HCM 700 Module 6 Milestone Two Example

Milestone Two: Stay and Grow, Then Catch It Early, a Two-Phase Plan for Willow Creek Care Center

[Student Name]

Southern New Hampshire University

HCM 700: Healthcare Administration Capstone

Module Six Milestone Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone Two: Stay and Grow, Then Catch It Early, a Two-Phase Plan for Willow Creek Care Center

The first milestone and the workforce paper established that turnover drives Willow Creek Care Center's decline and identified strategies to reverse it. This milestone presents the full solution and the plan to carry it out. It describes two phases, explains why they are sequenced, sets out governance, assesses staff readiness, describes how the change will be led and communicated, provides a timeline and addresses resistance, policy changes and legal considerations.

The Solution in Two Phases

Phase one, Stay and Grow, is the retention program: a wage step scale starting at $19.50, a structured first 90 days with peer mentors, consistent assignment, posted schedules with an internal float pool, a four-rung career ladder, coaching for charge nurses and a staffing floor with new lift equipment. Phase two, Catch It Early, introduces tools and training that help aides and nurses spot and communicate changes in a resident's condition before they become emergencies, modeled on the INTERACT program. Phase two begins only when aide turnover falls below 60% a year and at least 70% of shifts follow consistent assignment.

Why the Phases Are Sequenced

The sequence follows the evidence. Ouslander et al. (2011) found a 24% reduction in hospital admissions among facilities rated as engaged in INTERACT, compared with 6% among those not engaged. Kane et al. (2017), in a randomized implementation trial, found no significant overall effect, with benefits confined to facilities that used the tools heavily. Engagement requires staff who stay long enough to learn the tools and know residents well enough to notice subtle changes. Launching phase two while turnover is near 94% would likely waste the investment. Castle (2013) linked consistent assignment with lower turnover, and it is also the practice that makes early recognition possible.

Fit With Mission and Strategy

Willow Creek's mission promises "dignified, loving care," and families' most frequent complaint is care from strangers. Stay and Grow responds directly. The plan also supports the board's strategic goals of returning to three stars within three years, restoring a positive margin and rebuilding hospital referral relationships. Every element can be explained to staff and families in terms of the mission, which matters for winning their support.

Governance

A steering committee will oversee implementation: the administrator as chair, the director of nursing, the human resources director, the chief financial officer of the parent organization, two certified nursing assistants elected by their peers and one member of the family council. The administrator in training will serve as project lead. The committee meets every two weeks during the first six months and monthly afterward, reviews the workforce dashboard and decides on adjustments. Including aides and a family member gives the people most affected a real voice.

Readiness for Change

Weiner (2009) frames readiness as something a workforce holds jointly: people must want the change and must trust that, as a group, they can deliver it. A brief anonymous survey of 58 nursing staff found reasonably strong commitment, with 74% agreeing that retention was the facility's biggest problem, but weak confidence: only 38% believed leadership would follow through. Several comments said aides had heard promises before. Readiness was therefore high on commitment and low on efficacy, which shapes the change approach.

Leading the Change

Low confidence calls for visible early action. The first change staff will see is the wage scale, effective on the first payroll after board approval, which demonstrates that leadership means it. Within the first month, the administrator will work a shift on each unit and host listening sessions on all three shifts. Aides will choose resident groups for consistent assignment with their unit manager rather than having groups assigned. Progress will be posted monthly in the break room, including results that disappoint, so staff can judge follow-through themselves.

Timeline

Implementation runs over 36 months. The first six months launch the wage scale, onboarding, mentors, scheduling and supervisor coaching. Consistent assignment and the float pool follow in months four to nine as staffing allows. The career ladder opens in month six. Phase two is expected around month 15, depending on the trigger. Table 1 summarizes.

Table 1. Implementation Timeline

Note. Timeline agreed with the steering committee; phase two timing depends on the trigger.

Communication

Communication will be frequent, honest and specific to each audience. Staff will hear about changes first, at shift huddles and all-staff meetings, before any public announcement. Residents and families will learn about consistent assignment through the family council and a letter explaining what to expect. The parent organization's board will receive quarterly reports. Hospital discharge planners will hear about the plan once early results are available, since overpromising to referral sources could damage trust further.

Anticipated Resistance

Three sources of resistance are likely. Long-serving aides may resent new hires starting near their own pay; the step scale places every current aide at or above the step matching their tenure, avoiding compression. Charge nurses may see mentoring and coaching as extra work; mentoring is done by paid aide mentors, and coaching is scheduled during paid time. Finance leaders may doubt the savings; the financial analysis in the next paper sets out assumptions and a sensitivity test, and the plan includes a six-month financial checkpoint.

Policy and HR Changes

Several written policies must change: the compensation policy, to create the step scale and differentials; the scheduling policy, to set posting timelines, trading rules and the weekend rotation; job descriptions for the senior aide, medication aide and mentor roles; a tuition assistance policy with a two-year commitment; and a staffing floor policy that defines when the float pool or agency must be called.

Legal and Regulatory Considerations

The plan raises several legal questions for the parent organization's counsel. Differentials for mentoring, floating and weekends must be included in the regular rate when calculating overtime under federal wage and hour law. The medication aide role must follow the state's training and scope-of-practice rules. The tuition repayment agreement must comply with state law on repayment provisions. And the pay scale must be applied consistently to avoid discrimination claims.

Conclusion

The solution sequences a retention program ahead of a clinical early-warning program because the evidence shows clinical tools depend on stable, engaged staff. Governance that includes aides and families, visible early action to build confidence, a realistic timeline and prepared answers to resistance give the plan a strong chance of adoption. The financial analysis will test whether Willow Creek can afford it.

References

Castle, N. G. (2013). Consistent assignment of nurse aides: Association with turnover and absenteeism. Journal of Aging & Social Policy, 25(1), 48-64. https://doi.org/10.1080/08959420.2012.705647

Kane, R. L., Huckfeldt, P., Tappen, R., Engstrom, G., Rojido, C., Newman, D., Yang, Z., & Ouslander, J. G. (2017). Effects of an intervention to reduce hospitalizations from nursing homes: A randomized implementation trial of the INTERACT program. JAMA Internal Medicine, 177(9), 1257-1264. https://doi.org/10.1001/jamainternmed.2017.2657

Ouslander, J. G., Lamb, G., Tappen, R., Herndon, L., Diaz, S., Roos, B. A., Grabowski, D. C., & Bonner, A. (2011). Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. Journal of the American Geriatrics Society, 59(4), 745-753. https://doi.org/10.1111/j.1532-5415.2011.03333.x

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67