As nursing home leaders look ahead to 2024, it might still be worthwhile keeping the lessons of the Covid-19 pandemic in mind, with the goals to retain leadership and rebuild trust gaining a new significance. Among nursing home staff, residents, their families and the general public, developing trust has been a Herculean task for many leaders in the industry – but not impossible.
And ultimately garnering solid relationships will mean an investment in management skill sets and patience, Jerald Cosey, senior health care expert and owner of the leadership development company called J Cosey Speaks, told Skilled Nursing News in the latest episode of RETHINK. Cosey was previously affiliated with American Senior Communities (ASC) for over a decade, serving as the organization’s operational leadership development director.
Nursing home operators must “rehydrate and motivate” their staff through leadership development, reigniting purpose while investing in skill set growth for management, Cosey said.
“We’ll have another major issue come up – I don’t know when, and God forbid it’s not anytime soon – but there’ll be another Covid. There’ll be another something. When that time comes, we have got to have our leaders in place,” said Cosey. “If we lose those leaders, the industry loses. We cannot afford to lose leaders, especially vetted, competent and capable leaders.”
Success with building back purpose and drive among the industry’s leaders will bleed into other crucial areas, including employee recruiting and retention, quality of care, occupancy and the bottom line, he said.
Cosey is also author of the book, “Becoming a Five-S.T.A.R. Leader: A Life’s Journey to Senior Care Excellence.”
Highlights of the podcast, edited for length and clarity, are below. Subscribe to RETHINK via Apple Podcasts, Google Podcasts, or SoundCloud.
How have your own career goals shifted recently?
As of Sept. 1, I resigned from 10 years at American Senior Communities, an organization that is very near and dear to me. The reason behind my resignation was so that I could 100% dedicate myself to advancing leadership within senior health care as a result of this pandemic.
I find that two things have happened [since the pandemic]. One, as leaders we have lost our purpose. I say that loosely because the purpose in senior health care is different for everyone, but as we went through Covid it was very clear – our purpose was to make sure our people survive, to make sure we survive as we move out of the pandemic. The goal is to make sure that we reignite the purpose that our leaders feel. And two, we’re investing in the skill set development of our leaders so that they can maximize that purpose as we advance senior health care together.
As a speaker I’m always encouraging my audience members to chase the mission and trust that the margin will chase you back.
Why is retention especially challenging for SNFs and what can be done to counter the pressures?
In senior health care, we depend on [staff] to care for people in a very emotionally demanding career space. When you put all that together, the bottom line is that it’s easy to lose people. My daddy used to say nothing worthwhile is easy and that is certainly for sure in senior health care.
You get to live life with seniors. Nurses in the hospital, they lost patients [during the pandemic], and I can’t imagine how they’ve dealt with it. On the other side, we lost patients within our senior health care communities. In a lot of these cases, we are well aware of who the person is. We know them, we love them. In some cases we even know their siblings. The point I want to get across is that in senior health care, nurses play a critical role. They play a critical role in the development of nurse leaders. They play a critical role in developing and delivering high quality outcomes. And, they play a critical role just in advancing the career space.
My advice to nurses: Make sure you take care of yourself. We need you in our industry. Make sure you identify why you chose this career space. Focus on why you chose this industry. Tough times, they help us to develop as leaders. We just can’t lose the leader to the tough time.
Why do you suggest a special focus on rebuilding trust with staff, residents and the public?
Trust in our world is compromised today, in my opinion. The thing about senior health care is, whatever occurs in our world also occurs within our communities. I think it’s safe to say that everyone at some point in time has lost some level of trust through this pandemic.
Now, how does that apply to our industry? Well, we don’t have snow days, we only have go days. Throughout the entire pandemic we worked; we paid taxes on our payroll and we brought it every single day. Our quality outcomes were tremendous. We put our families at risk, but we answered the call. As a matter of fact, career choice became career duty through this pandemic. But with that, people have a tendency to feel like, do you really care about me?
Various cultures can build trust differently. When you have a diverse population of people serving others in senior health care, I think it’s imperative to understand how trust can be compromised just because of cultural differences. That’s just one example.
Aside from efforts by employers, name some other moves that have made a difference in regaining trust.
So, when it comes to building trust, the American Health Care Association partnered with the CDC to build a curriculum entitled ‘Building Trust in Long Term Care.’ The goal was to provide education to facility leaders with a leadership development skill set, so that we can understand the components of trust within the industry, as well as work towards improving trust, ultimately improving vaccine uptake.
The first step with the [CDC] grant was to create the curriculum. The American Healthcare Association partnered with faculty team members, I’m one of those faculty members. We developed this curriculum based upon Frances Frei, who is a Harvard professor. She’s in leadership management. She presented a TED talk on the components of trust – empathy, logic, and authenticity. When these three drivers are in alignment, it increases your chance of developing trust with others. And so we developed the curriculum, the CDC came back and said, ‘we love it, this is great. How can we use this now to systemically help change and improve upon building trust from today forward?’
Focusing on Frei’s three drivers – logic, empathy and authenticity – we train staff to ask themselves, ‘Can you communicate your logic? Do you share why you are making decisions? Because when you do, I may increase my chance of trusting you.’
Other questions to note — that both employers and staff — can ask each other: ‘Do you care about me? Do you show empathy?’ If I feel as though you care about me, then it’s going to increase my chances of trusting you.
The last set of questions would be on authenticity, and asking, ‘Are you showing up as your true self?’ If I feel that you are, then it’s increasing the likelihood of me trusting you. When you’re in any demanding career space, trust and building trust becomes compounded, and it’s even more important.
We had 100 leaders from across the country and over a 17-week virtual experience, the Leadership Academy met with the faculty team members every other week. We picked a critical priority for every community that’s participating. For instance, one of the teams that I work with their critical priority was to reduce falls with injury. Their goal was to increase trust between the executive director and the DNS.
Leaders who participated in the Academy now understand one the components of building trust [was] the importance of aligning a trust building initiative with a strategic goal for the building. Ultimately, they were able to build more trust, and falls with injury declined.
Tell us about the Administrator in Training program that you’ve been part of in Indiana.
As we increase our leaders’ abilities, ultimately, it’ll help with staffing. As we evolve, as the industry advances, ultimately it’s going to help with staffing. As we continue to attract and retain top talented people, eventually, we should see an improvement in regards to our staffing. But how we get there, that’s the million dollar question. That’s the challenge.
Whatever skill set you bring from outside industry, you bring within senior health care. We have to grow, we have to develop, we have to put people in a position where they can be successful. We started the Administrator in Training (AIT) cohort program where leaders can come in together and they can be internal candidates from within the organization; we typically have at least one person from outside of the organization.
They go through a cohort program over a six-month period. When they come out they’re fully licensed with the state of Indiana and nationally. They also have one-on-one coaching with me for the first two years, mentors assigned to them for the first two years. The goal is to slowly walk them though so that they are delivering excellence this year, next year and years to come.
What’s the future of skilled nursing given the current challenges with staffing?
I think the future will be dependent upon CMS and those working with the industry. There’s been a shift. If you want people to serve in this career space, then you have to meet them halfway.
We’ll have another major issue come up – I don’t know when, and God forbid it’s not anytime soon – but there’ll be another Covid. There’ll be another something. When that time comes, we have got to have our leaders in place. Ten thousand people turn 65 years of age every single day. If we don’t have vetted leaders who understand the marketplace, who understand the care component with deep levels of knowledge, if we lose those leaders, the industry loses. We cannot afford to lose leaders, especially vetted, competent and capable leaders.
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