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Process Improvement in Workforce Development

About Kentucky River Community Care, Inc.

Kentucky River Community Care (KRCC) provides Mental Health, Substance Abuse, Trauma, and Developmental Disability services to an eight-county region in southeastern Kentucky. Employing 455 staff at 45 sites, KRCC used NIATx process improvement strategies to make significant improvements in each of the four aims. With a strong foundation in process improvement, KRCC has been working to spread process improvement to other areas of the organization—most notably, workforce development. In 2005, the KRCC Workforce Development Change Team formed to address the problem of staff recruitment and retention in several critical staff areas. Baseline data showed that 47.88 percent of new staff in Mental Retardation/Developmental Disability (MRDD) and 42.10 percent of Customer Service staff left employment within the first six months. In addition, 35 percent of staff working as residential technicians in children’s’ services programs were leaving within the first six months of employment.

The organization’s residential technicians who support individuals with mental retardation or a development disability monitor and assist with all the individuals’ daily living activities, working round the clock, seven days a week. Staff turnover among residential technicians was very disruptive, affecting the behavior of individuals in the program as well as their quality of care. Equally disruptive to KRCC’s delivery of services was turnover in customer service staff at outpatient sites:

Residential technicians in KRCC’s children’s services programs work in a crisis stabilization program for children with mental health issues. These staff provide support for children’s activities, daily living, and educational services.

The Change Team gathered information through focus groups that included staff from the targeted areas, as well as staff from KRCC’s adult residential services division, which has had very good employee retention. The team also conducted exit interviews with Customer Service and MRDD staff that left employment early.

Through these activities, the Change Team learned that a key difference in employee retention was in how new MRDD and Customer Service staff were trained. Those who chose to leave employment shortly after hiring said they did not feel adequately prepared for the jobs assigned to them, or for severity of the illnesses of some of the individuals they were assigned to support. Many stated that they felt overwhelmed, that they did not feel valued, and that their opinions did not matter.  

However, staff in adult residential services received more structured and in-depth training, with one-on-one attention from a peer mentor.
Based on this information, in late 2005 the KRCC Workforce Development Change Team began to test several improvements to recruit, recognize, and retain committed and caring staff in the targeted programs.

Project Information

These successful strategies have been implemented, with significant positive impact on workforce development at KRCC:
1. Quick Hire Process: This process streamlined the hiring process for supervisors to assist with their need to get staff “fast.” The Change Team dentified the absolute requirements and placed a “Quick Hire” session in between the regularly scheduled orientations. This cut the process from three weeks to five days or less in some cases. 

2. Welcome Packet: All new employees receive a welcome packet at the beginning of orientation. The packet includes:

  • a welcome letter signed by the Executive Director, Dr. Louise Howell
  • an overview of the history, development, and mission of KRCC
  • a “What to Expect during Your First Two Weeks as a New Employee” sheet.
  • a facility directory
  • a recent copy of the agency newsletter
  • a New Employee Training Guide
  • an ink pen bearing the KRCC logo, phone number, and address

3. Mentor Assignment for all New Employees: the supervisor assigns a seasoned employee to work directly with the new employee and provide leadership during training. This employee is knowledgeable in all aspects of the job and available to answer questions and provide instruction as needed.

During the rapid-cycle testing phase, the Change Team surveyed new employees who were assigned a mentor and those who were not. Each was asked to rate their satisfaction with orientation and new job training on a scale of one to 10, with 10 being the highest. The highest score given by staff without a mentor was four; for those with a mentor, the score rose to eight.

4. New Employee Training Guide: a checklist to guide supervisors in reviewing policy and procedure with new staff and to provide training on essential job functions.
New employees learn about the purpose and process for the New Employee Training Guide at orientation. The supervisor and new employee complete the checklist during the first two weeks on the job; once completed, both supervisor and employee sign the checklist. It then becomes part of the employee’s Human Resources training file.

During the rapid-cycle testing phase, this process had a dramatic impact on staff retention, with 100 percent retention rate in Customer Service and 80 percent in MR/DD. 

5. Employee Recognition Luncheon: Employee surveys from November 2005 and March 2006 indicated that staff did not feel valued or recognized for their efforts.

Given this, the Workforce Development Team decided to test a monthly Employee Recognition Luncheon, using the following procedure:

  • Supervisor submits nominations of staff they wish to recognize.
  • Workforce Development Change Team makes the selection based on written summaries of employee performance (names omitted).
  • Formal (inexpensive but nice) invitations are sent to the selected employees’ home address inviting them to “a special luncheon.”
  • At the luncheon, employees are “surprised” with a personal presentation made by their supervisor.
  • Each recognized employee receives a plaque honoring them for their efforts and contributions to the agency.
  • Each plaque is personalized according to the individual achievements of the staff person: “Outstanding Performance in the area of Customer Service” or “Outstanding Service and Dedication to Children in Crisis Stabilization.”
  • Luncheons were held in June and July 2006. An August 2006 survey showed that response to this strategy was very positive.


The KRCC Change Team has put all the tested changes in “sustain” mode, and will assess again at the end of 2006.

Kentucky River Community Care has made process improvement a part of its organizational culture, extending from service delivery to workforce development. In fact, every KRCC job description includes participation in process improvement activities as a primary responsibility for each employee. Adds KRCC Change Leader Robert Jackson, “Almost 40 percent of KRCC staff has participated in a Change Exercise since (need year here) and we’re expecting to make that 100 percent by (year here.) Process improvement is part of the way we run our organization now.”

Last updated 04/15/2010

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