HCM 700 Module 9 Final Project Example

Final Project: Stability First, a Capstone Report to the Board of Willow Creek Care Center

[Student Name]

Southern New Hampshire University

HCM 700: Healthcare Administration Capstone

Module Nine Final Project

[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.

Final Project: Stability First, a Capstone Report to the Board of Willow Creek Care Center

Executive Summary

Willow Creek Care Center is caught in a cycle. Staff leave, agency workers fill the gaps at twice the cost, losses prevent better pay and staffing and residents receive care from strangers, which erodes quality, ratings and referrals. This report recommends Stay and Grow, a retention program covering pay, onboarding, stable resident assignments, scheduling, advancement, supervisors and workplace safety, followed by an early-warning clinical program once staffing stabilizes. The plan costs about $520,000 in year one and $590,000 a year thereafter, is projected to return the facility to a positive margin in year two and is worth close to $1 million in today's dollars over three years. The report requests approval of the plan, a $250,000 reserve commitment and a six-month checkpoint.

Willow Creek Today

The facility's 120 beds were 81% full last year, with Medicaid covering nearly two-thirds of resident days at a rate about $38 below daily cost. It holds two federal stars overall, received 14 deficiencies at its last inspection against a state average of nine and sends 25.8% of short-stay residents back to the hospital within 30 days. Nursing staff turnover was 94%, aide vacancies number 22 of 64 positions and agency labor made up 18% of nursing hours. The share of families who would recommend Willow Creek has slipped from 84% to 71% in three years.

Diagnosis: The Turnover Cycle

The capstone's assessment traced these results to workforce instability operating through two loops. In the financial loop, departures create vacancies, agency hours fill them at high cost and losses block the investments that would keep staff. In the quality loop, unfamiliar and overstretched staff miss early warning signs and care plan details, producing rehospitalizations, deficiencies and lower ratings, which cost referrals and census. Exit interviews point to causes the facility can change: pay below nearby employers, unsafe shifts, unpredictable schedules and little recognition, with nearly half of departures occurring in an aide's first 90 days.

What the Evidence Says

Research supports the diagnosis and shapes the remedy. Gandhi et al. (2021) found nursing home staff turnover averaging about 128% nationally and linked higher turnover to lower ratings, while Castle and Engberg (2005) associated turnover with poorer quality indicators and Castle (2009) found quality better where agency use was lower. Castle et al. (2007) tied aide job satisfaction, including supervision, to turnover, and Castle (2013) linked consistent assignment to lower turnover and absenteeism. On rehospitalization, Mor et al. (2010) documented its frequency and cost, and the INTERACT studies by Ouslander et al. (2011) and Kane et al. (2017) showed that early-warning tools help mainly where staff use them thoroughly.

Recommendation

Phase one, Stay and Grow, begins immediately. Its components are a starting aide wage of $19.50 with tenure steps to $22.00; paid peer mentors and structured check-ins across each new aide's first three months; consistent assignment of aides to resident groups; schedules posted four weeks ahead with trading, a weekend differential and a six-aide float pool; a ladder from aide to senior aide, medication aide and practical nurse; leadership training for the nurses who run each shift; and a minimum staffing rule backed by two new ceiling lifts. Phase two, Catch It Early, adds INTERACT-style tools and training once aide turnover falls below 60% and consistent assignment reaches 70% of shifts, expected around month 15.

Why Stability Comes First

The board may ask why the plan does not start with the rehospitalization problem, which affects Medicare revenue directly. The answer lies in the INTERACT evidence: the randomized trial found no overall benefit when the program was introduced broadly, with gains limited to facilities that used the tools heavily. A workforce that turns over almost completely each year cannot learn and sustain such tools. Stability is the condition that makes clinical improvement possible.

Implementation and Governance

A steering committee chaired by the administrator, including the director of nursing, human resources, parent organization finance, two elected aides and a family council member, will oversee the 36-month plan. A staff survey showed strong agreement that retention is the top problem but low confidence that leadership will follow through, a gap Weiner (2009) would describe as commitment without efficacy. The plan therefore starts with the most visible change, the new wage scale on the first payroll after approval, and publishes progress monthly.

The Financial Case

Costs rise from about $520,000 in year one to $590,000 in years two and three, plus $60,000 for lifts. Benefits come from cutting agency hours from 18% to 5% of nursing time, lowering recruiting and orientation costs as departures fall and recovering census the facility now turns away, valued at contribution margin. Year one runs about $55,000 behind; years two and three are ahead by about $511,000 and $796,000. Projected margins improve year by year, crossing zero in year two and reaching about 2% in year three. If occupancy gains and agency reductions both fall short, the plan still roughly breaks even in year two.

Table 1. Financial Summary (thousands of dollars)

Note. From the Module Seven financial analysis; excludes $60,000 one-time capital in year 1.

Measuring Results

Results will be judged with an interrupted time series against 24 months of history and eight regional peer facilities, using federal payroll staffing data for comparison. Outcome measures cover turnover, retention, vacancies, agency hours, rehospitalization, falls, antipsychotic use, deficiencies, star rating, census and margin. Fidelity measures show whether each component is actually happening, and balancing measures watch overtime, injuries and admission of complex residents. Year three targets include turnover of 50%, agency at 5%, rehospitalization at 21% and three stars.

Risks

The largest risks are a regional wage spike, the departure of the nursing director and a new outbreak; Xu et al. (2020) found outbreaks associated with staffing shortages during the pandemic. Each risk has an owner and a response, from an annual market wage review to cross-training the float pool for outbreak coverage. Specific triggers, such as agency hours failing to fall by a quarter within six months, require the steering committee to revise the plan before further spending.

The Policy Environment

A federal minimum staffing standard finalized in 2024 would have required Willow Creek to add registered nurse hours, but Roush (2026) reported its rescission after a court had blocked it. Regulation will not force the facility's hand, so improvement depends on the board's choice. Willow Creek should continue working through its state association for Medicaid rates that reflect the cost of adequate staffing, since the rate gap limits every nursing home serving mostly Medicaid residents.

Sustaining and Spreading

Stay and Grow will be written into compensation, scheduling and staffing policies and funded in the operating budget rather than as a project. Mentor and coaching training will repeat for new cohorts, and stay interviews will continue quarterly. If year one meets most targets, the parent organization should adapt the program for one of its two other nursing homes in year two, with Willow Creek's aide representatives helping to teach it.

Decisions Requested

The board is asked to make five decisions: approve Stay and Grow and its 36-month implementation plan; authorize the new aide pay scale to start with the next pay period; commit $250,000 from the board-designated reserve for year one, to be repaid from later results; establish the steering committee with elected aide and family representation; and schedule a six-month checkpoint review of agency hours, turnover, census and spending, with authority for the committee to adjust components.

Conclusion

Willow Creek's residents asked a simple question at the start of this capstone: who will take care of me today? For too many mornings the answer has been someone they have never met. Stability First offers a practical, evidence-based and financially sound way to change that answer, beginning with the people who provide care and building toward the clinical improvements that depend on them.

References

Castle, N. G. (2009). Use of agency staff in nursing homes. Research in Gerontological Nursing, 2(3), 192-201. https://doi.org/10.3928/19404921-20090428-01

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

Castle, N. G., & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43(6), 616-626. https://doi.org/10.1097/01.mlr.0000163661.67170.b9

Castle, N. G., Engberg, J., Anderson, R., & Men, A. (2007). Job satisfaction of nurse aides in nursing homes: Intent to leave and turnover. The Gerontologist, 47(2), 193-204. https://doi.org/10.1093/geront/47.2.193

Gandhi, A., Yu, H., & Grabowski, D. C. (2021). High nursing staff turnover in nursing homes offers important quality information. Health Affairs, 40(3), 384-391. https://doi.org/10.1377/hlthaff.2020.00957

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

Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Affairs, 29(1), 57-64. https://doi.org/10.1377/hlthaff.2009.0629

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

Roush, K. (2026). HHS rescinds the nursing home minimum staffing rule. AJN, American Journal of Nursing, 126(4), 17. https://doi.org/10.1097/AJN.0000000000000283f

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

Xu, H., Intrator, O., & Bowblis, J. R. (2020). Shortages of staff in nursing homes during the COVID-19 pandemic: What are the driving factors? Journal of the American Medical Directors Association, 21(10), 1371-1377. https://doi.org/10.1016/j.jamda.2020.08.002