Page 33 - Tale of Transformation

Envisioning the Future
“I’d rather die than live in a nursing home.”
Let’s change that sentiment uttered by so many at the slightest mention of the words “nursing home.” As we know, culture change is a journey: there are benchmarks, steps backward, and steps forward. People contribute individual skills, talents, and ideas, while teams, communities, and organizations work together to get there. (Misiorski, 2004).
Artifacts of Culture Change Development
The movement sweeping the country called culture change represents serious reform of institutional culture to one that gives voice like never before to the people living and working in such a culture. Pioneering leaders have adopted principles and worked toward making actual, concrete changes to their policies and practices such as how they manage staff, how they honor those in their care, and environmental changes to create home. Culture change is not a singular item, it is multifaceted with homes deciding to make changes that may be different from other homes. The beauty of becoming more person-centered and less institutional is that it is based on what the persons living and working in each home decide.
Culture is comprised of beliefs and values, basic underlying assumptions, and behaviors and artifacts. In any culture, artifacts are the physical evidences that can be readily seen by an observer: structures for living and working, objects for daily use, rituals and activities, dress, and ways in which people interact (Shein, 1992). The presence of artifacts distinguishes facilities that have progressed in making changes from those that are still in the thinking stages and those that have not begun the culture change journey.
Turnover is perhaps the most researched outcome of culture change. Results thus far, reported by both researchers and providers, is that once culture change is underway and a home has made changes to how it operates, great declines in turnover take place. Homes that have been innovators for many years find that not only is their turnover relatively low, but that the longevity of their nursing staff and their administrator is quite long compared to other homes. (Refer to Outcomes section of this report.)
Recent research shows that implementing culture changes can also affect turnover within a short amount of time. 51 homes took part in the QIO Improving Nursing Home Culture pilot study from August 2004 to October 2005. The baseline quarter of August-October 2004 was compared with the re-measurement quarter of March-May 2005. The homes experienced a 5.6% decline in their annualized turnover rates from 55.2% to 49.6%. Besides showing that turnover can be affected in such a short period of time, the pilot “has proven that transformational changes within nursing homes that will positively affect the lives of residents and staff can take place in a very short span of time (Quality Partners of RI, 2005).”
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