Page 18 - 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
17
How to Progress
From the Institutional to the Transformational Stage
in Leadership
Grow leadership everywhere. Study and implement deep process changes that are centered in Shared Leadership. Bring formal and informal leadership together first to learn new leadership skills together and then to work on your culture change efforts. This is sometimes the most challenging part of changing your culture to resident centered.
While many Administrators and department head leaders are willing to involve informal leaders in team efforts, and are often delighted by the very effective way that front line staff can participate and contribute – it remains a mystery and a struggle as to how to involve them because of time and staffing issues. Be prepared to take this on as your first and most important challenge to High Involvement and to Shared Leadership. You can not be successful if you can not work this through.
What are the signs and symptoms of the problem? Caregivers and other frontline staff do not show up for team meetings. You find yourself a little frustrated with them. They knew the time of the meeting; they had agreed to do this; they can surely get off the floor for a few minutes; they can come in a little early for their shift, etc. You find yourself tiring of their excuses. Time to take the big leap! The leap that needs to be taken is the realization that this is not a personal performance problem, not a sign that ‘they don’t care’ – but merely a reflection of the institutional nature of your organizational structure. Not the person but the system!
Your solutions should include frontline staff, but must include the people with ‘check-writing’ authority. In other words, this problem can only be adequately resolved if you’re willing to consider solutions that cost a bit in staff hours. Perhaps your High Involvement Team should take it on as their first goal. Find a set of solutions that can be applied to encourage informal leaders to participate.
Solutions that other teams have discovered:
• All culture change meetings are held on Tuesdays. Every Tuesday we staff an additional caregiver who is able to go unit to unit to cover for staff in meetings.
• Transformation meetings are held at shift change. Caregivers and dietary folks come early and/or stay over. It doesn’t even have to be the person who attends the meeting, but could be someone else who’s willing to stay over and cover for someone from second shift to attend the meeting.
• Dedicated department heads and other leadership use or increase their skills to care for residents directly – CNA training and feeding assistant training – and take the caregiver’s place while the meeting is going on.
• A Department head holds a resident meeting and/or activity with as many residents as possible from that hallway so the caregivers who are not attending the meeting will not have such a heavy load.
• Meetings are held in the hall or near the wing where the member who is a caregiver works. Other staff try to cover but she’s available if needed.
• Frontline staff is asked to come on their days off to attend meetings but are provided a differential for the hours of attendance. This type of incentive should be made known before attendees are recruited for various teams.
As staff grow in their abilities to lead, provide lots of training. And be sure that the training is available for managers and non-managers to sit together and learn.
Please e-mail me at lavrene@actionpact.com with other successes you have experienced. We will continue to collect these ideas and pass them on. This is truly one of the more serious obstacles in early stages of culture change efforts.