Page 19 - Tale of Transformation

How to Progress
From the Transformational to the Neighborhood Stage
in Decision-Making
Short but regular team meetings (on a weekly or every other week basis) provide the opportunity to begin, over time to address issues that are truly neighborhood, culture, and work flow issues. These are ideal for early decisions.
Address issues of identity, membership, and inclusion early in the team’s formation. These decisions shall be made by the team and will include naming the neighborhood, determining how to recruit and engage folks from other departments into the ‘extended family’ of the neighborhood; and how to get everyone (all shifts, residents, families, departments) involved.
Look toward the future as the team progresses beyond these early issues. It needs to ask the following questions periodically and get everyone’s input:
Where are we now? Do residents direct their own lives? Do they meet with staff in these very meetings? (We recommend that at least one meeting a month includes residents.)
Make a list of decisions that direct our daily work life on a flip chart. These may include: • Daily care assignments
• Residents rising – when they want to
• Daily activities with individual residents
• Group activities in our neighborhood
• Snacks available and method of distribution • Hydration activities
• Bath schedules
Can we have more say in any of these decisions? Who would we have to talk to, in order to address this?
Example: How resident rooms are assigned for cleaning to the housekeepers. Perhaps they currently have one housekeeper doing bathrooms and trash, and another cleaning the rooms. But this creates a feel of ‘institution’ by feeling more rushed, and limited in what the housekeeper can do. Can the team decide that each housekeeper could do one of the halls in the neighborhood, doing the overall cleaning as well as doing the trash and bathrooms? Who would we talk to, in order to give our team the ability to study this issue, to determine the times involved, to talk with the housekeepers about the specifics (who are here in our team and say they would love it).
ATTRIBUTES STAGE 3
Decision-Making
• Learning circles and other group processes
encourage real input – it’s no longer symbolic
• Daily life decisions determined by group process
Staffing
• Staff are permanently assigned and rarely float across neighborhoods
• Work in self-directed teams lead by coordinator
• The administrator, DON and Dept. heads may work
evenings shifts and/or weekends
• Staffing schedules are more flexible
Physical Environment
• Decentralized dining offered without full kitchen • Some food prep is done closer to the residents • Nursing stations and med carts are still used but
often less intrusive and more home compatible
Organizational Structure
• Neighborhood coordinator position is formalized
and added to the worker’s primary duties on the
neighborhood team
• Org chart emphasis is resident-centered
• Neighborhoods are often named by the people
who live and work within to create identity and a sense of community
Leadership practices
• Leadership becomes more decentralized
• Many decisions made by consensus in
neighborhood teams
• Leaders develop skills in conflict management
18