Tone at the Top: Build a Home for Your Senior Living Organization

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Senior living organizations face scrutiny from many stakeholders, including the general public, but ultimately must stay committed to their purpose of serving seniors. The phrase “tone at the top” has gained attention over the past few decades in part due to the growing epidemic of fraud and abuse, which has affected senior living organizations when it comes to billing, coding and other operational aspects of health care. 

Tone at the top, which translates to the organization’s overall culture, is built much like one would build a house. The board of directors (board) serves as builders, and the executives serve as carpenters, of organizational tone and culture. In senior living, culture encompasses the actual business but also the residents and their families, employees and vendors. The builders and carpenters should be intentional in their work because, just like a physical building, the effect of intentionality, or lack thereof, will begin to show over time. Employees serve as the culture’s foundation. The board and executives set the tone that leads to the hiring of specific employees who form this important structural aspect. It’s imperative the senior living organization has a strong foundation to withstand the tests it will face involving changes in reimbursement, federal and state laws and consumer preferences. 

The vertical and external structure of organizational culture has several contributors. The policies and procedures, designed to guide operations, serve as the structure’s frame and are based on items the executives bring to the board that are voted on and implemented. The mission, which defines what everyone is called to do, is like the siding of the house, and with the proper orientation, it helps protect the senior living organization from the changing seasons. The values serve as the interior finishes and should create an atmosphere that’s appealing, supportive and healthy to those who work and live there. The organization’s purpose is like the roof, pointing to why an organization exists. Of course, an often after-the-fact element when one starts a construction project is how to furnish the building. In our analogy, the furnishings of organizational culture are the organization’s decision-making processes, as laid out by the builders and carpenters.

The combination of these elements becomes the senior living organization’s culture, which is the atmosphere and attitude, beginning with the executives and trickling to those employees closest to the residents. Though every senior living organization’s culture is different, each is built with the same general components. Therefore, each can be influenced by the same best practices to achieve desired outcomes.

Hiring for Mission Alignment

Decision making starts with enlisting individuals whose personal mission aligns with the organization. When you achieve this alignment, individuals thrive and are empowered and engaged. To accomplish this, ask interview questions that help you understand the candidate’s core value system. Job skills can be easily taught, while values are more innate. Thus, hiring and promotion are areas where tone must be taken seriously, and everyone involved must allow adequate time to protect the organization’s mission and make decisions with the greater good of the organization in mind.  

Clear, Concise, Consistent & Collaborative Communication

The key principle in healthy leadership is communicating policies and procedures in a way that empowers employees to be self-directed. Employees need to make decisions many hours a day when the executives aren’t present, and when empowered, employees are more engaged and have a vested interest in the organization’s success. For the house to remain standing, it must undergo preventive maintenance. In other words, employees should be trained on policies and procedures at initial orientation and continually throughout employment. Part of this maintenance is reviewing and updating policies, as the organization’s goals and operating environment change over time. When doing so, there should be open communication with employees, as their feedback can provide helpful insight regarding potential necessary changes. While these policies and procedures ultimately affect various stakeholders, the carpenters (executives) internalizing this process set the tone of a positive, inclusive culture. 

Recognizing Achievement That Aligns with the Mission 

Incentivizing and rewarding individuals aligned with the organization’s mission can be a positive way to encourage compliance with the organization’s policies and procedures. Promotion is an effective incentive for employees who have exemplified the organization’s goals and expectations, as it can motivate other employees to improve their efforts. Sometimes cracks in the foundation need to be repaired or even removed and replaced. If an employee isn’t respecting the organization’s established values, they should have the opportunity to understand this privately. Appropriate sanctions, including terminations, may be necessary to maintain the organization’s overall mission. This is another way the carpenter sets the organization’s tone. 

Teaching Employees How to Make Decisions

Determine what is most critical to the organization’s success, and then protect it with all the resources you have. As an example, one executive started interviews with, and taught on a daily basis, this credo: “First and foremost, protect the residents’ safety and satisfaction. Second, protect the employees’ safety and engagement. Third, protect the organization’s financial health. And finally, maintain the highest ethical standards every day.” This simple four-step process became the living and breathing daily culture of the organization, supporting its purpose, mission, values, policies and procedures. Each organization should put as much effort into discerning its organizational credo as it does developing the purpose, mission, values, policies, procedures and budget. 

Empowerment Determines Success

The tone at the top is clearly different for every senior living organization. The tools put in place to accomplish this can vary depending on boards, executives and resident demographics. It should be noted, though, that tone isn’t dependent on cash in the bank or the state or quality of the actual building, but rather how empowered the organization’s workforce is allowed to be on a daily basis.  

Reach out to your BKD trusted advisor or use the Contact Us form below for more thoughts on senior living leadership.


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