Page 16 - Tale of Transformation

How to Progress
From the Institutional to the Transformational Stage
in Organizational Design
The key organizational design focus in this phase is High Involvement. Study the concept as a team. Read about it in the nursing home culture change literature, but read about it in organizational development literature as well. It is often called ‘high involvement’ or ‘universal participation’ in the general literature. Edward G. Deming, father of the Quality Improvement movement said that you could not succeed in a deep change without everyone participating. The wonderful truth is that in the world of long term care ‘everyone’ should include all stakeholders - residents and families as well as all of staff. The side benefit of this is the creation of community as you get everyone involved. And that makes for a better place for residents to live!
Form a Steering Team (refer to decision-making and leadership categories for more information).
Be sure that everything you do involves people in a non-traditional way – that is, as ‘people’ rather than ‘positions’.
your roles as managers and supervisors – and work together as a team.
Step out of
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
Plan on continuing to work hard – but now you’re working hard at creating a climate of participation. An administrator came up to speak to me after a one-hour presentation. She told me that it was all so easy – doing this culture change thing. She just stopped making decisions and told the teams it was their job to do it all from now on. I tried to caution her, but I often wonder what happened to that facility. Remember, this is not about giving up responsibility but about engaging others in embracing responsibility.
Department heads and other managers participate on unit teams. Once you have engaged more non-traditional informal leaders in your Leadership Team (steering team) look for ways to involve your formal leaders (managers) in relationships with residents and frontline staff. This may be by assigning formal leaders to become members on hall or floor teams. Establishing ‘buddies’ to explore daily pleasures of residents and then bring those pleasures (and the residents) to a hall team meeting is a great way to begin breaking through the barriers of position, shift, and department. This naturally results in the team working together to bring about satisfying moments of pleasure for the residents each day.
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