Tying the Hardest Knot: Creating and Sustaining a Culture of Hospitality.

The notion of hospitality has existed as long as there have been travelers--centuries upon centuries of strangers making themselves at home in unfamiliar places. Four-star hotels and luxury spas exist worldwide for fortunate vacationers. Meanwhile, in today's long-term care facilities, residents also desire the same fundamental qualities of welcome and comfort. Our management team at Glen Cove Center for Nursing and Rehabilitation wanted to supplement our most basic goal--to provide unsurpassed healthcare--with a program to narrow the gap between the spectrum of luxury and the archaic levels of nursing home care so often ridiculed in the media. We realized that by developing a program to directly address hospitality and quality-of-life concerns, we could combat both negative images in the media and resident concerns of comfort while still providing the very best care possible.

But the art of hospitality is an intangible phenomenon that is effective only when it permeates the culture of the institution and its workers. The transformation of our existing milieu would require all of our employees to understand and embrace the concept of hospitality. And so, in March 2005, our facility launched the program Tying the Hardest Knot: Creating and Sustaining a Culture of Hospitality.

Setting Goals

Our program was designed to develop and implement a culture within the nursing home that would ultimately improve the quality of life for our residents, improve the facility's reputation, and provide a better work environment for our employees.

These objectives were quantified as follows:

* Increase our guests' overall level of satisfaction at the facility as a direct result of improving the quality of life from 53% "satisfied" to a significant rise in the "very satisfied" category.

* Increase the occupancy rate from 94% as a direct result of increasing the facility's reputation.

* Decrease the overall percentage of employee turnover from 10% as a direct result of employee satisfaction.

Implementation

At the outset of the program, the administrator provided the management team, composed of the department heads, with a copy of the book Fish!: A Remarkable Way to Boost Morale and Improve Results by Stephen C. Lundin, Harry Paul, and John Christensen, which served as a basic primer on the fundamentals of hospitality. After reading the book, department heads became completely immersed in the quest to understand, practice and, ultimately, teach this delicate art. Sharing the administrator's knowledge of and experience with the subject ignited the passion in all of the department heads to continue to read books, view DVDs, and glean information about hospitality programs in facilities as diverse as nursing homes, hospitals, hotels, and Disney resorts.

For approximately two months, the department heads met weekly with the administrator to educate themselves and share resources, ideas, and information regarding hospitality (see "Hospitality Principles," p.32). Once the management team felt that it had a working knowledge of the concept of hospitality, it created a blueprint for implementing the hospitality program. The program was divided into three main components:

* Making Knots (Hospitality Training)

* Teamwork

* Guest Relations

Making Knots

The first goal was to share the concept of hospitality with all of Glen Cove's employees. It was essential, however, that these ideas were not written off as simply another ordinary in-service. We wanted to foster a deeply internalized sense of what hospitality means to everyone involved, so we devised the idea of KNOT (Knowledge, Not Ordinary Training). The management team created an outline of hospitality, and the director of nursing worked with the staff development coordinator to arrange a schedule of classes, exercises, and programs that would incorporate aspects of hospitality training throughout the year. Some training classes were simply practice exercises in improving communication skills, while other in-services were more elaborate exercises dedicated to hospitality issues. No matter what method was used to teach the concepts, we emphasized the idea that knots are deliberate structures that bind and hold elaborate structures together. Hospitality is a deliberate mind-set that strengthens and holds together the fabric of the community. By using the knot metaphor, we hoped to make these ideas second nature to all our employees.

Although the staff development coordinator provided many lectures on hospitality, along with participation exercises, to the staff, department heads were also responsible for presenting specific aspects of hospitality training to the employees in their areas, as well. Topics addressed included body language, attitude, and anticipating resident/family needs by going the extra mile.

Unlike other in-services that attempted to teach new procedures or review existing ones, hospitality training was geared to foster a mind-set among the staff. Although the staff development coordinator and department heads had specific guidelines to follow during training sessions, the real focus was on developing a hospitality culture born from nurturing employee interactions with each other, the residents, and their families.

It was imperative that all members of our healthcare team knew that they played a vital role in the success of this program. As employees passed through the KNOT program, we reinforced the idea that, like an actual knot, employees throughout the facility are bound by a lofty and noble ideal. From the business office to the medical records department, from the porters to the pot washers, every Glen Cove staff member was part of the transition from employee to customer relations representative.

At first the employees were reluctant to attend additional in-services, claiming that if they attended too many in-services they couldn't complete their work. Fortunately, this problem resolved itself as in-services became more interesting. Eventually, the staff looked forward to learning new techniques for dealing with difficult families or new ways to support a culture of hospitality. (Providing little food goodies at sessions also helped.)

Teamwork

The management team's initial review of the literature showed that employees who work together toward a common goal share their feelings of success and pride with one another, develop strong bonds with one another and, ultimately, work together to produce a better outcome. Investing in the well-being and satisfaction of the employees was a critical part of the hospitality program.

The administration at Glen Cove has invested time and energy into promoting and maintaining positive employee morale. Simple gestures, such as enclosing instant-win lottery tickets in employee birthday cards, send a clear message that the facility cares. Company picnics and parties have also brought the employees together. As a team, they provide a richer and deeper level of care and comfort for our residents. Glen Cove has used every opportunity to encourage its employees to laugh and have fun in facility-sponsored events so that when more stressful work-related issues present themselves, they will have a reserve of positive energy to tap. There were many fun and creative events at the workplace this past year. On St. Patrick's Day, the administrator secretly placed little gifts (e.g., $5 bills, candy, lottery tickets) wrapped in green leprechaun paper throughout the building. Foodservice workers found them in refrigerators; nursing assistants found the gifts on nursing carts. On Valentine's Day, the recreation director posed as a radio DJ and announced "love-related questions" over the paging system. If the DJ asked for the 10th "caller," and the employee could correctly answer the question, he or she won one of a myriad of prizes including candy, red T-shirts, and pink baseball caps. But holidays were not the only impetus to create some fun. The administration welcomed any and all wacky ideas that could be implemented. These events cost an insignificant amount of money and planning, but reap a wealth of goodwill.

Simply providing a fun and pleasant work environment is not enough. Employees need to understand and appreciate the roles of their peers, which helps them to empathize with their coworkers, offer assistance, and truly function as a team with one goal--to provide exceptional care for the residents. To create this awareness, the administrator organized a Walk in My Shoes Day. This event offered workers from each department the opportunity to experience someone else's job, replete with its obstacles and challenges. Interested employees signed up one month in advance, which gave department heads time to find replacement workers and arrange the schedules accordingly. The administrator randomly assigned participants to a position outside their own department. Approximately one-third of the employees participated in the event, which ran from 7 a.m. to 3 p.m. Each participant was assigned a buddy. Although participants were not responsible for their buddy's work, they did have the opportunity to experience walking in the shoes of another worker. One CNA served as the administrator while a nurse manager learned to make vats of stew in the kitchen. A dietary aide worked in the admissions department and a porter functioned as the director of environmental services. All participants had the chance to make decisions that would affect other employees, residents, and/or family members. It was an incredible experience for everyone involved.

Guest Relations

The results of the short-term satisfaction questionnaire our guests completed indicated that Glen Cove could improve the overall satisfaction rating. The management team, with the approval of the owner, created a new position called "guest relations." This full-time, 11 a.m. to 7 p.m. employee would serve in a similar capacity as a hotel concierge. The guest relations employee visits with all short-term residents on a daily basis to resolve any problems and offer assistance with any non-nursing/medical issues. The job description covers a variety of tasks, including making phone calls for residents, finding information for them, taking walks with those who seek companionship, and ordering pizza for those who crave one. The guest relations representative strives to answer call bells, giving nursing assistants a chance to spend more actual time providing care. The guest relations person also speaks with family members who have questions about bills, discharge plans, or equipment. Guest relations is a contact or a liaison between residents and everything else. This person makes the day a little easier, and the time spent at the facility a little brighter. It is an opportunity to pamper our guests and make them feel especially comfortable.

The administrator selected an employee for the guest relations position. Although the position did not include any special education or experience, it did require a personable and friendly demeanor, the ability to follow through on requests, and a resourcefulness to get the job done. The administrator and staff development coordinator spent time with the guest relations employee to ensure that she understood hospitality and incorporated it into every facet of her workday. She serves as the face of our facility--a flag bearer for all the work we have done to make our facility as comfortable as possible for our guests.

Evaluation

To fully understand the overall impact of this hospitality program, one needs only to walk through the doors of Glen Cove. Everyone, from vendor to family member, is greeted warmly by the receptionist. From there, the culture of hospitality unfolds.

Our staff has participated in many varied hospitality training sessions. The guest relations position was so successful that the administrator decided to hire yet another person to also function in that capacity. An analysis of the short-term residents' satisfaction questionnaire demonstrated a clear improvement in the overall satisfaction of the residents. Approximately 53% of the residents said they were "satisfied" with their stay at the facility and 20% were "very satisfied" before the inception of the formal hospitality program. One year after the program's inception, only 5% of the residents said they were "satisfied" with the facility while 57% were "extremely satisfied" with their overall experience (figure). Since the nursing, medical, and rehab sections of the questionnaire all continued to reflect excellent care, it was apparent that this improvement in overall satisfaction was, in fact, related to the hospitality program.

Our occupancy rate was 94% in 2004. At the end of 2005, our occupancy rate increased to 96%. It would be unfair to unequivocally determine that the increase was solely attributable to the hospitality program. But it would be naive to think that the hospitality program didn't play some significant role in the increased admissions.

Most impressive of all is the unity that has emerged and flourished over the past year among the employees at Glen Cove. Departments plan their own parties and outings with one another. There is a strong desire on the part of all employees to help one another and revel in the successes of the facility. It is heartwarming to work in a place where the employees have this tremendous sense of pride and accomplishment. The overall employee turnover rate has decreased from 10% to 4%. At a time when nurses are hard to attract and even harder to retain, it is comforting to know that nurses seek out this facility for employment because of its reputation. And they are not disappointed.

Conclusion

On one hand, it is difficult to prescribe rigid operating procedures for instituting a project as conceptual as inculcating hospitality. At the same time, a relatively simple combination of education, morale-boosting contests, immersion programs, and the creation of a staff position has yielded clear results to help our facility meet its goals. While any management team must assess what its unique staff needs to achieve this ideal, we hope that our program can serve as a model for facilities that also wish to increase resident satisfaction and its public perception. A combination of education and team building helped make our employees more sympathetic to each other and to our residents while making work time fun. Our unique KNOT program distinguished hospitality training from ordinary in-services by appealing to a conceptual ideal rather than a materialist procedure. The good times at Glen Cove are more than just an exception to conventional wisdom about the workplace. Our data show that the ultimate benefactor of these programs is our population of residents on whom no smile or laugh is ever wasted.

For more information, contact Administrator Jill Smoller at [phone]. To send your comments to the editors, please e-mail [e-mail].

Program Staff

Jill Smoller, Administrator

Surrinder Kaur, Staff Development Coordinator

Clara Vasquez, Guest Relations

Alejandra Gonzales, Guest Relations

Angelo Familetti, Guest Relations

Tina Morgan, Director of Therapeutic Recreation

Carolyn Loudovikos, Director of Social Services 

Sasha Rivera, Director of Admissions

Diane Skinner, Administrative Assistant

Ron Goodman, Director of Nursing Services

Patty Braille, Assistant Director of Nursing Services

Philippe Blot, Director of Rehabilitation

David Post, Director of Food Services 

Francois Negri, Director of Environmental Services

T. Ravishankar, Medical Director

The entire staff at Glen Cove Center for Nursing and Rehabilitation

by the staff of Glen Cove Center for Nursing and Rehabilitation, Glen Cove, New York 

Suggested Resources

Covey SR. The Seven Habits of Highly Effective People. New York: Simon & Schuster, 1989.

Hospitality Service Teamwork: Making Teamwork Work at Your Hotel, DVD. Sunrise Basic Training.

Jarrell J. Simple Hospitality. Nashville, Tenn.: W Publishing Group, 2005.

Johnson S. Who Moved My Cheese?: An Amazing Way to Deal with Change in Your Work and in Your Life. New York: G.P. Putnam, 1998.

Lundin SC, Paul H, Christensen J. Fish!: A Remarkable Way to Boost Morale and Improve Results. New York: Hyperion, 2000.

Lundin SC, Christensen J, Paul H. With Strand P. Fish! Tales: Real-Life Stories to Help You Transform Your Workplace and Your Life. New York: Hyperion, 2002.

Peters TJ, Waterman RH Jr. In Search of Excellence: Lessons From America's Best-Run Companies. New York: Harper & Row, Inc., 1982.

RELATED ARTICLE: Hospitality Principles

The administrator of the facility had attended several hospitality seminars and programs over the past few years, and had read numerous books and articles, as well. She was instrumental in sharing, teaching, and guiding the management team on various topics of hospitality. The following outline delineates the topics discussed by the management team as part of their quest to become hospitality ready:

* Lead by example

* Recognize proper customer service

* Do not tolerate poor customer service

* Know your services

* Initiate employee motivational techniques

* Handle guest complaints effectively

* Remain positive

* Teach employees

The management team discussed the possibility of hiring a hospitality training expert to provide information to the management staff, but the team decided that they could secure resources themselves and read and learn from one another. This, in and of itself, would promote a feeling of accomplishment and teamwork. And it did.

Results of Short-Term Rehabilitation Questionnaire: 2005

Question # 8 -- Please rate your overall impression of your stay at our
facility.

                    Minimally                             Extremely
      Dissatisfied  Satisfied  Satisfied  Very Satisfied  Satisfied

2004  0%            16%        53%        20%             11%
2005  0%             8%         5%        30%             57%

Figure.