SERVICE model fosters greater staff satisfaction

“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

Satisfaction with training and education

p = <.0026

Open-ended questions addressing what they like and dislike most about their job, what would increase job satisfaction, benefits that would increase satisfaction, and additional comments were offered as well. An example of the more than 1,000 baseline comments is included in Table 2; comments expressing improvements after two years, approximately 500 comments, can be found in Table 3.

Staff comments before SERVICE (June 2007)

My input may be listened to but it often does not matter. Decisions are already made.

Employees are unhappy here and take it out on other employees.

Management staff is not willing to help. They leave. They don’t care.

I think about leaving every other day. I hate coming into work sometimes.

I want appreciation, not monetary, but just the courtesy of acknowledgement.

People are very distant, everybody goes their own way, no bonding, just talk about it.

From the top down, there is too much “I,” “me,” “my,” and “mine” and not enough “We,” “Us,” and “Ours.”

My supervisor has no idea what all I do and does not back me up.

Staff comments after two years of SERVICE (September 2009)

Administrators are open to the new ideas and are willing to do these ideas.

I have found that if I help other departments do their job, they are willing to help me.

I want more interdepartmental activities so that we can get to know our coworkers.

Much improved feeling about my position and where we’re going than one to two years ago. We take care of each other, residents, families better now, too.

I feel that the SERVICE model has made a difference.

I think Sharon Towers is constantly trying to improve. Management cares about the team members and tries to find ways to help them personally and professionally.

I really enjoy what I do and for the most part I think others enjoy their jobs as well.

I am satisfied and happy working at Sharon Towers… the entire staff demonstrates a willingness to serve.

Resident and family satisfaction has improved in many areas as well, particularly in the skilled nursing area of the community. Families who were historically unhappy contacted administration to specifically relay their happiness with the changes in staff interactions and enhanced care. Reportedly, even those residents and families who it seemed were never satisfied, no matter what the community did to make them happy, voiced their delight at the changes they were experiencing.


Culture creation or change requires everyone in the organization and cannot be mandated or transformed by leadership alone. And it does not happen by chance-it takes a plan and requires all staff. When employees are dedicated, committed, respectful, motivated, care and nurture one another, the outcome is enhanced care and satisfaction, reduced turnover, fewer complaints and problems. As demonstrated here, any assisted living and long-term care community dedicated to service can be a happy, joyful place to work. It results in satisfied residents and families, enhanced financials and consistent, productive, caring employees whose work has become meaningful and fun.

Susan Gilster, PhD, FACHCA, NHA, Fellow, is a leader in innovative healthcare project development. As an educator, researcher, practitioner, and consultant, Dr. Gilster has published and presented nationally and internationally focusing on leadership, organizational development, staff retention, and Alzheimer’s disease and dementia care and programs. Dr. Gilster developed the Alois Alzheimer Center, Cincinnati, Ohio, which opened in 1987 as the first freestanding dementia facility in the United States.

For more information, phone (513) 673-1239 or visit or As an educator, researcher, and writer, Jennifer L. Dalessandro, BS, NHA, has been an innovator in long-term care for more than 18 years. She is the Assistant Administrator and Research Coordinator of the Alois Alzheimer Center, Cincinnati, Ohio. She has helped the Alois Center to evolve into a person-centered facility that continues to be service-driven. In 2006, the facility was one of the top 25 in Ohio for family satisfaction. To send your comments to the editor, e-mail

Long-Term Living 2010 February;59(2):18-23

Topics: Articles , Facility management , Staffing