Direct Care Staff Satisfaction Survey Report
2009
The Direct Care (DC) Staff Satisfaction Survey was conducted beginning in the 2nd quarter of 2009. DC Staff were invited via email to visit the employee login section of the website and complete the survey. Staff in every region (Triad, Triangle, and Coastal) was sent the invitation and had equal access to the survey. The survey remained open until July 31st for all staff to participate. August 1, 2009 the survey was closed and the data began to be aggregated. All responses were anonymous and shall only be reported in the aggregate.
The Survey
The survey consisted of six sections. The first section gathered general information (i.e. which region do they work, how long they have been with the agency etc.) about employees using multiple choice questions. Secondly, respondents were asked to rate their satisfaction on a number of general employment topics such as compensation and job satisfaction. The next three sections asked questions pertaining to satisfaction with the Clinical Department, Human Resources Department, and Billing Department. Employees were able to rate their satisfaction on a scale ranging from Strongly Agree with the statements to Strongly Disagree with statements presented. The last section asked three open ended questions to obtain further feedback regarding DC satisfaction and recommendations.
The Participants
Direct Care staff in all regions were sent an email with the link to the survey on the employee login page of the agency website. The approximate number of staff employed by Lindley Habilitation Services who would have been eligible to participate in the survey was 500. This included all DC staff from all three regions served by LHS. One hundred and eighteen staff viewed the survey online and 97 began taking the survey. Of the 97 who began the survey 86 completed it. This gives a completion rate of 89% of those who began the survey. Assuming the total number of DC staff invited to participate is 500, only 17% of LHS Direct Care Staff completed the survey.
The Results
Section 1: Demographics
Q1. According to the data collected 58% of respondents have been with Lindley Habilitation Services for less than 2 years. Of the 58%, 32% have been with the agency for less than one year. It was also interesting to note that the next largest group at 15% has been with the agency for more than 5 years. This shows that the agency has many new employees but also a fair number of “long term” direct care staff.
Q2. Of the respondents 81% were from the Triad Region which serves Guilford, Forsyth, Rockingham, Randolph, and Alamance Counties. Respondents from the Coastal Region and Triangle Region were 15% and 4% respectively. This is not unusual as the DC staff in the Triad Region outnumber the other regions due to the number of counties served, longevity in the region, and number of cases in the region.
Q3. Respondents were asked: Do you have a consumer you work with on a permanent basis. From the choices given it is noted that 86% of respondents have a permanent consumer or consumers that they work with on a regular basis. Sixty five percent of respondents stated they had only one consumer they worked with regularly while 21% said they worked with more than one consumer regularly. Seven percent stated they were looking for permanent cases while the other 7% stated they were only interested in doing fill in type work. It should be noted that the 7% who are looking for a permanent case may be a low number and not completely reflect an accurate number of employees wanting more hours due to the fact that only 17% of employees completed the survey.
Q4. From the survey it is noted that 70% of respondents stated that prior or during their work with LHS they have never provided direct care services through CAP MR/DD. This could be attributed to the large pool of employees LHS has that are college students or recent graduates trying to gain experience in the field.
Section 2: General Topics Regarding Employment
Q1. Regarding Compensation for direct care work performed, 65% of respondents stated they were either satisfied or very satisfied with the compensation. This may reflect the demographics of 70% never having worked in the field and LHS being their only DC employer.
Q2. Respondents were asked to rate their satisfaction for compensation for required trainings. Seventy two percent were either satisfied or very satisfied with training compensation. Only 9% stated they were unsatisfied and 17% were neutral on the issue.
Q3. In rating satisfaction for the opportunity for advancement, 39% responded they were satisfied or very satisfied with the opportunities while 23% stated they were unsatisfied or very unsatisfied with opportunities provided. It should be noted that it is the policy of LHS to advertise for new positions in the Administrative offices to all employees before posting openings to the public. As a result, more than 90% of all administrative staff is hired from within the company.
Q4. Respondents were asked about their satisfaction with the “friendly work environment”. Of those who responded, 80% were satisfied or very satisfied with the friendly work environment. Only 9% were unsatisfied or very unsatisfied. The question was unclear, however, if the work environment meant the Administrative offices or the homes in which the DC staff work. Therefore, this question should be made null.
Q5. LHS provides training to work directly with consumers. DC staff was asked their level of satisfaction regarding this training. Eighty three percent were satisfied or very satisfied with direct training. Six percent were unsatisfied or very unsatisfied with 11% being neutral.
Q6. Direct Care employees were asked about their overall job satisfaction. Of those who responded 83% chose satisfied or very satisfied. In contrast, 9% chose unsatisfied or very unsatisfied.
Q7. LHS has a grievance procedure for employees to file should the need arise. Respondents were asked their level of satisfaction regarding “the LHS grievance policy and the process to file a grievance” should they feel they have been treated unfairly. Of those who responded 61% chose satisfied or very satisfied with the process while 18% remained neutral. This could be attributed to the fact that very few grievances have been filed by employees. It should be noted that the grievance forms and process are located on the employee login side of the website for easy access.
Q8. Since the creation of the LHS website and employee login there have been many improvements and changes. Respondents were asked to rate their satisfaction on the “user friendliness to navigate and locate” items needed. A total of 83% were satisfied or very satisfied with the website and 13% were unsatisfied or very unsatisfied. LHS maintains most of the information and documents needed for employees to access and print on the employee login of the website as well as many of the trainings offered by LHS. In addition, LHS has a computer available at every regional office for employees to use if they do not have access to a computer of their own.
Q9. The agency has recently changed its strategy in staffing cases to be more proactive in using current employees in filling consumer hours. Respondents were asked their satisfaction level with the agency’s ability to fill needed hours. The total number of those satisfied or very satisfied was 77% with 9% being satisfied to very unsatisfied. This should be viewed also with the demographic information that 86% of respondents stated they worked permanent shifts currently.
Q10. LHS maintains a 24/7 on call system for emergencies. In rating their satisfaction, 66% of respondents were satisfied or very satisfied and 9% were unsatisfied or very unsatisfied with 21% neutral. If this information is compared to recent on call reports for number of calls and nature of calls there are a very small percentage of employees using the on call system in comparison to the total number of LHS DC employees?
Q11. By policy each DC employee is required to have an annual performance evaluation completed by their supervisor. Sixty two percent of respondents were satisfied or very satisfied with this process and 10% were unsatisfied or very unsatisfied. It should be noted that LHS is in the process of looking at performance evaluations at all levels and possibly revamping the system. This should be completed by the end of the 2nd quarter for 2010.
Section 3: Billing/Payroll Processes
Q1. Respondents were asked to what level they agreed or disagree to the statement that LHS payroll schedule is easy to understand. Of those who responded 81% agreed or strongly agreed that the payroll process was easy to understand. Eleven percent disagreed or strongly disagreed that the payroll process was easy to understand.
Q2. Employees are asked to contact the agency with any payroll questions. Seventy one percent of respondents agreed or strongly agreed that their payroll questions were answered in a timely manner while 11% disagreed or strongly disagreed with this statement. Since respondents were not asked who they asked their payroll questions to and it cannot be assumed all questions were asked to the proper person this question should be made null and the system and process for posing questions and notifying employees of such should be researched and possibly clarified.
Q3. It is the responsibility of the Clinical Supervisor to contact employees when there is a change in pay due to billing corrections. Respondents were asked if they agreed or disagreed that the CS contacted them regarding changes. Of those who responded 51% agreed or strongly agreed that they were contacted by the CS regarding changes. A total of 15% disagreed or strongly disagreed with this statement. Twenty one percent chose that this question was not applicable to them and 13% were undecided.
Q4. How to complete data sheets is taught in orientation. Respondents were asked if they understand how to properly fill out data sheets. An overwhelming 92% agreed or strongly agreed that they understand how to complete data sheets with only 3% disagreeing or strongly disagreeing. With this number being so high in understanding the data sheets, it should stand to reason the number of staff error should be low. However, with only 17% of staff responding to the survey, it is possible that staff making errors are staff not responding to the survey. It would be interesting to compare the number of staff error with this information.
Q5. Each consumer is to have a calendar of billable hours and billable services. DC staff is expected to follow this calendar in billing services worked. Respondents were asked if they agree that they use the consumer’s calendar to know which services to bill. A total of 78% of DC staff responding stated they agreed or strongly agreed that they followed the consumer calendar. This should be compared to the number of billing errors by staff relating to calendar issues.
Q6. If changes are made to the consumer’s calendar which will affect the services being billed by DC staff, the CS is suppose to contact the staff to notify them of changes and make changes on calendar which can be accessed by staff on the employee login page of the agency website. Direct Care staff respondents were asked if they were notified by their supervisor when changes were made. A total of 65% of respondents agreed or strongly agreed they were notified by the supervisor when changes were made. However, 22% disagreed or strongly disagreed that they were notified of changes. The high number of respondents who could not agree that they were contacted by their supervisor could possibly mean the system of notifying and making changes to the calendar as well as the use of the calendar should be studied by the agency.
Q7. Respondents were asked if they knew when and where their data was to be turned into when completed. An overwhelming 98% agreed or strongly agreed with only 2% strongly disagreeing to this statement.
Q8. The statement was made “I have not had any problems with my pay” and 68% agreed or strongly agreed with this statement. However, a high number of respondents, 28%, disagreed or strongly disagreed with this statement. Since such a high number of respondents seem to have had pay issues, further study may need to be made into this issue.
Q9. There are instances when changes in the agency or in billing are made that may affect DC staff pay. Respondents were asked to what level they agreed to the statement that LHS informs them when changes are made that affect pay. A total of 81% agreed or strongly agreed the agency notified them of changes and only 8% stated they disagreed or strongly disagreed with this statement. There were 11% that were undecided on this issue.
Q10. LHS posts payroll hours to the website prior to pay day for DC staff to check and contact the agency prior to pay day for corrections to be made in order to eliminate or reduce the number of payroll errors due to billed hours. Respondents were asked if they checked their hours prior to pay day. Eight three percent stated they agreed or strongly agreed that they did check their hours. A total of 11% stated they disagreed or strongly disagreed that they checked their hours. It is possible that the high number of respondents that stated they had pay problems might be correlated to the 11% who do not check their hours before pay day and therefore, there are issues with their paycheck.
Q11. LHS requires all DC staff to complete and turn in data by the 2nd and 18th of each month. Respondents were asked if this allowed them adequate time to turn in their data. A total of 76% agreed or strongly agreed this was enough time for them to complete data while 12% stated they disagreed or strongly disagreed with this statement. There were 12% that were undecided on this issue.
Q12. There continues to be an issue with documentation requirements causing correction issues for DC staff. This survey posed the question if staff would like to have an on-line training to review documentation requirements. Less than half, 43%, of respondents agreed or strongly agreed that they would like this additional training while 21% disagreed or strongly disagreed with the additional training. There were 30% that were undecided on this issue.
Q13. When DC staff has data corrections to make they are asked to come into the office and complete them. There are also times the CS will take corrections to them. In either case, the corrections should be explained as to prevent the mistakes from reoccurring. Respondents were asked if their supervisor adequately explains how to make corrections. A total of 84% agreed or strongly agreed that the supervisor did adequately explain corrections and 10% disagreed or strongly disagreed with this statement. Six percent were undecided or chose N/A as their answer.
Q14. The last question regarding the Billing department stated “I am comfortable with the payroll and billing procedures”. A total of 87% agreed or strongly agreed with this statement and 5% disagreed or strongly disagreed with this statement.
Section 4: The Clinical and Activities Department Satisfaction
Q1. Each Clinical Supervisor is responsible for a number of direct care staff and the clinical oversight of them with particular consumers. Respondents were given the statement: I am satisfied with the clinical supervision I receive from my CS regarding my consumer care”. Of the respondents, 71% stated they agreed or strongly agreed with this statement while 12% chose they disagreed or strongly disagreed with this statement. At total of 10% were undecided. Although a high number of respondents chose they agreed with the clinical supervision provided, a 12% negative response is one that needs to be evaluated further.
Q2. Respondents were asked if they agreed that the CS providing supervision is knowledgeable and gives suggestions and clinical feedback when needed. The percentage of agreeing or strongly agreeing was slightly higher than the satisfaction of the clinical supervision coming in at 76%. The respondents who chose disagree or strongly disagree was slightly lower than the previous question at 11%. Again, this trend points to need to look at our clinical knowledge and oversight.
Q3. It is the policy of LHS that a CS return phone calls within one business day. A total of 65% of respondents agreed or strongly agreed that the CS followed this policy. However, a large percentage, 25%, disagreed or strongly disagreed with this. With workloads increasing for all CSs due to budget cuts and increased caseloads, it may be necessary to rewrite this policy to one that is more feasible for a CS to achieve.
Q4. One of the cornerstones LHS was founded on was to provide quality activities for consumers to participate in with their staff. Respondents were asked to what level they agreed that LHS provides an adequate number of activities for them to take the consumer to. Seventy two percent agreed or strongly agreed to this statement. Only 8% disagreed or strongly disagreed with this. Looking at all regions it is noticeable that some regions have more activities and more participation than other regions due to location and availability of activities. It should also be noted that a Quality Assurance meeting is held monthly in each region for consumers to recommend additional activities they would like to participate in with the agency.
Q5. Consumers who attend LHS sponsored activities cover a wide range of ages. Participants in the survey were asked if they agreed that the activities provided were age appropriate for the consumer. A total of 71% agreed or strongly agreed with this statement and only 6% disagreed or strongly disagreed. There were 17% who chose not applicable as their answer. This could be due to the consumer not attending the activities.
Q6. In addition to a wide range of ages, the consumers served by LHS also are of various levels of functioning and disabilities. Respondents were asked if they agreed that the activities provided were done on the developmental level of the consumer. For this question only 65% agreed or strongly agreed. Nine percent disagreed or strongly disagreed that the activities were on the developmental level for the consumer. Only 15% chose N/A and 12% were undecided. It should be noted that LHS takes steps to have different levels of participation for activities according to consumers. For example, a consumer in an art class that can complete the entire project is encouraged to do so. Another consumer may only be able to complete 1-2 steps with assistance. Most activities can be modified to fit the consumer. Perhaps the low number of respondents who agree points to additional training or instruction which needs to take place with staff on how to modify activities to fit the consumer.
Q7. An important matter for all staff to understand is how to complete an incident report should an incident occur. A total of 86% of respondents agreed or strongly agreed that they understood how to complete this paperwork. Only 6% stated they disagreed or strongly disagreed on how to complete the paperwork. Seven percent and 1% were undecided and N/A respectively. It can be assumed these respondents have never had to complete an incident report. It will be interesting to compare these findings to the ones found by the Safety Circle asking respondents in their survey what they consider to be an incident. This may show that less than 86% of staff understands how to complete a report as they do not fully understand what constitutes an incident.
Section 5: The Human Resources Department Satisfaction
Q1. There are many reasons a direct care staff may need to contact the Human Resources (HR) department. Respondents were asked to respond to the statement: The HR department returns my calls in a timely manner, within one business day. A total 74% of respondents agreed or strongly agreed with this statement while 15% disagreed or strongly disagreed with the statement. Eleven percent was undecided and only 1% chose N/A.
Q2. One of the reasons a DC staff may contact the HR department is to try and acquire fill in hours which are posted. Of respondents, 62% agreed or strongly agreed that the HR department was easy too work with when they called to inquire about fill in hours. Only 5% disagreed or strongly disagreed with this statement. A large number, 24% chose N/A and 10% were undecided. Since 86% of respondents said they had consumers which with they worked with on a regular basis, it is likely the 34% of N/A and undecided respondents do not inquire about fill in hours.
Q3. The HR department is also responsible for covering permanent hours. Respondents were asked if they agreed with the statement: The HR department is easy to work with when I am trying to find permanent hours. A quarter of respondents said this question was not applicable to them and 9 % were undecided. Removing these responses from the survey yields 86% who agree or strongly agree and 14% who disagree or strongly disagree with the statement.
Q4. All DC staff are required to have certain trainings and documents on file to work. Many of these trainings and copies of documents must be renewed and updated. The HR department goes through a procedure to notify staff of compliance issues so they may continue working uninterrupted. Respondents were asked if they were aware of compliance items and the deadlines which are given. An overwhelming 93% of respondents agreed or strongly agreed that they were aware of these issues and only 2% strongly disagreed.
Key:
Aware of Compliance Issues and Timelines
Adequate Notice of Compliance Items is due
Q5. On the compliance issue, respondents were then asked if they had received adequate notice when compliance items have come due. Again the largest response, 91%, agreed or strongly agreed and only 3% disagreed or strongly disagreed with 4% being undecided or N/A.
Q6. In an effort to reduce cost and improve efficiency, LHS has moved much training to online. Respondents were asked if they were aware of online trainings which were available. A total of 95% agreed or strongly agreed with this statement and only 4% disagreed or strongly disagreed.
Q7. This question was in regards to the video interview available for families to view. This question is being thrown out due to the fact it was only available for new hires and not advertised for all DC staff. Therefore, the findings are unfair.
Q8. The knowledge of HR representatives was questioned. We asked respondents if the HR representatives they dealt with were knowledgeable in answering questions and giving feedback. A total of 85% of respondents agreed or strongly agreed with this statement, while 6% disagreed or strongly disagreed.
Section 6: Open Ended Questions for Comments
The last section of the survey offered 3 open ended questions to allow respondents to comment on areas of the agency they thought might need improvements and to offer suggestions.
Q1. A total of 15 or 18% of respondents made comments on question one: Do you have any specific recommendations to improve employee moral?
Four respondents made comments regarding appreciation. These respondents would like to see more appreciation opportunities to be made by families as well as by LHS itself. In the past LHS has hosted “Staff Appreciation” days and it was suggested to have these more regularly and on a schedule. Staff also made comments that the Administrative staff should make the DC staff feel more appreciated and respected. One respondent suggested that families or caregivers be allowed to nominate staff for awards. It should be noted that families are currently invited to nominate staff for “Employee of the Month” awards. However, this may not be common knowledge and there may need to be a link on the parent login for families to be able to nominate their staff.
A suggestion was also made to help families understand the rules and regulations of the agency so that staff is not taken advantage of while they are working. On this same issue, one respondent stated that they felt like LHS needed to make staff feel like they matter, not just that families matter.
Several respondents stated they would like to have more opportunities for DC staff to get together without consumers to discuss client issues and gain support from other staff as well as get to know other people in the agency so as not to feel so isolated while doing direct care. The agency is currently looking into the possibility of conducting group supervisions at the administrative offices to allow staff to participate in group discussions and offer their knowledge and expertise as well as gaining knowledge from those conducting the groups as well as other direct care staff.
One respondent stated they believed LHS should go to a regular raise schedule since there is no incentive for staff to stay with a consumer long term. They also suggested an incentive program or goals for employees to work towards so there would be a way to recognize hard work and success. Due to the Medicaid rates being the strongest variable in allowing the agency to give raises it is impossible to implement a regular raise schedule. This is especially true since over the past 11 years LHS has served the CAP MR/DD community there has been no increase in rates. Therefore, even though cost of living increase is estimated at 2% a year, Medicaid has not adjusted their rates for this which means the agency is down approximately 22%. Moreover, CAP MR/DD suffered a 5% cut in rate reimbursements beginning October 1, 2009. This means the agency has to make up approximately $293,000 per year in lost revenue. LHS has made many cuts and changes, including all administrative staff taking a 4% pay cut to reduce the number of layoffs as well as keep the cut to hourly staff as low as possible.
In regards to incentives and goals, LHS will continue to look at various ideas to create incentives for staff to stay with consumers and goals to work towards to recognize the hard work of DC employees. LHS recognizes that lower staff turnover means a savings in cost and those happy employees means a lower rate of turnover.
Q2. The second question in this section yielded 26% of respondents making a comment. The question was posed: How would you improve any supervisory procedures/process?
The suggestions were able to be divided into 5 categories. The first category would be communication. A total of 9 of respondents to this question stated that communication by the Clinical Supervisor was an issue. Suggestions were made for the CS to return phone calls and not just email staff, communicate more with the family regarding staffing and calendars so there is less conflict, return calls in a timely manner, and notifying staff better about visits and other issues they need to be made aware of to complete their duties.
The next category suggestions could be put in is professional behavior/professional environment in the office. A total of 4 of respondents commented to create the trend that some DC staff sees the Administrative offices as being “slack” and unprofessional. It was stated they would like to see a stricter environment in the office and to have their time respected more when they need to come into the office. At least 2 respondents stated it was an issue that there are times with a CS makes a mistake and they do not admit it and it reflects badly on the DC staff.
The third category is supervision itself. This had the second largest response at 6. Suggestions ranged from giving CS more clinical knowledge to be able to contribute, group or team meetings to share ideas, working with all team members so goals are run the same on each shift, to having more client interaction and follow up after a new staff is trained.
Next there was one respondent who raised the issue of staff appreciation. Although this is a small percentage it should be taken seriously. This staff made the suggestion that the CS treat the staff like they would a consumer, with person centeredness.
The last category can be that of positive responses. There were 4 of respondents to this question that stated they believed things were working well and they had no suggestions at this time.
Q3. Lastly, the survey asked: Is there anything else you believe needs change or improvement in the agency. There were a total of 23 respondents to this question. Eleven stated they had no suggestions for change or improvement and/or they gave a positive response about the agency. One stated “I have worked with many agencies in the past 20 years, and by far, LHS is the BEST”.
Seven respondents stated that communication needed to be improved. Communication between CS and staff, HR and staff, as well as among the different departments in the agency was all listed as issues which needed to be improved. There was one respondent who felt there was too much communication to DC employees regarding compliance.
Again, professionalism and office environment were mentioned. Lack of follow up and follow through with DC staff regarding paperwork etc. as well as checking a staff’s schedule before asking them to work were mentioned as well as lack of organization.
Three respondents stated they had issues with the billing calendars not being correct, turning in timesheets being difficult and needing longer than one day to review payroll hours.
In addition to these, comments were made by DC staff wanting more weekend activities, list of activities in the community available to consumers, pay being too low for DC staff, wanting to change from CPR to American Heart to cut training cost, and making arrangements for needed injections by the consumer.
Conclusion
The trends found in this survey point to the need for LHS to improve communication in all areas of the agency. LHS is working towards using cost effective mediums available to communicate with staff and families. Many respondents pointed to the issue of getting return calls being a problem. LHS will look at amending its policy for a 24 hour response time due to the fact that all Administrative employees will have a larger workload as well as a pay cut in light of the Medicaid cuts made to the CAP MR/DD program. LHS will work on additional ways to inform staff of issues and answering questions.
Another trend seemed to be the staffs desire to meet with other staff to discuss clinical issues as well as feel like a part of the agency. Currently, LHS is looking into conducting group supervisions. This would allow a number of staff serving different consumers to get together and be guided regarding clinical issues in discussions. This would allow all staff to benefit from the experience of one another and gain new ideas and understanding. It would also allow the Clinical Supervisors to lend their knowledge to a wide number of staff whom they may not have direct contact with normally. In addition, this would help DC staff to meet other staff and create a greater sense of community among staff.