A post-acute care provider delivers on its promise of excellence.

“In acute care, patient experience is all about making a good first impression in the hospital. In post-acute care, patient experience depends on sustaining a lasting impression,” explains Mary Barks, resident and family relations coordinator at Legacy Living and Rehabilitation Center, a long-term care and short-term rehabilitation facility with 160 beds in Gillette, Wyoming. Legacy is part of the Campbell County Health system that serves diverse patients in rural Wyoming.

Today, overall resident satisfaction at Legacy is at the 98th percentile up from the 30th percentile in July 2015. Here’s how they did it:


“We explain at new employee orientation that we are committed to creating an environment and culture where people can have the best time of their life at this time in their life,” notes Barks. “We tell new employees that if they’re just here for a job, Legacy won’t be a fit for them. We want staff who are here every day to provide the best care possible.”

When it comes to training staff on the use of AIDET® — Studer Group’s communication framework to reduce patient fear and anxiety — the Legacy team is laser focused on demonstrating the care, compassion and safety intent behind it, much more than the actual words. Communicating safety through both words and body language is critical.

In fact, Barks enlisted one of the residents, Rosetta, to share her personal experience with new staff on what it feels like to be truly cared for. Rosetta said, “I can tell what kind of day it will be when I roll over in the morning and see whose name is on my whiteboard…whether it’s someone who really cares about me or someone just going through the motions.” Employees are validated for AIDET during new employee orientation and during annual competencies. AIDET and the use of key words is ever-present in ongoing training and coaching at Legacy..


Accountability starts at the top with Legacy’s Vice President of Continuing Health Services Jonni Belden, who communicates the “why” with a clear vision for the strategic plan as well as specific expectations and resources for the leadership team to meet those goals. Legacy uses Studer Group’s Leader Evaluation Manager® to align and track leadership goals to measure success.

For example, one of Campbell County Health’s strategic goals is to increase resident satisfaction for seven key drivers above the 50th percentile. The vice president of continuing health services (which includes long-term care) and Legacy’s administrative director of nursing also carry that goal. Both leadership and staff evaluations align to that overall goal by measuring things specific to their roles.

Nursing staff have a goal, for example, of achieving the 50th percentile or better for resident ratings for courtesy and respect and coordination of care on satisfaction surveys. Likewise, nutrition supervisors need to rate higher than the 50th percentile for quality of food and dining service.


When Toyota chose Legacy’s nutrition services as a LEAN improvement project in November 2017, resident ratings were low: quality of food was at just the 15th percentile. Eight months later, patients rate quality of food in the 61st percentile (compared to long-term care facilities nationwide), and a new item surveyed reflected the dining experience is at the 68th percentile.

A core team of 12 staff and leaders at Legacy began by measuring the time it took to serve food daily for a month; they set a goal of reducing that time by 47 percent through better coordination and efficiencies.

Now, cold food is cold and hot food is hot, and the bar has been raised on the quality of meals that are served to residents. An unexpected outcome: better team work. Clinical staff now huddles with nutrition services workers before meals so they can communicate about pertinent nutrition issues.

Barks’ top tip for success? Communicate the “why” behind new initiatives consistently for high staff engagement. “When we initially asked leaders to round on staff, they viewed it as a time sink,” says Barks.

“But when we explained that we round because we care about the people who work here…that we want to recognize them for great work and find out what they need to do their jobs better, that made sense to them. We connected the dots by asking, ‘If our mission is to deliver great care to everyone we serve, don’t we need our staff to feel the same thing from us?’”

  • Mary Barks is resident and family relations coordinator with Legacy Living and Rehabilitation Center in Gillette, Wyoming.

    Mary Barks, Legacy Living and Rehabilitation Center

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