Page 6 - Tale of Transformation

Organizational Dynamics and Key Attributes
LAVRENE NORTON, MSW Executive Leader, Action Pact, Inc.
As a nursing home moves from stage one toward stage four, decision-making becomes consensus oriented and relies more on group process and resident-direction. Stage four really maximizes resident directed care, so it is truly the stage everybody should strive for in as many ways as they can.
Staff roles and assignments become more permanent and consistent, shifting the focus from tasks to relationships. Ultimately, staff are cross- trained as versatile workers bringing far more face- to- face time to the residents.
Physical environments are made more cozy
and homey by breaking large nursing units into neighborhoods and households, with smaller groups of residents.
Organizational structure is re-invented to support staff in new roles and to position elders as the boss in charge of their own lives. By the time the facility reaches the household stage departments are eliminated and all staff are accountable to their households. Boundaries real and imagined begin to break down.
Finally, leadership, a powerful dynamic to the ongoing success of culture change, becomes more highly skilled, shared and participative.
Each facility begins culture change by focusing on different aspects of its organization. Often the facility is at a more advanced stage on some attributes than on others. A consulting change leader can easily gather enough evidence to understand a facility’s current situation and identify potential areas for growth.
One can view this segment of the video (3 minutes) with a handout of each of the Dynamics listed. Talk about each Dynamic and then choose one or more of the exercises from the paragraphs below.
Decision-Making How do we make decisions now? Exercise: Take the current organization chart and make copies for each participant on the team studying this issue (may be the Steering Team, a Study Team or a Change Agent Team). Have participants pair up and identify decisions that are made at each positional point on the chart. Share some of these decisions into the team through discussion and perhaps jot them on a flip chart or white board where you have drawn the organizational chart. What decisions would be better (in an ideal world) if the were closer to the elder? List these. Are there 3 or 4 that could be worked on now? If so, circle them. Now use weighted voting, providing each team member with 3 votes (using slash marks next to the circled item they would like to start with). After you have added up all the slash marks, choose the item that has been given highest priority with this method. Consider again – could we move this decision closer to the elder? What would have to be
in place to make it happen? Could we set up a small Action Team that could work on this, bringing issues and recommendations to the Steering Team? Establish membership (ask for volunteers within this group and from the staff at large), identify parameters for their team work and determine a time line.
Staffing How can we begin to shift staff focus from tasks to relationships? Study the concept of daily pleasures or simple pleasures. Can we begin to work together to discover residents pleasures and make them happen here?
Physical environments Is our facility homey? What about the physical environment lends itself to pleasant home life? What detracts from the concept of home? What small changes could this team make? What is home to you? (These questions are useful in a group discussion, or as a learning circle question, or as the focus of a Creating Home Team.
Organization Design What functions can be moved closer to the elder? Can we decentralize dining? Or some aspects of dining (continental breakfast on the halls? breakfast clubs, informal dining for special events in the neighborhood?) How can everyone begin to have ‘membership’ in a unit to begin to create neighborhoods?
Leadership Think first about oneself. How can I become more of a leader? (Definition of a leader: one who influences others to do the right thing). Read books on leadership and search websites. Http://pfdf.org offers a great newsletter with contributions from authors and other experts.
You may want to make a handout for your team by
copying this page and cutting and pasting a handout
with space for notes between each of the above paragraphs.
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