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Tool time Featured

8:00pm EDT September 25, 2009

Tim O’Toole hates to see an employee walk out the door and never come back to VITAS Innovative Hospice Care. It’s more than just the lost training and effort he and his leadership team have put in trying to develop employee skills to serve the company’s hospice patients.

It’s the bonds that develop between caregiver and patient and between the caregiver and the patient’s loved ones that can’t be easily replaced.

“Our patients are taken care of mainly at their home,” O’Toole says. “Any time we lose a caregiver, that patient loses the connection with their caregiver.”

Those bonds are critical in the highly emotional times that come about during a person’s last stages of life. But as O’Toole looked at his company and reviewed internal employee surveys, he didn’t feel VITAS was doing enough to help its employees or to encourage them to grow in the organization.

“One of the main reasons why a caregiver leaves a company is they were not feeling appreciated or treated fairly by their manager,” says O’Toole, CEO since 2004 at the company, which is part of Chemed Corp. “We want our employees to think that they work for a place that cares about them because we do. It’s important to the culture and important to the quality of service we provide our patients.”

Employees rated the feeling of being valued higher on the surveys than how much they were being paid. But O’Toole decided it was more than just a pat on the back that his employees needed.

They were looking for direction and looking for a means of growing and learning how to do their jobs better. And that’s how the VITAS Retention Tool Kit was born.

“The service you provide is only as good as the employee who is providing it,” O’Toole says. “We wanted to make sure that we were doing the right type of hiring with the right people and then training them and educating them about their job and then giving them very good management oversight.”

The tool kit is built around helping managers in their efforts to hire, manage, reward and retain productive employees.

“We put in some practices under an initiative where we tried to teach our managers to coach and assist and reward employees for their future successes and I think that’s helped a lot,” O’Toole says.

Here’s how O’Toole sold the idea of the tool kit to his employees and used it to keep them from leaving the $808 million company.

Don’t fix what isn’t broken

O’Toole thought VITAS was doing a lot of things right in the way that employees helped patients and went about doing their jobs. So he refrained from using the word “change” to describe his plans for the company.

“My own view is that change is a word that people are not comfortable with in many cases when they feel they are currently being successful,” O’Toole says. “Absent a particular issue that’s been identified that’s broken and needs to be fixed, I would prefer to use the words ‘continuous improvement’ as opposed to change. My style is to focus on every identifiable issue in the company as far as systems, products and procedures we use and brainstorm in a collaborative group about how they might be a little bit better.

“When you talk to people and you tell them, ‘What I am seeking is to analyze everything you do to constantly make it a little bit better,’ it’s better received than if you tell people, ‘We need to make a change.’”

So that’s the approach O’Toole took in presenting his plan to his management team, right from the moment it was introduced.

“We didn’t reinvent the wheel in a lot of cases,” O’Toole says. “We just did a lot of research about what best practices are and issues surrounding management and relationships between management and staff. We identified certain areas we learned from the survey and certain areas we learned from exit interviews that we do with every employee that leaves as far as where their concerns were. We tried to address those concerns and learn from other companies and build common-sense initiatives.”

When O’Toole was creating the tool kit, he wanted feedback from his managers about what they felt they needed to best work with their employees as well as to provide an opportunity for O’Toole to see what was missing.

“You need to have a culture where people feel comfortable speaking two ways in your company,” O’Toole says.

He found a way to put himself in each of his company’s locations, all at the same time, to encourage employees to speak with him.

“We put life-sized posters of me out in each office with cards where they could communicate with me about any questions they would have and we would respond to those,” O’Toole says of the program, which was dubbed “Talk to Tim.”

“You must respond to people when you get questions or it becomes a negative and not a positive. I put in my communication that this is an important initiative of mine and that I will be following up throughout the future of the organization to make sure this initiative is being complied with. It’s an important part of how we operate in the field with our caregivers.”

O’Toole constantly reiterated through the selling process that this project was about continuous improvement and not about a complete overhaul. He sought to create an air of collaboration by meshing what had made VITAS great before with the things that would make it even better in the future.

“I replaced the founder of the company, Hugh Westbrook, who was the founder in the early 1980s and a leader in the hospice industry,” O’Toole says. “I tried to build on the success that he had and I tried to build from what I learned about him [and] about the business. But I would also tell people to be your own person and reinforce the qualities you can bring to the job.”

Aim for consistency

O’Toole thought one of the most important aspects of the tool kit would be consistency. Mixed signals or confusion from leadership about direction is often a factor in an employee’s decision to leave an organization.

“You want consistency across the entity because you don’t want people making it up on their own,” O’Toole says. “You don’t want good practices to not be known across the organization.”

The tool kit would be an opportunity to create a common way of doing things throughout the organization.

“It’s highlighting areas we do have in the company for recognition and reward and satisfaction and coaching and managing difficult employees through situations,” O’Toole says. “It was put together in a written document, which means they could share the whole document and program with new managers that come in from time to time or with individuals that feel they need to be refreshed on it. If a manager is not having success with turnover or an employee has a complaint against them, they have a kit that can tell them, ‘This is probably something you’re not using as well as you should.’”

For example, one of the points in the employee retention booklet, which is in the tool kit, talks about the importance of giving employees meaningful work to perform.

“Allow employees to express and create themselves through their work,” the booklet reads. “Give employees challenging assignments a

nd reward them with praise and recognition. Engage employees in conversation about their career goals and aspirations. Ask and listen. You’ll be surprised what you may learn.”

The section goes on to list questions that can help the manager and employee analyze whether an employee feels like he or she is getting the most out of his or her talents.

O’Toole says role-playing is another method that is strongly emphasized in the tool kit.

The point is to put together a common way of training your employees so that no matter who is doing the training or when they are doing it, it is being done in a consistent manner.

“Issues that we historically had coached and trained people to utilize just had not been packaged together under a communication effort,” O’Toole says.

While emphasizing consistency, he also reiterated throughout the planning process that the tool kit was not being written in stone.

“It’s like anything else, you don’t want to work on it forever,” O’Toole says. “You can always keep working on something and make it a little better. It allows that tool kit to be a living document that can be improved and modified from time to time as the situations change over the years.”

The booklets that make up the tool kit are kept in a binder. This leaves room for new booklets to be added or for older booklets to be replaced by versions with updated policies and procedures.

The company uses a checklist to make sure the tool kit is being used and O’Toole takes it upon himself to monitor this checklist and talk to his employees about the tool kit on a regular basis.

“As a CEO, it’s my job to shake the tree a little bit and follow up with them on areas they are working on and just remind myself to say, ‘Hey, what’s been going on with the tool kit?’” O’Toole says. “’What new things do we need to add? Give me your thoughts.’ Hopefully, you get that from management, and if not, you need to ring their bell a little bit.”

Track your progress

As O’Toole began to circulate the tool kit to his managers for them to use, he took stock of the environment into which it was being introduced.

“When there is no crisis occurring and you’re just trying to improve, there’s no urgency necessarily,” O’Toole says. “When you’re looking at a situation where there is more of a problem or a crisis developing, then you’re going to want to accelerate the program to implement change or improvement. We’re reinforcing what we’re already doing, so that’s not scary to people.”

While the urgency was not high, O’Toole wanted the tool kit to be used and wanted to know how effectively it was fulfilling its goal. Doing so often comes down to simple common sense.

“What are the data points it affects?” O’Toole says. “If you’re working on employee satisfaction, you would look at turnover. If you’re looking at your training programs, you might look at whether the training programs you’ve accelerated have improved the area of productivity that maybe you were training about. Just a lot of common sense and connect-the-dots logical analysis of what the business metrics are that should be impacted by the area you’re focused on.

“You know when the business has been performing well over the years and you know what those data points are. If those data points move in a different direction, you need to understand why. Analyze the way the business is running through the information you can glean when it’s doing well. You use those to benchmark against. When there are variations against the benchmarking, you can get into it.

“Look at areas of your company where your gut tells you you can have improvement and then look for processes or systems to put in over top of them that will train individuals to avoid mistakes whenever possible.”

The tool kit has led to a reduction in employee turnover, dropping from 28 percent when the project was introduced in 2007 to 20 percent currently, its lowest level in six years.

O’Toole says the key is to keep these types of initiatives fresh in the minds of your people and regularly remind them of why they are important to the company’s success.

“If you don’t train people as to what the expectation is for the tools that we want them to use, you shouldn’t be surprised when they don’t use them,” O’Toole says.

How to reach: VITAS Innovative Hospice Care, (866) 418-4827 or www.vitas.com