Page 11 - Tale of Transformation

Are We at Stage One? The Institutional Stage
If your organization is within the first year of studying culture change you are probably still at the institutional stage, as it represents the more traditional model of nursing home.
A quick and easy way to identify if you are in the Institutional Stage is to ask yourself the following: • Hospital-like rather than Home-like?
• Institutional clutter?
• Wheelchairs congregated around the nurses’ station?
• The Nurses’ Station takes up more common space than the ‘living’ areas - which are in short supply.
• Is the central dining room crowded and loud during meals?
• Is breakfast served at a certain time with the only option being to have a tray delivered to the resident’s room?
In the following pages we will examine each Stage. We will discuss the organizational dynamics and their key attributes and will then explore a number of skills, approaches and attitudes that can be used to drive the change.
Remember these are tools to assist you and your organization on beginning and/or continuing your progress on the road to resident- directed care. It is not a complete list, nor must these ideas be enacted in chronological order.
Study, think, talk, struggle with what you want your organization to become. Figure out some early steps to take, remember to get lots of people involved. Celebrate every step. Think about the elements of home and work together to create them in a thousand ways. Celebrate again.
Review your successes, study your failures, plan for improvements. Grow team, grow community, improve daily life for residents and staff.
The animation highlights the following components often observed in the Institutional Stage:
Centralized nursing units
Central dining room
Sense of security
Feels like a hospital
7:00 a.m. Breakfast Time
Institutional clutter
Nurses station – imposing stature, central command
Parked their wheelchair – where the action is; and near the caregivers
Dining room Hierarchical Departmental silos Resident rooms –
Rotate staff regularly with frequent floating to cover open shifts
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