Page 14 - Tale of Transformation

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
How to Progress
From the Institutional to the Transformational Stage
in Staffing
The primary goal as you move your organization to the transformational stage should be consistent assignments to the same unit, wing, floor or hall.* If you rotate staff regularly there is no opportunity for meaningful relationships between caregivers and residents. Deal with the resistances that staff might present to this idea, but be firm. We must create an opportunity for relationships to flourish, only then can we begin to change our culture. Ideally staff should be assigned to a unit or hall area that is 25 or less residents.
If staff is resistant to the idea what can you do to change their views?
Create a Staffing Team. Don’t be afraid to include one or two people who are resistant. Be sure that there are strong leaders (formal and informal) on the team who deeply want to change the culture for the residents. The team may engage in any or all of the following activities:
1. Study. Read. Talk (phone, e-mail, visit) other facilities that have moved to consistent staffing. Find out how they feel now. Have them share their resistant feelings from before the change. What benefits have the residents experienced. What benefits have staff experienced. How did they move their organization? What scheduling processes and forms are they using?
2. Have team members (or training participants from an in-service) go and talk to residents about staffing. Have them go out immediately (as part of the team meeting or in-service) and talk to an elder and come back in the same session and report on it.
• They might ask:
- Who’s your favorite caregiver and why?
- When you learn that your favorite staff person is working today, how does that make you feel?
- Tell me what makes your favorite staff person a favorite for you?
- Why is it hard for you when someone you don’t know cares for you?
• Use a learning circle to share what people experienced in these interviews – - The Learning Circle Question:
- “What did you ask and what did the elder say? And how did that make you feel?” • Then open up for general discussion on the values of consistent assignments.
* There is some disagreement among culture change educators. Some feel that you must always be assigned to the same 8 or 10 individuals. This author believes that you and others should be assigned to the same small group of residents (preferably under 25) so that you each are acquainted with these residents and they with you; that you are able to rely on each other; that you begin to solve problems together and that team and community begins to flourish.
13