Page 24 - Tale of Transformation

ATTRIBUTES STAGE 4
Decision Making
• Group process used to decide issues affecting life • Food choices become resident-directed
• ’Refrigerator rights’ and decides when and what to eat
• More control over daily life
Staffing
• Workers permanently assigned to a household
• Household teams create work schedules
• Staffing mix evolves toward ‘versatile workers’ CNA
certification for all staff becomes vital
Physical Environment
• Renovated into self-contained households • Each has own kitchen
• Personal laundry done within the household • Common dining room and living area
Organizational Structure
• Traditional departments eliminated
• Restructured support services for each household • ‘Nurse leader’ reports to ‘clinical mentor’
• Household coordinator reports to ‘social mentor’
Leadership Practices
• New leadership team emerges
• Conflict management skills operational • Leadership skills are improved
How to Progress
From the Neighborhood to the Household Stage
in Decision Making
While the progress from traditional to transformational to neighborhood stages has been dramatic, nothing compares with the deep changes that take place if you decide to progress to the household stage.
Picture people living at home. In households of 12 – 20 folks centered around a kitchen, dining room and living room. Where every resident is in charge of their life, and consistent and committed staff work in self-led teams to create a resident-directed community.
While much can happen in an advanced neighborhood, it is in the household that all aspects of daily life are within the environs of the household. The skills and knowledge that is needed, the hours and staff that are needed, all the resources for a good daily life are at hand.
Residents are in control – they are the decision-makers, individually related to their personal lives, and as a group in the life of the household.
What is a self-led team? A self-led team is a group of individuals assigned to and committed to carry out designated responsibilities with full accountability. The responsibilities usually include staffing and personnel, nursing care, social services, activities, housekeeping, dietary and often laundry. However, the self-led team is granted these decisions upon obtaining the skills and abilities within the
team. Sometimes this is by assignment (an RN assigned to each house to oversee each resident’s clinical assessment and care); and sometimes this is by development of knowledge and skills (i.e. hiring, disciplining and firing).
Let’s look at hiring to understand the progress a self-led team makes. Initially the team is responsible for self-scheduling. This leads to a clearer understanding of the qualities and competencies needed. As this awareness is coupled with training on hiring including, legally, what not to ask a candidate as well as behavioral interviewing techniques – then the team, with the support of the HR or Administration, is ready to interview for open positions.
Often decision-making in the household begins with the routines of daily living (i.e. who cleans residents rooms and how) and progresses to these more advanced areas that have previously been carried out by an individual department head.
As a result we see a wide variance in the degree of decision-making of self-led teams in organizations practicing the household model.
23