It Takes a Neighborhood to Build Retention

Coronado Nursing and Rehabilitation Center is a 188-licensed-bed facility in the small city of Abilene, Texas. Staff turnover at the facility was very high and retention was an issue. New Administrator Jay Hobbs, BBS, LNFA, had some previous success with staffing at other facilities, such as his former location, Manor Park, where it took about six months to get staffing manageable. In that situation, the openings for staff went down from 16 to one. Hobbs saw opportunities to bring this experience to Coronado.

One of the first improvements that Hobbs implemented to solve the problem of retention was to engage the frontline staff to work with human resources (HR). In March 2022, Hobbs began an “Action Team” to look at ways to recruit and retain staff and create high involvement. This Action Team is called Get ’em, Keep ’em, Grow ’em, and is led by the HR director and includes frontline staff like a certified nurse aide, licensed vocational nurse, dietary staff and laundry staff.

As a result of the Action Team’s efforts, “We are working toward slowing down the hiring process with the use of standardized behavioral questions that can be used in a peer interview process,” Hobbs said. “This will help with high involvement and commitment to having success with new hires.”

At Coronado, hallway regions are divided into neighborhoods, in which a bank of staff work together so that they can build to self-scheduling. According to Hobbs, the groups of staff take ownership of their neighborhoods; they tend to stay, not quit.

"Now, each neighborhood has one coordinator and one or two staff members involved in peer interviewing. Each participant would have the same set of behavioral questions to be asked during the interview, and each peer would rate the questions answered as ‘not-so-good, good or best.’ The scores are placed on a grid, and they discuss the results and come up with a consensus on the hiring decision,” explained Hobbs.

Coronado’s larger Get ’em, Keep ’em, Grow ’em team is broken into two committees: onboarding and mentoring. In the beginning, the committees met once a week for about 30 minutes and brainstormed on questions like: What does the first week of employment look like to a new employee? Are we choosing our candidates well? What is our process? How is it working? Should we create a task list that helps the mentor with the process?

“For example, we found it helps to personalize the onboarding process by taking the new employee to lunch,” said Hobbs. “We make the candidate feel like they were chosen out of many applicants. This high involvement helps to retain employees by making them feel like they are part of the team. Employees now have a voice,” he said.

Coronado also continues to work toward creating an environment that puts the residents at the center. For instance, instead of everybody having breakfast at 7:30 a.m. from one menu, Coronado extended breakfast hours to 11:30 a.m., so that residents can choose their breakfast time and they have a menu of options. This change made it easier for staff to get residents ready for breakfast in a staggered manner, and residents enjoy the choice and flexibility.

Hobbs also referred to the support he and his team have received from the TMF Quality Innovation Network-Quality Improvement Organization to find ways to measure Coronado’s success. “Quality Improvement Specialist Arthi Vamsi is very helpful in finding ways to focus on our outcomes and how to track and trend the solution options,” said Hobbs. “Next we will be looking closely at the development of measures that we can use to evaluate the process.”

What is Coronado’s key to success? “We looked from within to our own staff for the solutions,” Hobbs said. “That’s what works. We want employees to say they love coming to work now.”

Joy Deike started as a night nurse at Coronado 28 years ago, assisting in laundry and housekeeping when needed. She then became a treatment nurse before moving into staff development as admissions director. She was promoted to unit supervisor and today coordinates the medical records for the Minimum Data Set (MDS). Deike says she still loves her job and plans to stay until she retires.