Staffing is your most critical function.

Although people are a critical component of seniors housing and care, recruiting and retaining staff are some of the most problematic aspects of the business. In a study released a few years back by the Centers for Medicare & Medicaid Services, 54% of the nation's nursing facilities were so understaffed as to threaten quality of care.

The problem is not limited to nursing homes. A report published recently by the Assisted Living Federation of America (ALFA) foresees the need for an additional 600,000 caregivers in its business by 2011. But ALFA expressed concern that there "just aren't enough applicants to fill these vacancies." That concern is compounded by turnover rates approaching 100% in some sectors, with CNAs being perhaps the prime example.

Given all of this, the need to hire the right people, keep them productive, and retain them as satisfied employees becomes one of the most telling responsibilities of the successful seniors housing and care manager. (See last month's article on leadership.)

As if one needed any further proof of the crucial need to recruit, retain, and motivate staff in one's community, consider the critical relationship between management (and its ability to attract and maintain qualified personnel) and company profit and shareholder value. A company can, of course, "buy" growth (e.g., through acquisitions, development, etc.), but only sustained profit from normal operations can drive a sustained increase in value. And the most critical driver of sustainable growth is an expanding base of loyal customers who are willing to pay premium prices.

Such customers are created only by providing them with a superior product. Sales and marketing can offer "brand promise." The quality of the product is what creates "brand experience," and only the engaged employee can provide that. The only way to engage talented employees successfully is to select great managers and provide them with the culture in which they, in turn, can select the best people, set accurate expectations for them, develop them, and motivate them. How well the managers do this determines how well they succeed.

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The single most important managerial decision that we make is the hiring decision. All other responsibilities are likely to end in failure if the wrong person is selected for the job. Other activities are important, but they rest on the assumption that the right person was hired. And there seems to be a growing consensus that talent is the most critical of the attributes managers should search for when recruiting new staff. Knowledge and skills can be taught to employees. Talent cannot.

Talent can have different definitions. Buckingham and Coffman define it as "a recurring pattern of thought, feeling, or behavior that can be productively applied." (1) Allen refers to it as a "passion" for one's tasks. (2) However you define it, there is agreement that it can't be created; it has to be hired. As Pearce says, "An employee's long-term behavior patterns are rarely changeable; do not assume you can manage an unsatisfactory applicant into a good employee." (3)

Different jobs require different talents. Therefore, in the selection process it is critical to know which talents are prerequisites for success in a given position. Talent is not rare. It is actually rather common. But different functions require different talents. The most important talents for a successful personal care assistant might be service, discipline, and empathy. Vision, strategic thinking, and command would probably make for a bad fit for a CNA but might be critical for the CEO.

Once you have decided what talents to look for, make at least the first interview exclusively devoted to determining if those talents exist in the applicant. Counter to common wisdom, a highly structured interview is not the way to go. That can come later. Talent is more likely to be recognized with open-ended questions in which the interviewer's primary role is to listen, while looking for specifics and clues as to the applicant's recurring patterns of thought, feeling, or behavior.

So you've hired for talent. What's next? Well, the other components of management's staffing responsibilities are to focus, develop, and motivate employees once hired. We've talked about selecting employees by emphasizing talent. We focus them best by stressing outcomes. We develop them best by highlighting strengths. We motivate them best by supporting self-fulfillment.

Let's talk a bit about focus, particularly about internal (procedure-based) versus external (outcomes-oriented) focus. Admittedly, certain job processes in seniors housing and care (for any number of reasons) need to be adhered to for reasons of either safety or regulations. A procedure for transferring residents from a bed to wheelchair, for example, must be adhered to for both reasons. But for most functions, independent judgment is not only acceptable, it is desirable--as long as the employee knows what outcomes are expected. Whatever the required process, it should not get in the way of the desired outcome. Southwest Airlines certainly requires its staff to follow FAA regulations, but not in a fashion that might militate against customer satisfaction. And the major pitfall of forced consistency is, in fact, customer unhappiness. Just look to nursing homes as a primary example.

As long as you've hired for talent (and trained for skills and knowledge), you don't have to dot every "i" and cross every "t" to focus your employees. The way I would make a bed is perhaps not the way you would do it, but as long as enough beds are made in a timely fashion (and the customer is happy with the result), it shouldn't matter.

A basic rule, therefore, is that few procedural steps lead to customer satisfaction. Managers who emphasize process in focusing their employees might well be attempting simply to exercise control. That may be a personal need on the manager's part, but it does not necessarily serve the customer's interests and is not likely to contribute to his or her satisfaction.

Procedures essential for reasons of accuracy, safety, or regulatory standards certainly have their place. But, where possible, define the right outcomes and let employees find their own way to meet them. If the sales manager, for example, can specifically define the outcomes she expects from her sales staff, then she can ignore how well they filled out their call-reporting sheets.

Focusing employees on outcomes allows them, in turn, to concentrate on the overriding outcome in the community as a whole--customer satisfaction. And in defining outcomes for the staff, managers need to keep them focused on that reality. Also bear in mind that whatever you, as a manager, happen to think, if the customer doesn't consider the outcome valuable (and worth the price you're charging), it isn't.

Eventually, we have to determine whether the talent and focus have "taken." In short, we have to develop and motivate our employees, based on their success (or failure). And the process we use, for better or for worse, is the performance appraisal. For most managers, the performance-appraisal process is the most odious of their responsibilities. But it's critical to management's responsibility to develop and motivate. It should be the most gratifying, particularly if employees are being held responsible for outcomes.

Furthermore, if we have successfully recruited for talent and trained for requisite knowledge and skills, the performance appraisal becomes truly a coaching experience designed to focus on strengths. Don't spend a lot of time trying to fix weaknesses, especially if they reflect a lack of talent. Talent can't be taught. Skills and knowledge can, but here, too, the evaluations should look at gaps in knowledge and skills as part of a focus on the future, not the past.

An excessive focus on weaknesses in your performance appraisals, especially those that reflect an absence of talent, suggests a belief that talent can be taught. If talent is the issue, then "casting" may have been the problem, and new opportunities might have to be sought for the employee. Remember, the key to great management is not instructive, but catalytic: turning talent into performance.

But managing around weaknesses is not to ignore them. No manager can simply avoid (or discharge) employees who display weakness, assuming their weakness is not simply a reflection of nonexistent talent. Look first for the "mechanical" or personal reasons for nonperformance. Have the appropriate tools been made available to the employee? Have you trained adequately? You can't expect "killer" PowerPoint presentations if the person responsible has never been trained on PowerPoint. Or has there been a family crisis? While it needs, ultimately, to be resolved in terms of its effect on the work environment, don't expect full productivity while that process is going on.

If the root causes of nonperformance are neither mechanical nor personal, great managers look to other routes to success before they assume the issue is one of inappropriate "casting," i.e., putting an employee in a position for which he doesn't possess the appropriate talent. Ultimately, however, if you find you are spending most of your time managing around weaknesses, then it's time to fix the casting error and stop trying to fix the person.

What about motivation? Well, let's start with Laurence Peter: "In a hierarchy every employee tends to rise to his level of incompetence." (4) It's inevitable. It's built into the system. Our approach to employee satisfaction in most companies seems to entail promoting individuals into positions for which they don't possess the necessary talent. That, in turn frustrates both the employee and her supervisor. The end result is a dissatisfied supervisor, a dissatisfied employee and, worse, dissatisfied customers. It doesn't have to be that way.

First, we have to rid ourselves of the notion that an individual's success on one rung of a "career ladder" is somehow predictive of success on the rungs above. Actually, if success is predicated on the individual's "talent" for that particular job, success in the job one rung up can be assured only if it requires the same talents. And that is not always the case. Ignoring that fact means only that we will lose an exemplary employee and turn him into a mediocre one. Both the employee and the company lose.

Rather, look to methods of recognizing, promoting, and compensating (and, ultimately, motivating) employees within their demonstrated areas of excellence. In other words, "break all the rules." What's magic, for example, about pay ranges? Who says we can't pay the stellar employee more than the range allows? What is that employee's contribution to the company's bottom line? Who are we serving if we promote her into a position for which she lacks the requisite talent? Or lose him to a company less shackled by form? Do we need to document the rationale for our decision? Of course we do. Do we need to subject it to the constraints of procedure? Only at the risk of company failure.

Performance appraisals need to be simple, constant, and frequent. They are certainly not the time for surprises. If management has done its job throughout the year by providing continuous feedback, then the formal year-end appraisal should be nothing more than a continued recognition of employee strengths, a discussion of how one might work around employee weaknesses, and a joint affirmation of future goals.

Ultimately, the primary purpose of the evaluation is to stimulate the employee's motivation to succeed, not based on management's expectations, but on the employee's own need for personal and professional affirmation.

Seniors housing and care is a "people" industry. It can attract, retain, and satisfy customers only through the talent, knowledge, and skills demonstrated by its employees. And management's primary responsibility is to select, focus, develop, and motivate those employees. It selects best by emphasizing talent. It focuses best by stressing outcomes. It develops best by highlighting strengths, and it motivates best by supporting self-fulfillment.

Great managers also know that even having selected for talent, performance must be managed and that meaningful feedback must be constantly offered even to the excellent performers, if only to constantly build on their excellence. That is where focus, development, and motivation come in. And, finally, great managers realize that performance management must itself be managed. Good management is, after all, the most critical outcome for the successful community.

References

1. Buckingham M, Coffman C. First, Break All the Rules: What the World's Greatest Managers Do Differently. New York: Simon & Schuster, 1999.

2. Allen JE. Nursing Home Administration. New York: Springer Publishing Co., 2002.

3. Pearce BW. Senior Living Communities: Operations Management and Marketing for Assisted Living, Congregate, and Continuing-Care Retirement Communities. Baltimore: The Johns Hopkins University Press, 1998.

4. Peter LJ, Hull R. The Peter Principle: Why Things Always Go Wrong. New York: William Morrow & Co., Inc., 1969.

Paul R. Willging, PhD, was involved in long-term care policy development at the highest levels for more than 20 years. For 16 years as president/CEO of the American Health Care Association, Dr. Willging went on to cofound the successful Johns Hopkins Seniors Housing and Care postgraduate program (cosponsored by the National Investment Center for the Seniors Housing & Care Industries), and later served as president/CEO of the Assisted Living Federation of America. He has enjoyed an equally long-lived reputation for offering outspoken, often provocative views on long-term care.

To send your comments to Dr. Willging and the editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].