Page 28 - 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 Leadership
A new leadership team emerges. Accountability is through the households to the Administrator and Director of Nursing, rather than through department directors. Departments are eliminated and the professional leadership has made its way into the households where leaders continue to provide services of their profession, as well as influence and grow the knowledge within the household.
For example, the leader who had been the Activities Director may now be a household coordinator, responsible .5 FTE for coordinating the life of the house, and .5 FTE monitoring and mentoring other households in Activities.
Often there are numerous ARENAS FOR LEADERSHIP:
Household Leadership Team. This team of 4 – 6 people in each household may reflect different functions and shifts. There are no requirements of license, degree or certification. Demonstration of a caring approach, a positive attitude and a desire and willingness to lead often positions the individual as a leader in the eyes of his/her peers. They may be chosen by appointment or by consensus and are often frontline staff as well as the Nurse Leader and Household Coordinator. This team works to represent the staff of the household. They usually meet weekly and address the everyday challenges of the household. This team makes it possible for anyone who wants to grow, to participate as a leader.
These positions have responsibility in the house, but also have leadership responsibilities across the facility – coming together in planning, assisting each other as good neighbors, covering a facility-wide
schedule and role-modeling wherever they are.
Professional leaders in the organization may include social work, activities, nursing, therapies. Their leadership includes the responsibilities to bring the knowledge and skills of their discipline to practice in the household. But they have an additional responsibility which is an expectation that goes with their job description and pay – that is to serve as a formal leader, to be a guide or mentor, and to grow leadership and skills in others.
Leadership or Neighborhood Council. Many facilities establish a council to replace the department director meeting. This is a coordinating group that brings together the needs of the households and services for discussion, communication, consensus decision- making, and updates on knowledge.
Functional Leadership: Each discipline or area of function also has leadership. Usually designated in some fashion, this person is responsible for the expertise and development of their discipline.
Nurse Leader and Household Coordinator
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