Loretto’s Innovations in Leadership Strategy Maximizing Clinic and Operational Expertise in Today’s Changing Healthcare Environment

By: Becca Taurisano

L-R Lori Sakalas, COO and Dr. Joelle Margery, CNO

In response to the evolving and complex changes in a post-COVID healthcare world, Loretto Health and Rehabilitation installed two members of its leadership team in new roles to guide the future of eldercare in Central New York. Dr. Joelle Margery has been promoted to Chief Nursing Officer of Skilled Nursing, bringing her experience as the former Vice President of Skilled Nursing and newly achieved Doctorate of Nursing Practice to the role. Lori Sakalas was hired in February 2022 as Chief Operations Officer, bringing her extensive healthcare administration and operations expertise as the former Vice President of Operations for Guardian Healthcare in Pennsylvania. Together, Margery and Sakalas will work collaboratively to ensure seamless operations and efficient care, while maximizing their clinical and operational expertise in today’s changing environment.

Sustaining Healthcare in Challenging Times

The healthcare industry is facing a significant staffing shortage, thanks to the pressures of the COVID-19 pandemic, but Margery and Sakalas are prepared to meet the challenge in new ways. Part of that is keeping recruitment and retention plans at the forefront of their focus and empowering Loretto employees to be part of the solution. “Our employees are vital to running a successful referral program,” says Sakalas, ”potential employees are more likely to respond to someone they know.” Loretto is seeing an increase of applicant flows when their employees are fully engaged in the recruiting process, such as higher numbers of employee referral submissions and an increase in candidates attending hiring events. In May, Loretto launched the “Amazing Race” program which asks employees to give leadership 4 or 5 names of potential employees they know personally who would be interested in hearing about Loretto’s services and benefits. Reaching out to the community for potential employees is part of the plan as well. Loretto recruiters go on college campuses, work with nursing programs for clinical rotations, seek out high school students and reach out to local refugee centers. “We try to work with individuals who have that heart for healthcare and want to work in our industry,” says Sakalas.

“The critical workforce shortage is the biggest challenge we are facing today,” says Margery. To combat this, Margery and Sakalas are looking at growing and promoting Loretto employees from within, mentoring them for success in their current role and assisting them to advance into other roles. Loretto offers mentoring programs for employees to pass their Certified Nursing Assistant (CNA) or Registered Nurse (NCLEX-RN) exams and leaders encourage employees to seek out opportunities in other areas like social work, dietician, operations, and administration. “We recognize that individuals want to be part of a career path,” says Margery, “we guide them on how to move forward in their career.”

Many of Loretto’s 2,500 employees are single mothers or support extended families and are unable to attend school full-time without an income. To meet their needs Loretto, offers a Licensed Professional Nurse (LPN) apprentice program, the first in New York State to be approved. While attending the program, employees attend classes as well as receiving on-the-job training at the Loretto facility while earning a paycheck. “Our program gives them support while they are in school so they can be successful, we incorporate emotional intelligence and leadership traits which are not taught in schools,” says Margery, “they can support their families while advancing their career goals.”

Supporting the Community

Loretto is always looking to support Central New York and surrounding communities with innovative ways to provide care, including a recent expansion of their sub-acute care units. Having found a need to care for a more clinically complex patient than they have in the past, Loretto has opened their Restorative Care Unit (RCU). “Hospitals are under duress with a shortage of beds and staff ”, explains Margery. If Loretto can take those patients and provide a hospital-level of care, hospital community partners benefit. “We are working to ensure those individuals can get a hospital bed in the community where they live,” says Margery, “when we can step in, it helps the community, it helps the hospital partners, and it helps healthcare in general especially with cost.”

Loretto’s 19 locations offer a continuum of care to their nearly 10,000 residential and home-based patients, whether that is skilled nursing, assisted living, independent living, or in-home care through their PACE program. “Our services allow patients to stay in their home if they so choose, while receiving the community-based care they need,” says Sakalas.

In December 2020, Loretto opened a COVID-only building that served many surrounding communities with a little over 300 admissions. “When there is a need in the community, we are often the first reach. If we are able, we will provide the support,” says Margery.

In December 2021, the Department of Health asked Loretto to take short-term rehabilitation patients because the hospitals needed to free up beds to take additional COVID patients. Based on Loretto’s proven track record to be able to implement plans effectively with positive outcomes, the Department of Health allotted 18 National Guardsmen to serve as Certified Nursing Assistants at Loretto during this time. “I am always open to initiatives to promote the well-being of the communities we serve,” says Margery, “as a nurse it’s about the patient, the community and the employees.”

Recently, Loretto evaluated the need in surrounding communities to provide care for patients with both dementia and a psychiatric diagnosis. “This is a very specific population of patients to care for,” says Margery, “and no center of this kind currently exists in our area.” Margery says Loretto is planning to open a center to care for those patients in 2023.

Leading By Example

Sakalas began her healthcare career 25 years ago as a nursing assistant working her way through King’s College in Wilkes-Barre, Pennsylvania. She grew up in a close-knit family and seeing the challenges her grandparents faced, inspired her to help make the last years of their life as enjoyable as possible. After working her way through various administrative and operational roles with Genesis Healthcare, Guardian Healthcare, and Golden Living, she never lost sight that care for the patient comes first. Sakalas says Loretto’s history in the community, starting in 1926, and mission to provide exceptional care to families, aligned with her personal and professional values. Sakalas says, “We cannot expect from our team what we do not expect from each other. Our team needs to feel we are right there with them, that we believe in them and respect their opinion. At the end of the day, we know we can get through anything.”

Margery came to Loretto 15 years ago as Assistant Director of Nursing. She holds an Associate’s in Applied Nursing from St. Elizabeth College of Nursing in Utica, a Bachelor of Science in Nursing from Southern New

Hampshire University, a Master of Science in Nursing – Clinical Nurse Leader from Southern New Hampshire University, and in March 2022, awarded the Doctorate in Nursing Practice (DNP) from Capella University. “I’ve always been a caretaker,” says Margery, “the ability for us to provide care that is not typically done in the post-acute care world, that’s empowering. I want to push the limits and do at Loretto what nobody else in the community does. We are afforded the ability to think outside the box here.”

Both Margery and Sakalas are hands-on leaders, stepping in whenever their team needs their help. Leaning on their experience in the healthcare industry, they can relate to the challenges their employees face. “As leaders, we respect everyone no matter position or title,” says Sakalas, “we are motivators and inspirational leaders to our team because we have done what they do and we are right there with them.”

When New York State Department of Health regulatory requirements required employees to be COVID-tested twice a week, Margery stepped in to help with testing. “Knowing my team had their own fears, I couldn’t have my team test staff without me being there,” she says, “I was part of the team doing testing for a year. If your employees see you alongside them, they are more likely to do it also.”

Adapting to Change in Creative Ways

Creativity and thinking outside the box are critical to sustaining the healthcare industry during these challenging times.
Part of that is being flexible with their workforce, says Sakalas, working with the unions on scheduling and listening to their employees on what work-life balance they need. Loretto is embarking on a new Diversity, Equity, and Inclusion (DEI) initiative after surveying employees at the end of 2021. Earlier this year, senior leaders engaged in a 10-week comprehensive DEI training program. Next, training will be delivered to managers and they will initiate learning circles with frontline employees. Once education is complete, Loretto leadership will formulate action plans to improve employee experience with regards to DEI.

In order to provide leaders with the skills they need to lead teams during this time of tremendous change, Loretto is providing a manager training program, as well as investing in certification programs for frontline workers to develop specialized skills in areas like dementia care and food service to create career paths to improve retention.

Margery and Sakalas are dedicated to continuous improvement and look forward to collaborating on initiatives to support patients and employees. With four decades of experience between them in the healthcare industry, their combined operations and clinical experience gives them a solid foundation for building a bright future at Loretto. 

“This partnership between our clinicians and operations will be the key to operating smarter, innovating faster, and creating a cohesive care environment that grows our staff while providing the highest quality of care.” Lori Sakalas, COO

Retirement Income Planning: When Should You Start Taking Social Security?

By: Jason D. Nickerson, CFP®, EA, Executive Vice President & Chief Operating Officer, John G. Ullman & Associates

When should we start thinking of retirement income planning? Given the change to the definition of retirement over time, the answer to that is very individualized. Our parents’ definition of retirement may have been different from what we are experiencing now. A growing number of people decide to retire from a primary career but are worried that they will be bored, so they take up another job/career. However, some still hold to the pure definition of retirement and postpone activities and hobbies to enjoy when they have time capacity to pursue them.

Regardless of your definition, whether you live it now or are postponing to the future, we need to fund it somehow. For some, continued work provides a portion of their cost of living. Hopefully, their diligent savings over many years has been managed smartly to provide income to their chosen way of life. Maybe there are pensions, annuities, or other forms of income that will support them. As you can see, this is a very robust area; each option or potential funding source comes with its choices and the need to make decisions.

So let us start with one piece of the income puzzle that continues to raise questions; Social Security. When should we claim our retirement benefits and how should we consider Social Security as a part of our retirement income plan? The answer to these questions are as individualized as our retirement plans themselves, but let’s look at some universal considerations that perhaps people have thought about already.

What we know:

– The math says to wait as long as possible to claim your benefits. This is because each year you wait past 62 (the earliest claiming age) you will see an 8% average annual increase in your benefit, up to age 70. That is a nice rate of return!

– If you expect to live past your late 70’s, the math works out that you will have benefited by waiting to claim at age 70 versus age 62.

– If you expect to work past age 62 and expect to claim social security at the earliest age, the maximum you can earn (in 2022) is $19,560 before your benefits are reduced.

– If you have a spouse whose benefit is lower, waiting until age 70 to claim will maximize their survivor benefit if you die first.

Now let’s look at other considerations that many overlook about social security planning inside the bigger discussion of retirement income planning.

Some alternative thoughts:

1. No one else will benefit from your Social Security upon your death other than a spouse. They will only benefit if your benefits are higher than theirs are. Your accumulated savings can be left to more than just your spouse. You can leave it to children, other family, friends, charities, etc. Also, there is flexibility of when you give it away.

2. Claiming sooner can help insulate your accumulated savings. Social Security benefits can offset the need to take untimely withdrawals from your portfolio. Leaving your portfolio intact longer means it is there for more flexible and/or lumpy spending like cars, trips, house expenditures and more.

3. Leaving your portfolio intact also gives you the opportunity to earn more than not claiming your retirement benefit. We know your Social Security benefit will grow by 8%, maybe your portfolio can do better, but it could also do worse.

4. Most states do not tax social security and it is not 100% taxed by the IRS. It may be more tax beneficial than your other choices for retirement income.

5. Maybe you have health issues and don’t expect to live long enough to hit the crossover point of your late 70’s. Also, just because you decide to delay taking benefits at age 62 doesn’t mean you have to wait until your full retirement age to claim them. You can change your mind the next day if you would like.

Many of the unique planning and claiming strategies have been eliminated from Social Security over the years, but that does not mean the approach to claiming Social Security has gotten any easier. As we often tell our clients and those that are exploring our services, we are going to challenge the standard thinking and bring as many considerations to the conversation as possible. This ultimately leads to a more robust and individualized solution.

Kata: Your Approach to Daily Continuous Improvement

By: James A. D’Agostino, CEO, MEP Center Director

In last quarter’s edition, I wrote about Kata and its ability to transform organizations through the development of a culture of daily continuous improvement. With the continued headwinds that we’re all facing on multiple fronts, we need systematic, scientific ways of thinking and acting to achieve our goals and sustain improvements. This quarter, I want to expand more on Kata’s four-step scientific pattern and discuss its relationship with Lean.

As previously discussed, the four-step scientific pattern is as follows: 1- Set the direction or challenge for the organization. 2- Grasp the current conditions. 3- Establish your next target condition that represents a step toward the direction or challenge. 4- Conduct experiments to achieve that next target condition. When you successfully reach the next target condition, you establish another incremental target condition that represents yet another step toward the direction or challenge for the organization. Here are some additional key points about each step within the four-step scientific pattern:

Step-1: We often face challenges in life. But there’s no need to stress, because you don’t need to get all of the way there right away. A challenge often even gives us a useful sense of direction.

Step-2: It’s important to understand where you currently are before you set your next goal. Don’t pull goals randomly out of the air. A team should feel like its goals are meaningful.

Step-3: Break a big challenge down into smaller goals. Set an easier and closer goal that’s on the way to your challenge. When you get there, then you can set the next goal.

Step-4: You never know in advance exactly how you’ll achieve a goal. We need to test the ideas that we have, and a good way to reach a goal is through rapid experimentation. Try something, see what happens, and then adjust based upon what you learn. To learn from an experiment, you should write down what you expect and what actually happens so you can compare those two things.

So how do traditional Lean tools fit in with Kata and this scientific pattern? The great news is that Lean and Kata play well together. The obstacles that organizations identify through the effective use of the scientific pattern are overcome by the use of traditional Lean tools such as 5S, Kanban, TPM, Standardized Work, and others. However, when the scientific pattern is followed properly, the Lean tools are utilized only when they are needed. This scientific pattern of continuous improvement eliminates “recreational” activities that may, or may not, be an obstacle standing in between you and your challenge or direction. It also shifts an organization from a mindset of “what can we do today” to “what do we need to do today” to get closer to realizing their challenge or direction.

Once this routine is practiced enough, it becomes second nature. When employees at all levels of an organization are performing in this systemic manner, it quickly transforms into a high-performance culture able to tackle any obstacle it encounters. Scientific thinking is a basis for successfully pursuing seemingly unattainable goals in complex systems. This type of thinking also enables teams to make decisions close to the action and maneuver effectively and efficiently. These are all valuable skills in today’s hectic world.

A team that is pursuing continuous improvement will do well with Kata for developing new behaviors, habits, and culture, especially at the beginning of their journey. Kata is an incredibly powerful and transformative approach to daily continuous improvement. TDO’s team is fully certified to help manufacturers learn and implement these skills and develop the necessary coaches to sustain the habits. Reach out today to learn more and schedule a free consultation.


Where Has All the Talent Gone?

By: Pierre Morrisseau, CEO, OneGroup

Organizations around the globe are struggling with a talent shortage. It is a serious topic
for CEOs looking not only to grow their businesses coming out of the pandemic, but to ensure they can continue to offer their customers the highest degree of products and services.

According to a recent ManpowerGroup Talent Shortage survey, globally, 70% of employers report challenges hiring in high-demand areas, particularly in logistics, manufacturing, IT, sales and marketing. Our area of specialty—risk management and insurance—is also facing a talent drain as our most knowledgeable workforce retires and new talent is hard to find.

To manage the talent shortage challenge, organizations need to think differently about how they source, acquire and retain top talent. For both short- and long-term success, we need to continually be building a pipeline of qualified, desirable candidates albeit from a smaller pool, and increasing our agility in matching candidate’s personal goals and speed to hire.

As our firm, like most, was hunkered down as we entered the pandemic, I recognized the need to find innovative ways to source candidates even as they retreated to their homes or moved to new locations. What I came to realize was the paradigm shift in the employer-employee relationship had opened more doors than it closed. We now had ready access to the best talent wherever they wanted to work and in the ways that better fit their lifestyles. The rapid advancement in technologies also gave me access to global resources that could tap into that talent pool.

In a recent conversation with Nick Hoadley, managing director of UK-based Insurance Search, industry recruiters as well as founder and host of the Insurance Coffee House podcast, the #1 Insurance Leadership and Career Development Podcast on iTunes and Spotify, we discussed new ways to find and retain talent.

I asked Nick what he sees as the most important things a candidate wants from working with a company. I asked if it was having job security, great pay or something else that we should be aware of. Nick, through his broad global experience defined today’s younger candidate as caring far less about job security or money. He found that the best candidates were those whose personal values best aligned with the company both in terms of their personal growth and fulfillment, but also in terms of social and community values. He pointed out that today’s generation is more about continually learning and progressing in multiple varied positions. This is the secret sauce to retaining the best talent.
This led me to thinking about how successful startups happen, which in turn led me to letting go of past norms and rethinking how we could be more flexible and innovative when it comes to growing talent. I realized if the typical young person fresh out of college was going to have 6-8 job changes, why couldn’t we create a process that let them do that inside of our company? We have seen great success with encouraging our employees to look around the company and if they think they would like to make a change, to try it. We have had people who were highly analytical but had not realized their passion until they tried their hand in a new area of our business. Furthermore, we continue to evolve our business model to foster “startups” within our larger business. We want our people to experiment and to feel they “own” it, that their investment is valuable and appreciated. A major part of this new thinking is providing flexible rewards that better match an employee’s personal goals. We have seen this not only empowers and invigorates the employee, it brings many new ideas to our firm and is boosting our productivity and profitability.

Another important point made by Nick was employers must continue to build a database of desirable candidates and to invest in building relationships with these candidates. He espouses using social media, advertising, media, website, blogs, and other means to share stories about your company. Storytelling is the best way to share our true values, how we treat each other, our culture and our commitment to community. Through consistent messaging, candidates come to know us and become familiar with us, leaving us to place our full focus on the candidate and what is important to them in their career choice. It allows us to speed their decision-making process, so we are less apt to lose great candidates in this highly competitive environment.

Where has all the talent gone? The answer is talent is all around us and we all must work a little harder and a lot smarter to find, attract and retain them.

I would love to hear what you are doing to build your workforce and always happy to share what we are doing to grow our business.

Your Construction Employers Association of Central New York (CEA CNY)

By: Earl Hall, Executive Director, Syracuse Builders Exchange

From the beginning of the COVID-19 pandemic, the construction industry and the skilled crafts men and women who continued to work have been deemed a key component of New York State’s essential workforce. Contractors and their employees, while not immune from contracting or spreading COVID-19, have been able to complete vital projects, while limiting the spread of COVID-19 by following the latest health and safety recommendations from the New York State Health Department, New York State HERO Act, Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC).

Unfortunately, with the rise of COVID-19 variants, such as Delta, the construction industry is now subject to some of the same rules and regulations from 2020. Construction industry leaders believe that responding to the COVID-19 virus is of critical importance for the health and safety of construction workers throughout New York State, their families, and communities.

As a result, most industry leaders remain committed to encouraging all construction workers to get vaccinated unless there are underlying circumstances that would not permit one to receive the vaccine. Many believe a vaccinated workforce is vital protection for the employee and their fellow workers. A vaccinated workforce is also important for the industry and the contractors who have contracts in place to perform for a General Contractor or project owner.

Penalties for non-performance or an untimely completion of a scope of work is real and can be devastating to any business owner who failed to anticipate labor issues on a particular project.

On September 9, 2021, OSHA announced that it is developing a new workplace safety rule through an Emergency Temporary Standard. This new OSHA requirement covers all employers with federal contracts, as well as those employers with more than 100 employees. Covered employers will have to ensure their workforce is fully vaccinated or require any workers who remain unvaccinated to produce a negative test result on at least a weekly basis before coming to work. Additionally, many project owners, both public and private, are mandating all contractors and employees performing work on their site must be fully vaccinated or produce a negative COVID test result. These requirements are mandatory for all employers regardless of the number of employees employed.

At a time where there remains a significant labor shortage, losing valuable employees from an employer’s workforce due to some or many employees choosing to not being vaccinated poses unimaginable challenges for construction industry employers.
Without workforce compliance, construction industry employees will miss out on valuable work hours, while many employers may choose not to bid projects for fear of not being able to supply the appropriate work force to complete the project on time.

It is anticipated the industry will have a significant increase in building and infrastructure work over the next 5-7 years, in particular upstate New York. This construction work is expected to last for many years, but to bid on and secure these projects will require that all associated with the employer meet the OSHA, New York State and/or project owner rules for mandated vaccination or weekly testing. To ignore these rules means losing out on the billions of dollars in future projects and job opportunities. 

Additionally, ignoring such requirements exposes construction contractors to increased pressure to supply skilled labor to their projects, thus potentially jeopardizing the long-term viability of an employer.

While respecting personal opinions of whether vaccines should be mandated as a condition of employment, one being vaccinated addresses a government identified safety issue for employees and their coworkers while not limiting potential employment opportunities. And, equally as important, not causing undue pressure on employers who may not be able to supply enough skilled labor during an historic labor shortage era.

This is the new reality during the COVID-19 pandemic – governmental and project owner mandates on employees, all while employers endure a labor shortage crisis. The industry cannot afford to lose any more employees from the workforce for any reason.

Contractors rely upon a skilled and available work force. Each employee leaving the construction workforce poses great risks to contractors and project owners alike.

In the end, the COVID-19 vaccine will be the antidote that will attack a pandemic which has limited our freedoms, and may threaten our future.
Regardless of where one’s position is on vaccine mandates, personal freedoms, freedom of choice, etc., construction industry leaders must address this issue as an unvaccinated workforce impacts more than just the unvaccinated employee. It impacts others on the job site and the very contractors who employ them.

During an unprecedented era of significant labor shortages in the construction industry, employers today cannot afford to lose employees from their workforce. The project owners and governmental mandates may get more demanding over the next few months before such may be relaxed in 2022. While learning to live with COVID-19 in our day to day lives will someday be the new norm, it is evident project owners and government officials today are not ready to address this.

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Using Drones and Robots to Improve Health Care

By: Robert J. Corona DO, MBA, CEO, Upstate University Hospital

For several years we have been exploring the use of robots and drones in delivering health care. We created a new department, Autonomous Machines, to focus on this vision and to explore the potential. The use of drones and robots for critical deliveries relieves skilled personnel from chasing supplies or spending time on a task that takes them from the patient’s bedside.

The recent pandemic enlightened everyone in healthcare to the vulnerabilities that these technologies can address, including:

• providing support to address staffing challenges, 

• supporting a robust and resilient supply chain,

• minimizing in-person contact, 

• creating convenience for patients.

Internationally, drones have been used to deliver medical products to people who live in remote areas or where doctors are scarce. Across the U.S., drones are being used — mostly still in trial situations — to model how medical supplies could be distributed safely and securely to people who are in remote settings, or to save time over traditional delivery.

While the numbers would need to be calculated at scale, drone delivery for medicine and lab work is proving to be potentially faster and less costly than drivers for certain applications. The movement of material is currently a very labor-intensive and costly operation, and our hospital has a lot of situations where supplies must be in the right place at the right time. For the delivery of lab samples, we currently use a pneumatic tube system or a car courier, both of which have limitations: the tubes have a set footprint and the drivers have multiple delivery priorities. Drones have the potential to get critical samples to an offsite lab directly, within minutes.

For patients and the public there are additional advantages to develop drone applications. For example, future “hospital at home” patients can have drones deliver needed supplies. For patients who are in quarantine or contagious, drones can deliver medications without face-to-face contact or a trip to the pharmacy. For a patient who has transportation issues or limited mobility, a drone can bring medicine or supplies. For a person suffering a heart attack, a drone can deliver an AED to a bystander before the ambulance arrives.

Within our hospital, our use of new robots has become official and is happening now. We have invested in a fleet of 14 TUGs, an autonomous mobile hauling robot designed specifically for hospitals.

With the current staffing shortage that is likely to last for several years, these robots will allow our staff to work at the top of their skill set as the TUGs take over some of the more routine tasks.

Hospitals across the country are turning to robots to help with staff and nursing shortages and the medical robot market is projected to grow into a $43 billion industry in the next five years. Currently, 37 VA Hospitals use the same TUGs as we do, as does Stanford Hospital and University of California San Francisco Medical Center.

Beginning with the transport of critical drugs from our pharmacy within the hospital to our Upstate Cancer Center, we plan to use the new fleet to also transport medical supplies, drugs, linen, meals, and, potentially, clinical equipment.

The TUG robot is about four feet high and uses lidar, laser, sonar, and infrared sensors to navigate. It can get on and off an elevator. When it arrives at its destination it can let itself in. And each of its seven drawers can only be unlocked at the destination it was programmed for and by the person receiving the delivery.

As a level 1 trauma center, teaching hospital, and research center serving Central New York, Upstate serves a diverse population in both rural and urban settings. Developing more uses of technologies — to use within the hospital and outside it — has great potential, especially to reach patients who are traditionally underserved. We are dedicated to building a platform so that we are better prepared for future events, as well as for the future of healthcare.