During the last couple years I’ve visited with over 50 nursing home administrators and their department head teams to assist them
Define their facility culture,
Implement world class service practices,
Strengthen their teams, and/or
Improve their marketing efforts
I’ve had the pleasure of working with leaders at facilities everywhere across the spectrum of performance (from beginning of turnaround to market leaders). While I find my work fulfilling and important, I’ve concluded that those numbered areas of focus above are SECONDARY to the area in the facility that is really the FOUNDATION of everything is the relationship between Administrator and Director of Nursing. In fact, as I look back at most struggling situations (clinical, regulatory, financial) the vast majority of them involve a weak, strained, or dysfunctional ED-DNS ‘partnership.’
The opposite is also true! Where there is a strong, trusting, caring relationship between the administrator and the DNS, real transformation can take place – given competent, inspired leaders.
All efforts toward cultural change, implementing higher standards, or improving the facility must come AFTER the ED-DNS relationship is solid. Otherwise, the initiatives will be planted on a weak foundation and will fall by the wayside after a few months. Unless there is a unified front where the ED-DNS are on the same page and are authentically committed to the initiative regardless of what it is, no change will be lasting.
In healthcare we rely on DIAGNOSTICS to identify the problem.
I’ve developed a cultural diagnostic tool for administrators and directors of nursing to assess how strong their relationship is. Scoring themselves on a series of statements will not only give them a grand total but it serves as a powerful basis for conversation as the two most important facility leaders take steps toward that optimal ED-DNS relationship of trust.
A sample of the statements to be scored:
(Scoring: 3 = Always 2 = Sometimes 1 = Rarely)
We run decisions for hiring, firing, and discipline by each other regardless of position. We give each other a ‘heads up’ so there are no surprises.
Our loyalty to each other is greater than our loyalty to anyone else in the facility.
We leave meetings/conversations confident that we are both completely committed to the decisions that we agreed on, even if there was initial disagreement.
You get the idea.
We often wonder why bright ideas, great programs, change initiatives fail after 2 or 3 months in the facility. This is why. No matter how brilliant the program/system, if the ‘top’ is not first committed to each other and second committed to the brilliant program/system, it is destined to fail. Get this relationship right. You get the change (culture, clinical, etc.) you desire.
Of course, this assumes competent, inspiring administrators and directors of nursing to begin with. More on how to find and retain those all-stars later …