Page 13 - Tale of Transformation

How to Progress
From the Institutional to the Transformational Stage
in Decision-Making
Form a Culture Change Steering Team: Begin with your existing leadership team (your department directors). Study and learn as quickly as you can. At the point that you are ready to make the commitment that you want to move toward resident-directed care, invite informal leaders to join you. Mark this historical step in some celebratory way. Realize that you, as a team, will steer the organization along this journey.
Membership: How to Choose Membership in the Steering Team. You may be ready to have a resident and/or a resident family member to be part of the team. At least consider it. Choose staff members who demonstrate good judgment, motivation, concern for the residents. Even consider a particularly negative staff member if you have evidence that they always do the right thing for the resident (are resident-centered) and are strong motivators of their peers. Look for representation from different departments and shifts though this should not be your highest priority at the beginning. You will gradually, as you work on High Involvement, see the membership corrections that you need to make. Work to keep your overall team under 16 or 18 – but if you have 12 department heads, you may need to be 20 members strong to have adequate representation from staff.
Early Meeting Focus: Your focus in the first meetings should be the study of what is culture change. This will lead you to the personal and team struggles of articulating and embracing the vision. Seek always to use High Involvement as a strategy and as an ethic. Strategy: the more people are involved, the more they will seek to accomplish the vision. Ethic: it is right and good to be involved in defining our own lives (residents), in the care of our loved one (families) and in the meaning and purpose of our work (employees).
Early Decisions might include:
• What kind of study efforts shall we pursue?
• Visit other facilities in your area that are working on:
-changing their workplace culture
-moving toward resident-centered or resident-directed care -increasing choice through dining and bathing
-renovating into home
• High Involvement of staff, residents, families • How shall we involve others in this study?
• How shall we discuss the findings?
ATTRIBUTES STAGE 2
Decision Making
• Group process is used but its impact is more symbolic than contributory
• Administrator makes final decision on any plans
Staffing
• Defined by the department
• Nursing staff are permanently assigned • Some self scheduling by is allowed
Physical Environment
• Less institutional, more homelike
• Resident rooms , common areas are personalized • Institutional clutter is removed
• Residents have more choices at mealtime
Organizational Design
• Department heads are more involved in daily life with residents
• Department heads participate as members on
leadership teams with other staff on the unit level
Leadership
• Members grow in their ability to involve others in
critical thinking and decision-making
• Team leadership emerges
• Natural leaders emerge
• Preceptor training and leadership training programs are offered
For more information on Study, read Culture Change Now, Volumes I and II (see www.culturechangenow.com)
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