"Magical moments" at Beverly Enterprises: what happened when a major nursing home chain began to take CQI seriously.

Each individual can make a difference. An employee -- or, as we call them, associate -- can have a positive impact on another person' s life by taking that extra step or making an extra effort to exceed a customer's expectations. In doing so, the associate experiences positive feelings, feedback, and recognition. The whole thing becomes a "magical moment."

This may seem like a rather poetic concept, but in fact it underlies a quality improvement initiative undertaken by the largest nursing home chain in the United States. Beverly Enterprises, Inc. introduced its "Magical Moments" customer service program, aimed at continuously improving the quality of every action and service to the company's 67 Florida nursing and rehabilitation centers, in December 1992. The idea was to take what had been a successful program in our Region 6 (Wisconsin, Minnesota, Nebraska, and the Dakotas) where it began three years ago and bring it to all of the Beverly facilities throughout the country--to all of the nearly 100,000 employees in 865 nursing care facilities in 35 states.

And it appears to be working. Throughout the past year we have seen a substantial decrease in associate turnover and an increase in morale. Magical Moments also targets interaction between and among associates: We try to make "magical moments" for each other -- another important contributor to improved turnover and morale. We haven't been at it long enough yet in Florida to be able to quantify the results, but Region 6 saw its turnover rate drop from 62.8 percent to 44 percent between 1990 and 1992. Also the number of customer complaints coming in on the Region's 1 (800) line dropped markedly, while facility census went up to nearly 92 percent.

The theory of Magical Moments evolved from three basic principles exemplified in the philosophy of Notre Dame head football coach Lou Holtz: Do right. Do your best. Treat others as you would like to be treated. From these three principles grew what we call the "24-Karat Attitude Credo:"

K-indness

A-ttitude

R-eliability

A-ction

T-hankfulness

The 24-Karat Attitude focuses on meeting four basic customer needs: to feel welcome, to be understood, to feel important, and to feel comfortable. Beverly associates respond to these customer needs with four basic actions: extending a warm welcome to all customers with a greeting and a smile; showing patience, kindness, and respect for all customers; taking time to listen because all customers are important; and responding to customers' needs quickly, courteously, and to their satisfaction.

The key to Magical Moments' success extends beyond this, however, and differs from other customer service efforts. While those other initiatives have focused only on residents, Beverly's program focuses on all "customer" groups--residents, their families, fellow employees, and vendors.

Donita Tannenbaum, administrator of Suwannee Healthcare and Rehabilitation Center in Live Oak, Florida, says she sees positive results every day at the 180-bed facility. "Associates have learned that, when families verbalize concerns, we must immediately act on them. Instead of reacting defensively to a complaint, their perceptions have changed. Now associates see that customer complaints are the schoolbooks from which we learn. By listening to complaints, we have the ability to solve the problem and satisfy that person."

Based on residents' complaints, and using the 24-Karat Attitude, new ideas and programs have been created at Suwannee. For example, when a resident expressed a desire to see a change in the dining experience from the traditional nursing home meal plan, the dietary team designed selective menus for each of the three daily meals, seven days a week. The result was more than one satisfied customer. It made other residents and family members happy, people who had felt the same way but had never voiced an opinion.

In line with continuous quality improvement, Beverly Enterprises sees constant change in the Magical Moments program from year to year. Although it is a corporate and regionally sponsored program, each facility throughout the entire Beverly chain has a 24-Karat Team made up of front-line associates representing various departments. Each month, the teams meet and create several customer service activities and suggestions, allowing each facility to focus on its own individual needs, concerns, and areas of improvement. These teams are what really make the difference. (Some of that focus and individuality can be seen in sidebars accompanying this article, pp. 16.)

Scott Bell, Vice President of Operations, Florida, explains it this way: "This customer service program is successful and different from other concepts because it is facility-driven and improvement moves upward. Creativity and individual flavor is added to the program by the associates themselves."

Education and training is available to 24-Karat Teams and facility administrators on a scheduled basis, thus providing a support system from the regional staff. "Successful organizations in the '90s must place a significant emphasis on customer service," says Bell. "At Beverly Enterprises our associates are the most dedicated and caring professionals in the long-term care business today. Working together we strive to achieve excellence and exceed our customers' expectations by providing the kind of 'magical moments' that continuously improve the quality of our care and services."

Poetic? Maybe. But we are finding that this is how to run a nursing home in the 1990s.

Bringing Allie to Angie

Angie Stradling was a resident at Beverly Manor Nursing Center in Westminister, California suffering from advanced lung cancer. Her one wish was to get well enough to go visit a little girl in Illinois, Allie DeFarkas. Angle had taken care of Allie from the time she was born until her family moved. It was obvious to the facility's Social Services Director, Danielle Freeman, that Angle was never going to be well enough for the trip, so she created a "magical moment" for her.

Two weeks before Angle died, 4-year-old Allie, her mother Laura, and baby sister Hannah arrived at the nursing center. The facility had paid for the trip. Allie's mother Laura commented, "It was so unexpected that they would do something like this."

When Allie arrived, it brought a spark to Angie's eyes and a smile to her face. "That was a touching moment." said Richard Tovar, Administrator. Within seconds Allie clambered up Angie's lap into a hug. And that's how they sat for the longest time.

A Reunion

Darrell was no joy to the staff at Beverly's hallmark Care Center in Omaha, Nebraska. Unkempt, aggressive, and ill-tempered, he had been homeless prior to his arrival at the facility. As his condition deteriorated. Celeste McNulty, an aide who had been caring for him, became a friend. She brought in her family pictures and sat with him even on her day off.

One day Darrell told her about a son he had not had contact with in more than 20 years. Darrell gave Celeste some idea where his son might be. She tracked him down and found out he had not known his father's whereabouts and had been trying to locate him. The son came to visit that very evening. As the son stood at the side of Darrell's bed, the father reached out for his hand, a tear in his eye.

Four days latter Darrell passed away. Celeste was at his bedside. His final words to her were, "I love you." To Celeste, there was no more magical moment than that.

Leona's Story Lives On

Leona Gleiter was 92 years old, and having suffered a hip fracture, she was not expected to return home from Beverly's Fort Atkinson Health Care Center in Wisconsin. Elizabeth Alexander, Speech and Language Pathologist, listened to Leona's concern that she was forgetting the people and experiences of her life and searched for a way to respond to her anxiety. The answer was for Leona to write her autobiography. Elizabeth took the time to contact relatives to check names, dates, and events for Leona, and as Leona worked on the book she didn't give up on her dream to go home. Working with the center's therapy team, Leona was able to overcome the odds and go home with her completed autobiography in hand. Some time later one of the therapy assistants from the center, Pat Dillin, stopped at Leona's home to say hello. She found her sitting in her favorite chair. At her side was her autobiography, entitled My Memories. "That's the truth about me," she said, smiling proudly. Leona's story lives on because Elizabeth Alexander took the time to help record it.

Heidi Jordan is Regional Market Analyst for Beverly Enterprises in Region 3, Florida.