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Organizational Transformation 143 the entire household team. It’s everybody’s job. Each self-led team will self
organize around expected standards and accountabilities.
Nursing
Yes, according to the services you offer and the regulations you honor, this is still a nursing home, and skilled at that. So we must also introduce the creation of home and the honoring of resident choice into the development of new nursing systems. Frequently the most difficult for staff to conceptualize, the development of these system changes will require the most skill in leading change in your organizational journey.
First, guided by the Essential Elements offered in Chapter Four, you develop new patterns for delivering nursing care, and reconsider the roles of all nursing staff. Develop systems to define the registered and licensed nurses’ role in your households. Will they be full-time members of the household, assuming a great variety of roles in that household? Or, will they be neighborhood nurses, serving two or even three neighboring households in a less broad nursing role? In the formative stages of household model discovery, some organizations have chosen to have registered nurses act as visiting nurses entering the households only for defined nursing tasks at defined times of the day, just like home health services are delivered in our own communities today. We, the authors, do not recommend this approach. Remember the importance of keeping services close to the resident, and also of the myriad of opportunities for registered and licensed nurses to contribute their talents to the residents and the household team.
Key Nursing Systems Change
After you develop the systems for who does what in nursing, you need to develop the processes to honor individualized care in the delivery of nursing services. The hallmark systems changes in nursing revolve around the med pass and the MDS (Minimum Data Set) documentation process.
The options for individualizing med pass in ways that honor home and resident choice are endless, and they are often one of the most difficult changes to conceptualize. Meds, and sometimes even medical records can be stored inside each resident’s room in properly secured drawers or cubbies. They can be stored in a central med room and distributed individually to each resident wherever they may be at the moment using a small basket or tray. They may also be stored in a stationary cabinet close to several residents’ rooms, designed to look like household furniture but