Is there anything you need to do better at your job right now? Have you made friends at work? How's your, you know, your relationship with your coworkers. You know, the great thing about using software to do it is it's gonna automate all that and you're not gonna have to, you know, put it in the calendar every time someone gets hired and make sure you're following up 15, 30 days later.
Chris Magleby (25:34):
And so, but that check-in is so important. A lot of it, the reason that that's important is because we need that individual connection. You know, I, you'll see the theme of everything I'm always talking about is caring about people as individuals. And that kind of goes into the fourth principle, which is recognition. Recognition is so important and we need to make sure we're recognizing our staff. Constantly recognize your new hires. If we have a goal, you know, the first thing is create a plan. We want to try to get people to stay one a hundred days on the job. Well, when somebody makes it to a hundred days, we need to recognize them because, you know, that's one of the hardest, that is the hardest time. And once you get through that, hey con thank you, congratulations. Make sure you're recognizing them in front of their peers.
Chris Magleby (26:25):
And so recognition is very important. And then the fifth principle is one that I really love. Let me pull up this quote here. So in, I think it's 2014, this study was published and this was published by a couple professors at Wharton. One's name Siegal Barsade and the other one's name is Olivia O'Neil. And they published a study called What's Love Got to Do with It? It is a longitudinal study of the culture of companionate love and employee and client outcomes in a long-term care study. So it's got a long name, but the study was really powerful. And what they did is they looked at having, creating a loving culture, what type of effect does that have on staff members and what type of effect does that have on our clients? And looking at client outcomes. So they define what a culture of love means. Culture of love.
Chris Magleby (27:25):
They are quick to point out, we're not talking about romantic love. They call it companionate love. Mm-Hmm <affirmative>, companionate love. What that means is people who safeguard each other's feelings and they care about each other. And they were able to measure in a long-term care setting places that scored high for having a culture of companionate love. And what, this is a quote from one of the study, what does a culture of companionate love look like? Imagine a pair of coworkers collaborating side by side, expressing caring and affection towards one another. Safeguarding each other's feelings, showing tenderness and compassion when things don't go well. Now imagine a workplace that encourages those types of behaviors from everyone where managers actively look for ways to create and reinforce close workplace relationships among employees. And the conclusion of their study was, if you work in a place that has this type of companionate love and this connection that the outcomes are, you know, off the charts, they said employees who felt they live in a loving or worked not live but work in a loving, caring culture reported higher levels of satisfaction and teamwork.
Chris Magleby (28:42):
They showed up to work more often. How big of a challenge is that for us in, in this sector, when you know people are, are calling out of work too often very hard to find someone to fill those shifts. Our research also demonstrated this type of culture related directly to client outcomes, including improved patient mood, quality of light satisfaction, fewer trips to the er. So these are all things that we're trying to get from our, from taking care of our, our clients and our residents and our patients, is just by creating this type of caring culture, we are able to affect so many things positively. One of the things that they talked about in this study was this doesn't, this isn't just unique to healthcare. Any business that starts to have this type of caring culture among its employees will see higher employee satisfaction. They will see higher client outcomes.
Chris Magleby (29:37):
You know, we all rise together, but one of the advantages we have in the healthcare setting is that this type of culture is innate to our workplace. This is what we are providing to our customers, to our clients. We're providing this type of care and this type of loving so to speak. And so to have that amongst the employees is a little easier. You know, if I'm working in a bank and I go to the employees and I'm say, Hey, we need to love each other and care for each other a little more, sometimes it doesn't go over as well. But when we do that in a care setting, hey we we're caregivers, we're, we're going to try to foster a culture of caring where we care about each other. Cuz the way we treat each other is just as important as how we treat our clients because they can sense that, you know, when we start behaving in a certain way, it translates across all aspects of our life. When I feel that the people I'm with care about me, well in turn I want to try to take better care of the people who are in who, who are I'm charged with their care, so to speak. Mm-Hmm. <affirmative>. So to me I think that's very important is creating this culture of companionate love and we really have an advantage in, in healthcare because it's, it is kind of innate to our business.
Chris Magleby (31:00):
Okay. So those are five steps. <Laugh>, I'll grab a drink of water.
Linda Leekley (31:04):
<Laugh>.
Amanda Sternklar (31:06):
So just to review really quickly, cuz that was some, some great information, but very in depth for folks, it's step one is creating a plan. Two is onboarding and training. Three is systematic feedback, four is recognition, and five is creating a culture of love. So I miss anything Chris?
Chris Magleby (31:22):
Nope, that's it. That's great. Awesome.
Amanda Sternklar (31:23):
Let's dive in a little. You know
Chris Magleby (31:24):
What, one thing that I didn't say is, during that, when you create your plan, one of the things we always tell people is work on setting your expectations with your new hires. Let them know right from the onboarding process that the first 100 days are the most challenging. And one of our jobs is to try to usher you through those first 100 days and make sure that we are here for you. So if you ever come across any bumps and your first three months, this is what we want you to do. We want you to reach out to us and we're gonna try to help you. Because once you get past those three first three months, it, you'll hit that smooth sailing, you're gonna hit some the, the clear, the smooth water. But those first three months, you know, you're still in the harbor. It's a little bouncy. So we try to help people through that. Set expectations.
Linda Leekley (32:12):
I think that's a really good point, Chris. I think that, you know, it's, it's human nature, right? To try to paint when you're interviewing people to sort of paint this picture of a very rosy picture of how the job is going to be, right? Mm-Hmm. <affirmative> and, and you, as you say, those first few months can be pretty, pretty rocky. So I think without scaring people away, let them know that you've got, you're, you're there to support them through mm-hmm. <Affirmative> those first 100 days. So yeah, I totally agree with you there. And so to, to sum up kind of what you said, of those five steps, what have you found to be the leading indicator of staff tenure?
Chris Magleby (32:55):
Well, that's a great question. So I did talk about how they rate onboarding and training is, you know, there's almost a one-to-one correlation between, well, I'm getting a little ahead of myself. How they rate their training will be very highly correlated to how long they will stick around. And then the next part of this, which is really interesting, is that staff tenure correlates almost to that one-to-one correlation to client retention or to resident length of stay. So the the, the more tenured your staff is, the more experience they have. The longer you are in a, in a residential setting, the longer that length of stay is going to be in a home setting, the longer that that cut the client will be, will stick around. Mm-Hmm. <affirmative>. So having ha you know, having staff with a lot of tenure is not just good for business because you don't have to replace them.
Chris Magleby (33:59):
It start, you start to see benefits everywhere and you're, you're going to have your staff has a huge influence on your patient outcomes. And so creating, so training your staff has the biggest impact on your staff tenure. So that's kind of that, that arc I'm trying to create this circle is we got to onboard and train properly because that's going to correlate the highest to staff tenure. And then if we have high staff tenure, that's going to correlate to a longer length of stay. And when you work on that whole picture and then the whole thing starts to, to rise on its own. So I actually have a little story if I've got time, I know I've been talking forever, but
Linda Leekley (34:46):
Before it, Chris,
Chris Magleby (34:47):
When I've got a, my youngest is seven years old, his name's Jude. And when he was a younger guy, he was kind of a crazy person. When he was three years old, he stuck a Lego in his nose that we couldn't get out. Now we've, he's stuck Legos in his nose plenty of times before. Do you guys know how to get a Lego out of a stuck nose, by the way? Or out of a stuck Lego out of noses? No sir. I'm gonna, I'm gonna teach you so please, whatever, if the Lego's on this side, I'm gonna plug the other side and then you blow into their mouth and we'll shoot the Lego out. My wife knows how to do this. And we said that
Amanda Sternklar (35:20):
You'd learn valuable skills listening to Vision
Chris Magleby (35:23):
<Laugh>. A podcast is gonna be, yeah, we're, we're gonna learn employee retention, but we're also gonna learn a little bit about some parenting, some important life skills. Those stuck in the nose <laugh>. So she would goes to do this and it doesn't come out. He stuck it up way too far. So we gotta, so Sunday she takes 'em over to a, they're called InstaCare here in Salt Lake. They're like urgent care, urgent care, a little urgent care place. And they're trying to get it out and all of a sudden it disappears. And so then, then we gotta take 'em up to the ER and they're concerned because if he swallowed it, that's okay, but if he inhaled it into his lung, that's a problem. And that's going to, they've gotta get it out. So now he's gotta get a scope on his lungs Sunday afternoon at like four.
Chris Magleby (36:13):
And he can't eat anything all day in order to get the scope. Cause they gotta put him under, he hasn't eaten all day and or he can't eat before he goes on the scope. And so, you know, he's kind of getting fatigued and sick and he is three years old, you know, he wants to have love to eat or get something to eat. He's gotta go under and get the scope. So they put him under, they scope the lungs, the Lego is not there, so everything's okay. We go home, we think it's fine, we let him eat again. And then at about three in the morning he wakes up streaming louder than I've ever heard him stream. And he's really, really upset. And then for the next six months, trying to figure out what's happened to him. We were taking him to all these specialists.
Chris Magleby (36:55):
He started like urinating blood. It's, it's, it's really unpleasant. We don't know what's going on in my mind. I think there's a Lego stuck in this kid's body that's wreaking havoc or something because that seems to be what's happened. Well, what turned out, what happened after six months, we finally figured out that he had had kidney stone forming. And when he fasted for 24 hours, it, it did something and it got made it shift and, and it started to move and he started to pass the kidney stone. So he had to have surgery to, you know, blow this kidney stone up and remove it. And when we went into the surgery, we were really nervous and we'd been on this journey with him where he would get, you know, every couple of weeks he's screaming and he's crying and you'd get these ba you know, it's very painful to pass a kidney stone.
Chris Magleby (37:44):
And he'd and his was huge. And so we were, you know, kind of exhausted from these last six months. We go into the hospital and, and the first thing that they do when they check us in is somebody gives us this card. And I wish I had a picture of it, but it says, you know, tell us about your child, number one, and then number two, tell us what's most important to you today about your stay. What are you most concerned about? And we will make sure that we take care of that. And so we write this on this card and it's like a laminated card and we write it in a, in a dry erase marker. And that becomes our card and they hang it on the wall. Everybody that comes into the room picks up this card and, and reads it and say, okay, I see the, the, I think we said we were worried about him going under.
Chris Magleby (38:33):
Cause last time he went under it was this, you know, really unpleasant. And so every person that came into our room picked up the card and addressed the, what was most important to us. Even a maintenance person came in to check on us once, make sure we had enough tissues or something like that. And they read the card. Every staff member knew to refer back to this card and make sure that they were addressing what was the most important thing to us. And I was so impressed with this. And as we were walking into the operating room, I did see on a whiteboard, it said, today we are communicating with our patients about what's most important to them. And so you, I, you know, this is my field that I work in, so I'm paying attention to this stuff. But you can see that there's really great leadership and all these people have been trained, and this is a high focus area.
Chris Magleby (39:21):
I tell this story all the time because it was so impressive to me. And the other side of this story is one of my coworkers had to go take a kid into the pediatricians to get some a procedure done. And he saw the card on the wall, but none of the staff did anything about it. They didn't, they never referenced it. He even asked, Hey, what's that card on the wall? And they're like, oh, I don't really don't know what that is. Don't worry about it. And it just goes to show how important that training is and how important staff tenure is that they know what they're doing because it's going to affect the patient outcomes. I, it, I had a great experience because the staff had been trained of how to have the bedside manner with us and our family to take care of us.
Chris Magleby (40:05):
And so one of the things that we're seeing over the last two years is you're seeing a tick down in resident and customer satisfaction. Those, those rates are, are decreasing a little bit as the workforce shortage is impacting us. As a matter of fact, resident satisfaction rates in skilled nursing and assisted living were higher during the pandemic than they are right now. As we're dealing with the workforce crisis. The workforce crisis is having a, a bigger impact on customer satisfaction than the pandemic did. And think about how horrific the pandemic was for nursing home and assisted living residents. It was probably one of the scariest places to be because the most susceptible of our population were all together. And once Coronavirus came into one of those locations, it just spread like crazy. And to think of all that and to think that their, their satisfaction levels are actually lower now because of the workforce shortage than they were during the pandemic is very interesting.
Chris Magleby (41:09):
Our staff is just so incredibly important to patient outcomes. So the, I would just say how we're training and what we do to take care of our staff, especially in those first three months, it just correlates to everything that we're doing. Every, if we do a better job at that, at better job at training, you're just going to see client and patient outcomes improve resident satisfaction improves, staff tenure improves. So it just, that first 100 days in that training is so important. Linda, I'd be really interested to hear from you, you know, what, what are some of those training best practices that, that you've seen throughout your career to, to really make sure that they have a great experience during the first three months?
Linda Leekley (41:59):
Ooh. Well, Chris, you know, I think one of the first best practices to remember is that most adult learners don't want to be told, take these courses and complete 'em by X date and do it because it's part of your job. Adult learners wanna know why they have to complete training. You know, what, what is it doing for them, their job, their role. So if you describe your onboarding program and it's purpose, I think, you know, to your, to your employees, I think that's a really good best practice. For example, make sure that by a, you assign standard precautions, not just because it's something you've gotta check off your list, but because you care so much about their safety, that you want them to have this knowledge of how to take care of themselves, prevent infection for themselves as well as for their clients or residents.
Linda Leekley (42:52):
And that's just one example. But I think the more you explain the why behind your training and how you've come up with this, these series of courses, the more they'll go, oh, okay, well then I see how that affects me, that you're concerned about me and that I do a good, you know, it's gonna help me in my job. Hmm. To pi piggyback onto that, to offer some specialized training that can add to each employee's skill and knowledge base. And, you know, a, a good way to begin that is by providing with some disease specific training that ensures that each new employee is gonna be prepared for their clients or residents. You know, is, is it a, is your facility or your community focused on memory care? Then for goodness sakes, make sure that they have Alzheimer's and dementia training. Because without that and going into care for these folks, they're, they're gonna be overwhelmed and you're gonna lose them within those first a hundred days.
Linda Leekley (43:50):
If it's home-based care and you're sending somebody out to care for someone who's had a stroke and they have no idea they know what a stroke is, but they have no idea how to care for someone, you're gonna lose that person. So if you don't offer the specialty or specialized individualized training on top of the compliance, you're, it's kind of a recipe for disaster and it kind of fits with what you said. Ask them, ask them what they need. What do you need to learn in order to give the best care to your clients and residents? Again, going along with the part of your plan, recognizing and rewarding employees for training milestones, especially in those first few months. You know, this might be public rec recognition in front of their peers. It might be a handwritten note of congratulations, it might be a special pin or a badge they wear when they, you know, complete certain courses or the, the hundred days to, or it could be as involved in a very structured career learning path that they understand that they can, you know, take, move up these wrongs of the ladder and advance their career.
Linda Leekley (45:01):
But most importantly, and again, it kind of goes in with your culture of love is a culture of continuous learning. And that has to be from the top down. You know, I, I have talked to administrators who will say to me, oh my gosh, I, I know what you do and, and you're not gonna like this to hear this, but training is just a waste of time. Hmm. I train my employees and they leave anyway. And then I've talked to administrators who are just passionate about training and they just, you know, they love designing a good training program and they've created programs and processes that encourage employees to stay because of the training. And they do, they do stay. And so I know who I'd rather work for if I were given a choice between those two administrators. Right. I think that attitude of being focused on training and passionate about it, and it's gotta come from the top down because otherwise your employees are gonna feel it.
Linda Leekley (46:01):
They're gonna feel that you're just checking a box. And next, next, it kind of reminds me of a story when I was a brand new nurse and assigned to a busy oncology unit and no preceptor. And I, and I asked, I said, can do I have a preceptor? And they said, honey, we're too busy. You're just another body to fill a spots and just get to work. Hmm. Well, I I didn't stay even 90 days at that unit. So it's the same thing, right? If you're not trained, you're gonna lose them. And, and that hospital, that unit was not passionate about training me. They were, they couldn't see the forest for the trees, like you said. It was short-sighted and the cycle continued and I followed up on that unit and they kept losing people over and over and over. So those are just a few of, of kind of my best practices, but really do tie in with your five steps.
Chris Magleby (46:59):
Oh, absolutely. They do. I, you know, every, that, that phrase of adult learner I think is so important because as adults we do, I think we're all interested in learning, but I'm not very interested in someone saying, you, you have to go do this and this by this date. But when you have that, that's what goes back to the creating that culture of caring. When, when you know that I care about you and I want you to be successful and I want you to learn these things because like you said, you get out there and you don't, you don't know it. You, you know, you're, you're gone. Mm-Hmm. <Affirmative>. And so just explaining that and saying, look, this is why we do this and we have this culture of continuous learning because we care about you and we want you to succeed. And it, it just, I don't know.
Chris Magleby (47:53):
I, one of my favorite, I heard Brene Brown on a podcast once say that we used to think of ourselves as logical beings that sometimes felt emotion. And now we're understanding that we're emotional beings that sometimes use logic and the, there's a lot of truth to that. And when we see ourselves as, you know, we don't lose, we don't leave our humanity at the door when we clock into our job. And so if we have this sense of, you know, emotional caring and support and there's a reason why the be behind everything that we're doing is to get these outcomes and to care for our patients and care for our residents, it is, we're, we're trying to learn so that, you know, this rising tide moves all the ships upward. And I think that's really important.
Amanda Sternklar (48:44):
Absolutely. Thank you so much for your time. Thank you for so much great information. Since we are at, at time, if folks wanna follow up with you, if they have more questions about employee retention, where's the best place for folks to reach you, Chris?
Chris Magleby (48:57):
You can find me on LinkedIn, just if you search me Chris Magleby, you'll find me on LinkedIn. You can go to our website home care polls.com and there's, you can reach out through, through the website, you can go to pinnacle qi.com. Lots of different ways to get in touch with me. I'm happy to help however way, however I can.
Amanda Sternklar (49:17):
Awesome. And Linda, where's the best place for folks to reach you?
Linda Leekley (49:20):
Also on LinkedIn. I think that's the easiest. You look, look for me there
Amanda Sternklar (49:25):
And I am also most easily reachable on LinkedIn as Amanda Strangler. If you have a story like Chris's that you'd like to share on a vision or some other extremely helpful life advice, you can find our guest submission form@homecarepulse.com slash podcast. And while you're there, you can also find our previous episodes, you can find them on your favorite podcast listening platform as well. Thank you all so much for joining us. We'll talk to you in two weeks. Hi.
Chris Magleby (49:52):
Okay, thank you guys.