Is Culture Change Possible When Staff Keeps Leaving?

3 Things Management Must do to Reduce Employee Turnover and Succeed at Person-Centered Dining

Graph showing nursing and dining staff have highest turnover in senior living communities.Typically, senior care communities are plagued by high staff turnover, particularly in the dining environment. According to the American Health Care Association, food service staff has the second highest overall turnover rate, just behind nursing staff. [1] When discussing the problem, dining managers tell me:

  • “Many of the people on our serving staff are young adults. They end up leaving to go to college.”
  • “This is hard work and the pay is low. Of course they leave when they find a better opportunity.”
  • “Our servers don’t see this as a career; it’s just a job for right now, then they will move on.”

Sound familiar? If so, you are probably acutely aware of the burden this places on your organization, financially and in terms of transforming dining service. Staff stability is so important to achieving quality, person-centered care, it is one of the four goals of the AHCA/NCAL Quality Initiative for Assisted Living and Skilled Nursing and Goal #1 in the Advancing Excellence in America’s Nursing Homes campaign.

It is probably one of your most important goals as well. But what can you do?

Increasingly, studies show, the answer is to strengthen your efforts toward person-directed culture.

Embracing Culture Change Reduces Turnover

Controlled studies to date show that transformed nursing homes had better operating margins than traditional homes, with contributing factors identified as reduced staff turnover and subsequent retraining. With turnover rates at nursing homes hovering between 70% and 100% annually, homes embracing culture change have already seen reductions of 15%, significant when the cost of advertising for new staff, hiring, and training is calculated into the savings.

— Bonnie Kantor, ScD., Executive Director, Pioneer Network.

Abundant research shows the key leadership practices that support person-centered care outcomes are staff empowerment and decentralized decision-making. [2-7] Staff empowerment, which naturally includes giving staff the ability and authority to make decisions about their areas of responsibility, leads to higher rates of staff retention and lower turnover. [2,4,8]

Truly, person-centered care is about the staff. If you want better health and quality of life for residents, less turnover and more teamwork, plus a stronger bottom line, it’s time to include dining servers in the person-centered equation.

3 Things Management Must Do to Increase Staff Stability

1. Train, using a curriculum proven to change behavior. Staff was not born knowing how to deliver person-centered care, but they can be taught. Teach person-centered knowledge, skills, and attitudes:

  • Knowledge is what your staff needs to know in order to perform well. Servers need to understand the company goals and standards, what person-centered care looks like, their roles and responsibilities, and how to manage the emotional demands of working in senior care.
  • Skills are the ability to complete job tasks competently. Servers need both technical and interpersonal skills and the ability to balance their multiple roles as a service provider and team member.
  • Attitudes are the internalized feelings or values employees need to possess in order to deliver dining service that makes a positive difference in residents’ daily life. When employees care about the quality of their work and the people they are serving, positive change is inevitable.

Picture of students in Kind Dining class2. Reach critical mass as soon as possible. Time is of the essence, so set ambitious goals for getting everyone trained sooner rather than later. Once the majority of your staff are trained, they will:

  • Reinforce culture change among each other, putting positive peer pressure on each other to adopt new behaviors and standards.
  • Gain a greater sense of community and belonging, which will increase their job satisfaction and engagement.
  • Work toward your organizational goals and become a valuable company asset.

3. Foster change from the top down. Transformation depends on managers—from executives down the line to team leaders—committing to and modeling person-centered culture. Strong, positive leaders who have been trained person-centered management are necessary to:

  • Overcome initial staff resistance by proactively addressing employees’ fear of the unknown and issues with change.
  • Move from traditional hierarchical management practices to an evidence-based model that values relationships over tasks and empowers servers to make decisions that relate to their work responsibilities while management holds staff accountable for outcomes.
  • Invest the time and money needed to train, mentor, measure, and celebrate culture change.

 The Success of Your Organization is in Your Hands

Every time a staff member leaves, it costs your community thousands of dollars to recruit and train a replacement. In the meantime, long-term employees are burdened with extra duties and job stress. Resident health and well-being suffers, and so does their satisfaction with your community. Reversing these negative outcomes is possible and communities just like yours have done it—through forward-thinking leadership committed to building a person-centered culture that encompasses both residents and staff.

Originally published in 2014 Kind Dining® Connection. Want more information about how to implement resident-centered dining in your senior living community? Subscribe to our free e-newsletter, Kind Dining® Connection, today.

[1] American Health Care Association. Report of findings nursing facility staffing survey 2010. On-line at Published October 2011. Accessed September 8, 2014.
[2] Donaghue, C., Castle, N.G. 2009. Leadership styles of nursing home administrators and their association with staff turnover. The Gerontologist, 49(2):166-174.
[3] Holleran, M.D. 2007. Six key leadership behaviors that support culture change. A White Paper prepared by the American Association of Homes and Services for the Aging. Washington, DC: American Association of Homes and Services for the Aging.
[4] Barry, T. Brannon, D., Mor, V. 2005. Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist, 45(3):309-317.
[5] Hannan, M. 2005. Person-centered care nurtures social spiritual needs of elders and caregivers. Prepared by Action Pact.
[6] Kiefer, K.M., Harris-Kojetin, L., Brannon, D., Barry, T., Vasey, J., Lepower, M. April, 2005. Measuring long-term care work: A guide to selected instruments to examine direct care worker experiences and outcomes. Prepared by the U.S. Department of Health and Human Services and the U.S. Department of Labor. Washington, D.C.: U.S. Department of Health and Human Services.
[7] Dixon, D.L. 2003. Successfully surviving culture change. In Weiner, A. & Ronch, J.I. (Eds). Culture change in Long-Term Care (pp 423-438). Binghampton: The Haworth Social Work Practices Press.
[8] Castle, N.G., Engbert, J. 2006. Organizational characteristics associated with staff turnover in nursing homes. The Gerontologist, 46(1):62-73.

About Cindy Heilman

Cindy is the founder and owner of Kind Dining®, which she began in 2006. She’s traveled across the country and Canada working with and training senior living communities that want to create an exceptional dining experience for their residents and staff. In addition, she certifies select professionals in her Kind Dining® philosophy and provides tools, now in an eLearning format, that make learning stick and help people put insights into action. As a result of her work, clients often share their staff has a new sense of purpose, get along better and keep their focus and energy on what matters most. In fact, she wrote a book, Hospitality for Boomers on how to attract residents and keep good team members. In her free time, she enjoys walking Oregon trails and cheering on her favorite soccer teams, the Portland Thorns and Timbers.

Leave a Comment

Friendly reminder: Please protect other people's confidentiality as appropriate. Thank you!

Your email address will not be published. Required fields are marked *