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SERVICE model fosters greater staff satisfaction

February 1, 2010
by Susan Gilster, PhD, FACHCA, NHA, FELLOW and Jennifer Dalessandro, BS, NHA
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Culture change reaps untold benefits

“Would we do this again? Yes!

The implementation of this model has generated outcomes that have made this community more successful, productive, and fun! It simply feels much better; the atmosphere is now one that is inviting, caring, and nurturing, everyone working to serve another. We knew that we were a good facility but believed we could be better, happier, and more productive. We simply did not know how to make it happen. We were too close, too focused on traditional measures of success, regulatory compliance, and money.”

-Anne Moffat

Anne Moffat, CEO of Sharon Towers, Charlotte, North Carolina, wanted more-good wasn't good enough. She wanted her community to be better, to be “the best” and sought a means for making it happen. The change process began in the summer of 2007 when Anne discovered the book Changing Culture, Changing Care: SERVICE First. It offered a model, a framework to create a culture that was consistent with her vision, beliefs, and desires. Anne identified closely with the themes and practices; serving others, education, respect, vision, inclusion, communication, and enrichment. She gave the book to the leadership team, who agreed with the direction and committed to work on the implementation. They solicited the guidance and consultation of the author and developers of the model to assist them, and who, for the next two years, offered guidance and education, as well as measured change and discussed organizational progress. One of the areas that saw the greatest improvement was staff satisfaction with their jobs.

Journey begins

The journey began with an evaluation of the needs and desires of residents, families, and staff, using satisfaction surveys gathered by the consultants. Additional data included staff turnover, agency usage, census, and other financial reports. Quarterly staff in-service sessions were held for the first year then every six months, and included staff satisfaction surveys results and discussion of staff's role in culture change. All employees were responsible for creating a culture they desired, as it is an organizational approach. Staff desired respect and realized that if they wanted respect, they must offer it to others, and to be appreciated they, too, must appreciate one another. Serving residents, families, and one another was the reason they came to work each day-to be of service to others.

Using the book and model as a framework, supervisors, managers, and administration discussed the model with the staff, who collectively determined what was most important to them and how they would implement programs to support each component of the model in the community. Over time, multiple programs and initiatives were instituted to support each of the themes. Administrative monthly meetings were implemented for all staff on all shifts, enhancing communication and proving commitment to inclusion-that all voices are heard. The model was discussed in every meeting and incorporated into the new employee orientation, and resident and staff newsletters. Residents and families were informed of the initiative as well. Planned events and random parties were held, providing opportunities to celebrate their work together and facilitate relationships. Every staff member played a role; some provided an idea, others planned and implemented ideas, and the rest participated. In time, kindness and thoughtfulness toward others simply became part of the daily activity.


Turnover decreased by 50% the first year with a financial savings in excess of a half a million dollars.

Although the developers of SERVICE were involved with guidance, education, and evaluation, the CEO, administrator, and department managers were and remain responsible for implementation of the initiatives in their community. They continue to focus and talk about service. They have enhanced the hiring process, orientation, ongoing education, routine communication, and an atmosphere of respect and appreciation for one another.

Results are both tangible and intangible. Staff turnover has reached its lowest level since 1999. Turnover decreased by 50% the first year with a financial savings in excess of a half a million dollars. Turnover decreased an additional 13% in the second year to 20%. Sharon Towers is now known as “the place” to seek employment, although currently there are no jobs openings. Staff satisfaction increased significantly in the first three months and has continued to improve for the past two years. Each survey allows for the staff to indicate its level of happiness on 59 questions which center around assigned work, work conditions, policies and procedures, relationships with others, training, and education. Quantitative question answers range from 1 = very unhappy, 2 = unhappy, 3 = happy, and 4 = very happy. Results after two years indicated statistically significant improvement in most areas (Table 1). Greater improvements were seen in those items and activities that staff indicate as critical to their job satisfaction including respect, management, and administrative support and presence, and making a difference, etc. (See figures 1-5.)

Statistical results for staff satisfaction at year 2 from SERVICE implementation



Overall staff satisfaction

p = <.0001

Satisfaction with assigned work

p = <.0001

Satisfaction with work conditions

Trends upward

Satisfaction with policies/procedures

Trends upward

Satisfaction with relationship with others

p = >.0001




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