Page 22 - Tale of Transformation

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
How to Progress
From the Transformational to the Neighborhood Stage
in Organizational Structure
Leaders in paid positions of authority, and connected to a neighborhood, have responsibilities to role model, to teach, and to facilitate high involvement in terms of defining home life. It is very beneficial for them to be visibly involved in the neighborhood – for example, stopping in at meal times to assist in whatever way their license and training allows. They should work to get personally acquainted with residents and staff with the goal to develop meaningful relationships.
The Steering Team (as it’s helping shape neighborhoods in the facility) and the neighborhood team (as it works to create a healthy daily living environment) need to begin to examine the key principle underlying restructuring: moving decisions closer to the resident.
The Neighborhoods, as they progress in their efforts, may become sufficiently advanced for the organization to look at the possibility of re-designing positions to create a neighborhood coordinator and a clinical coordinator. New titles and new responsibilities (team coordination, resident and family response, 24-hour accountability) but usually not additional hours. These positions are often .25 to .5 FTE and are carved out of caregiver, social work and/or activities for the neighborhood coordinator, and nursing for the clinical coordinator. Only when it is a direct caregiver filling the role of neighborhood coordinator do we typically see additional hours added – perhaps .25 or .5 FTE.
New and/or blended roles other than the Neighborhood Coordinator and the Clinical Coordinator often include: CNAs cross-training for Activities - create more life in the neighborhood
Activities and Social Work so that each neighborhood could have more time with one person. In this scenario activities staff become trained as social service designees and social worker become certified in activities. Each continues to maintain the oversight of their profession; and coaches each other. This can be particularly beneficial when 2 neighborhoods are located in close proximity and of sufficient size to support 2 persons in this blended role.
Housekeeping and CNA could possibly blend or at least encourage CNAs to help the housekeeper, and where the housekeeper is or is willing to be CNA certified, could help the CNA.
Work toward versatility of staff – 20% of everyone’s time should be outside their job description. But be sure that you still meet your regulatory obligations for direct care.
21