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The Official Baldrige Blog

How Long-Term Care Center Grows Its Own Engagement


By 2022, the Bureau of Labor Statistics predicts that in the United States 19.4 percent more registered nurses (RNs) will be needed to fill vacancies to care for our population, including an increasingly aging population. In addition, our health care organizations will need 21.1 percent more nursing assistants, 48.5 percent more home health aides, and 24.8 percent more licensed practical nurses (LPNs) and vocational nurses.

But at Baldrige Award recipient Kindred Nursing and Rehabilitation - Mountain Valley, some registered nurses drive as far as 40 miles to work there—even though it is not the highest paying health care center in the area, and a “grow-your-own” philosophy has resulted in LPNs training to be RNs, nursing aides training to be LPNs, and even some housekeepers training to be nursing aides.

What’s the secret? According to Jodi Hagaman, director of nursing service, speaking to a Baldrige Quest for Excellence© Conference audience, the nursing and rehabilitation center truly values its workforce and creates a culture of safety, empowerment, innovation, excellence, and no fear. It also uses the Baldrige Excellence Framework and the feedback reports received from applying for the Baldrige Award and American Health Care Association (AHCA)/National Center for Assisted Living (NCAL) National Quality Award Program (based on Baldrige) to validate its strengths, and reveal and prioritize its opportunities for improvement.

The 68-bed, skilled nursing facility, located in Kellogg, Idaho, has 90 employees and 33 key volunteers. According to Hagaman, “We are not the highest paying center [in the area] by far, but [nurses] want to work with us because they have researched our culture and our reputation.”

Like the entire health care industry, Hagaman said that Kindred Nursing and Rehabilitation - Mountain Valley is challenged with the retirement of many of its staff members and with recruiting new staff and nurses that want to work in its rural environment in a formerly bustling silver mine town.

She said that the center has been more successful than most in “growing our own through our culture of excellence.” Growing this culture has meant using the Baldrige framework to guide a determination of the drivers of workforce engagement and then to develop strategies with action plans and goals to promote that engagement.

“Our employees want to feel safe. They do not want to work in an environment of blame [where] they would potentially end up spending most of their energy protecting themselves, not doing what is in the best interest of our organization,” she said. “In our center, staff are willing to speak up, to be honest, and have a positive approach.” Communication is our strength; we give our workforce the freedom and responsibility to be efficient, she added.

To accomplish its core competencies of a highly engaged workforce, resident/patient-centered care, and excellent customer service, Kindred Nursing and Rehabilitation - Mountain Valley has developed a Workforce Capability and Capacity System with seven steps. The system is also aligned with its mission, vision, and values and considers succession planning. “When you see things go bad in health care, it’s usually because of turnover,” said Hagaman.


Senior leaders at the center remain intimately involved in operations. Hagaman said that each morning during stand-up meetings, all senior leaders and nursing staff review data and any staffing concerns that may be felt in the next three–five days. Stand-up meetings are also used to discuss referrals and discharges and to ensure the center has appropriately trained staff for patients per day and prior to admission.

The management of changing needs occurs through a Learning and Development System, as well as through a Service Excellence Program, which was created after reading Baldrige opportunity for improvement feedback. Successes are celebrated at any opportunity, Hagaman said; for example, the center recently celebrated its 100 percent deficiency-free survey from the Idaho Department of Health, which requires each nursing and rehabilitation facility in the state to be thoroughly inspected and evaluated in areas such as safety, quality of care, patient rights, food service, nursing care, and administration.

In addition, Hagaman said frank, two-way communication with senior leaders has created an environment of credibility and openness, opening up a “code of trust within the workforce”; such a favorable environment is evident in employee engagement results. “How we create our culture of excellence is through a highly engaged workforce. . . . [We have a] culture of innovation that encourages workforce empowerment with no fear of retaliation,” she added.


About the author

Dawn Bailey

Dawn Bailey is a writer/editor for the Baldrige Program and involved in all aspects of communications, from leading the Baldrige Executive Fellows program to managing the direction of case studies, social media efforts, and assessment teams. She has more than 25 years of experience, 18 years at the Baldrige Program. Her background is in English and journalism, with degrees from the University of Connecticut and an advanced degree from George Mason University.

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Dawn, I think your writing is excellent. I retired from NIST as the resident video producer. Producing Baldrige videos was a labor of love. Keep up the excellent work. I really enjoy reading your articles as they so well done. Ron Meininger
Thanks, Ron!
Dawn, You have clear pictures of how a communication do work in between the employee , customer, and employers. If communication do flow smooth in between employees, and be honest with each other. Throughout a nursing home or group home, will be improve to become excellent. It really doesn't matter if there is no communications with seven steps or nine steps. Because of lack of an appreciation and "thank you." I work in a group home. Our Government do refuses to give "COLA" and that is only raise we receive for our income. In ten years I have received under $3.50. In these five years we received under $2 . Government employees received cost of living and paid live for having a baby. MN Governor said for state employees, what about us? We work caring people with disabled who are mentally and psychologically unstable. Governors don't understand about mental health. It is not only from psychological hospitals patients. It is also, people in group home as well. Nursing home is little different then mental health. People in group home must of residents have been in psychiatric hospitals and been discharged. We have nurses many CNA. Care givers, but, government refused to have group home employees as CNA because it is not nursing home or hospitals. We perform so many or more nursing skills. Out residence have G- tube feeding, psychological residents, dementia, Autism, OCD, schizophrenia effective disorders, and very aggressive behavior. We have been injured by residents, but we did not show to the world how tiring, it can be. We have to administration of individuals medications ordered by doctors as nursing home. The nursing homes get a raise but not group home staff. Staff leave because fast food companies treat and give better starting wage and raises. How are we to keep employees when government treat group home staff in the back burn. Are they waiting them to be institutionalized? Governors are having people from psychiatric hospital to discharge into the communities. Spending extra fiancée for that. How about people in a group home? They are also have mental health conditions as those in psychiatric hospitals. It is like having some plan a activities but only knew how to plan sn activities for who ca talk and have no behaviors. The other who have behavior, put them back in the corner, " this is what I am going to improve and they should live normal life." How about who really needed his help? None. Frustrated with Government ignorance of not understanding group home people are also came from psychiatric home or hospitals.
I have read a multiple excellent steps of improving life of individuals. Aldo, many workable plans. To improve a company or group home, the most important in between employers and employees to have better understanding what it means to serve a customers with excellent service with honesty, dignity and respected. Sonhui
Dawn, It is excellent post. Love reading your post Sonhui

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