How to Maximize Employee, Resident & Leadership Engagement (Episode 33)

July 3, 2018

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Darcy Grabenstein: Hello from SmartLinx! In today's podcast, we'll talk about best practices for engaging different communities or audiences within long-term care organizations — employees, residents, and leadership. Our guest today is Nikki Rineer, president of Holleran, a senior living community engagement research and consulting firm. Holleran's services include resident and employee engagement and satisfaction, leadership development, organizational engagement, and community engagement and needs assessments. Welcome, Nikki.

Nikki Rineer: Thanks for having me, Darcy. It's a pleasure to be with you today.

DG: So Nikki, Holleran Consulting specializes in working with senior living and Health and Human Services clients. What are the signs that an organization's communities are disengaged? We know that, in terms of employees, turnover is one sign. What are other signs, and what about for residents and leaders as well? I know that's a lot of questions all at once.

NR: It is, but it's good. For me, there are several signs that can indicate disengagement, and turnover is certainly an outcome of disengagement. But all too often, it's the team members that we want to keep who are leaving us, while the ratio of toxic employees swells.

Low occupancy is another thing that we look for as a sign of disengagement, where neither the residents, their loved ones, and sometimes not even the team would recommend the organization as a great place to retire. I've walked into communities where you could tell everyone loved being there, and then there have been times where I've walked into communities where I felt like no one did.

Engagement is palpable. And I think it's important that we understand the underpinning of engagement. At times it can be challenging to take it seriously and give it the credit that it's due. When we work with organizations who are at the heart of re-crafting their strategic vision and their plans are innovative and big and hairy and audacious, it's crucial to talk about their last employee and resident survey results and what they learned.

It can be impossible to guide your ship into a new horizon if you have too many people who are drenched in negativity and disengagement. The investment of your vision is just simply too much to risk without the right team. And we've seen even stellar teams struggle in the midst of massive change. Taking a disengaged team through a tidal wave of change has the potential just to be outright catastrophic.

DG: Is there a difference, Nikki, between employee engagement and employee satisfaction? And can you elaborate on that for me?

NR: Absolutely.  For the sake of simplicity, we see satisfaction as a one-way street. What do you need to do to make me happy to be a part of this organization every day? If you think about this from the Maslow's hierarchy of needs model, envision those bottom two rungs of the pyramid. Those two rungs are all about basic needs. Do I have enough money to care for my family? Is my work environment safe and secure? But once people feel they have these basic needs met, now they can move up the pyramid and experience a deeper sense of belonging. Engagement is knowing that you're valued, needed, and that you offer good to the cause. You're fulfilling your own purpose, and you're contributing to the greater good.

Now satisfaction turns from a one-way street to a two-way street of engagement, and you're tethered to something and you ultimately want what's best for the organization, even if it isn't ideal for you as an individual. If you think about a satisfied employee, they will work hard and do a good job for you. However, if the community down the street would offer them a 50-cent raise, they would most likely leave you without much consideration. An engaged employee, however, would question if the raise would be of much value if they lost their voice and purpose in their work day to day. An engaged employee is definitely a loyal employee.

DG: That makes so much sense. So if an organization isn't sure whether its audience is engaged, is that when you would say it's a good time to conduct an assessment? And could you tell me a little bit about Holleran's assessment process as well?

NR: I think it's a great time. It's also important to point out that we've seen organizations who felt they had great levels of engagement, only to find out that it wasn't what they thought. If you're not measuring it, you shouldn't assume that you know what it is.

Most of our client partners survey every year. We have a mixture of clients who will survey both their employees and residents each year, and another segment of organizations who will survey residents one year and then the employees the next.

We begin with an organization by finding out what's currently on the radar of their community. We want to make sure we know about what transitions they might be going through and of its importance to their strategic plan. We start after that conversation with a core survey that provides the ability to customize specific questions or factors that would be beneficial to add, based on those initial conversations. We make sure response rates are high, and on average we have a 70 percent response rate with all of our surveys.

DG: Wow.

NR: I know. We've been really blessed and honored to be able to secure such high response rates. We hear from lots of new clients that their response rates are currently only 30-35 percent, and it just doesn't give them enough information to be crafting new plans.

DG: What would you say is a statistically relevant number?

NR: That's a great question. Research shows that anything over a 30 percent response rate is considered a valued response rate. However, I would also question from a practical standpoint if that really gives you enough information to be crafting large plans when you know you're only hearing from 30 percent of the individuals.

DG: Right.

NR: Aafter the results are in, we arrange another one-on-one conversation to discuss what we saw in the results. And then, based on our experience, we provide recommendations on where they should prioritize their action plans.

For communities who are experiencing a higher level of disengagement than they would like, we often ask them how they define engagement and how they currently hold people accountable to that ideal. All of our team members come from varying backgrounds and experience, and sometimes we just need to clearly define engagement behaviors. It may be time to communicate with all members of your team and create a list of those engaged behaviors that is expected of everyone, from CNA to CEO. It may feel incredibly basic to some, but if it isn't part of the expectation it will fall by the wayside.

DG: So you were talking about the results of the assessments. From what I understand, then you develop a benchmark against which you compare the facility's engagement level, is that correct?

NR: Absolutely. We have a national senior living specific benchmark, and that benchmark encompasses employees, residents from each level of care, as well as affordable housing and short-term discharge benchmarks. We update those benchmarks on a quarterly basis, and it includes the last 24 months of survey completions in each one of those categories. For example, our independent living benchmark includes over 91,000 surveys from 300 organizations and represents 38 states.

DG: Wow, OK. So I think you would agree with me that communication is key when it comes to engagement, whether it's your employees, residents, or leadership. Nikki, could you give me some examples of effective, and I guess ineffective as well, communication to these groups? And also, do the strategies and tactics differ for these groups? And if so, how so?

NR: Sure. Diving into our benchmark we see consistently communication scores on the bottom of the benchmark. Whether it be for employees or from residents, it is one of the bottom-scoring factors as we look at all of the questions that we ask on our surveys. I wish there was a magic bullet that could solve all of our issues here, but we just haven't found it yet.

But what we do know is that one critical element is that communication needs to be available in different modes, not everybody's going to read an email or a flyer, an announcement on the community TV station. And in all honesty, the more people you include in the communication venture, the better the outcome. Consider forming a group of resident champions or even a non-management group of staff members who would take the lead in the community to spawn a creative new way to communicate. What we know is that we have to ask more questions about what's essential in the communication process. Empowering the residents and the employees to increase their level of engagement and buy into the project as well can be incredibly beneficial.

I spoke with one CEO last fall who ran a large multi-site organization who had communities in several different states. Obviously she wasn't able to spend a lot of concentrated time with any one of them, and she was feeling that her employees weren't all getting a consistent message about what was paramount for the organization, and that sometimes when the plans needed urgency that they weren't feeling that sense of urgency. She began to record two-minute videos of herself that gave every member of the team the same message. Since many of the team didn't see her on a regular basis, it provided the additional benefit of that personal approach. She really synthesized what it was that was important: They wanted to see more of her,and those video check-ins for communication really seemed to give them what they were looking for.

We also work with Garden Spot Village here in Pennsylvania and they scored in the 90th percentile of our resident engagement voice domain, all from the fact that they post things called Coffee and Conversations with the residents. And the CEO opens those up and there's no topic off limits.

Any feedback loops that contribute to a feeling by residents that they're being heard and taken seriously by campus leaders are essential to that conversation. There's no agenda for that time together, they just open it up and whatever the residents feel like they need to speak their minds about, they have that opportunity. I realize what we're suggesting could take time to foster, but the return on investment will absolutely be worth it.

DG: Another way to combat turnover, which is such a huge problem in long-term care, is to promote from within. So how can organizations promote leadership development and groom employees to move up in the ranks?

NR: I've seen and heard of many organizations who are promoting team members to supervisors simply based on the criteria of being good at their jobs. And this simply isn't working.

To lead we just all need to be developed. We need to learn the importance of self-care, emotional intelligence and how to lead in the face of constant change. Without that foundation, many new leaders will quickly feel hopeless and can often revert back to doing just the job part and ignore the leading part of their position. And development isn't always considered a priority, but what we know is that there's substantial cost to not investing in the team.

At Holleran, we run a year-long program based on the results of an organization's employee engagement scores. We engage with the executive team to select 24 individuals in the organization who are known for being highly engaged. And that course is geared to take place over an eight- to 10-month period and provides an intimate environment to equip those leaders to spearhead a heightened engagement from the rest of the team. There are members of our team who absolutely should be developed and promoted, but it's just not the only way to combat turnover.

I was at a conference a few days ago and heard a panelist who was studying the traits of a team that supported foster family services. They analyzed the entire work group to define what the best role was for everyone in the organization. When the results were received, there were four individuals who stood out as scoring the best to drive increased outcomes for the individuals and for the families. And the consultant jokingly said, whoever they are, don't promote them; you need them to drive your outcome. At that point he looked at the faces of the executives and he saw them all drop. Wwhat they realized is that as they discovered who those four team members were, they had already promoted all four of them into a supervisory role, and they had noticed that their outcomes had declined over the same time frame. We need to start considering role expansion as another opportunity to combat our turnover issues.

DG: Lastly Nikki, what role would you say organizational culture plays in all this?

NR: It's the lynchpin. Edgar Schein in his book called Organizational Culture and Leadership says that while leaders are the principal architects of culture, an established culture influences what kind of leadership is possible. We see organizational culture in terms of an ecosystem where employees impact residents and residents are impacting those employees as well.

And we run a lot of correlations from our benchmark data, and it's really revealed a great wealth of discoveries. For example, we know that one in four employees in senior living are considered disengaged. We know that when employee disengagement is ignored on the campus, the repercussions can actually be felt in how the residents feel about their ability to connect with one another, be fulfilled, and even their own well-being.

We've also discovered that in assisted living, even a 1 percent point increase in another employee's telling us that they plan to be working at the community in the next three years, the mean satisfaction level with the quality of care also goes up significantly. So, organizational culture is paramount to engagement.

DG: Great. Well thank you, Nikki, for sharing your expertise with us today. And to all our listeners, thank you for tuning in. If you'd like to learn more about Holleran, visit And if you'd like to learn more about SmartLinx and our fully integrated suite of workforce management solutions that make work better, visit us online at



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