The Phases of Culture Change

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GUIDANCE ARTICLEREPRINT
The Phases of
The Phases of
Culture Change
Culture Change
by LaVrene Norton
Thanks to the trailblazing by Live Oak, The Eden Alternative, the Mount and others, there are lots of examples within the industry today to help guide nursing homes on their cul-
ture change journey. There is
no “cookie-cutter” model that
fits everyone—every home
must decide for itself what
mix of elements will work
best in its own unique envi-
ronment. After all, there is no
place like home.
Nonetheless, there is a replicable process for creating a shared vision and moving forward as an organization to create a more home-like envi- ronment. The process in- cludes six phases: the study circle, the design team, skills assessment and development, team development, imple- mentation and evaluation.
Phase l:
The Study Circle
Everybody on board—Staff and resi- dents were less than receptive to the idea of culture change when it was first pre- sented at Northern Itasca Health Care, a hospital and health care system in Bigfork, MN. “To put it mildly, there was huge opposition,” Says Linda Bump, for- mer Administrator of Northern Pines, the attached nursing home.
For one thing, most of them were unfamiliar with alternatives to the med- ical model of long-term care. Rick Ash, the CEO, suggested that they work to get everybody on board, literally. So they organized 17 bus tours to facilities hun- dreds of miles away to observe other models of care delivery. Board and family members, staff, residents and people from the community—about 150 per- sons—boarded the bus to help determine how to make life better in a home with only 40 residents and in a town with a
total population of 401. After a year of touring and intense study, they were able to define for themselves what would work at Northern Pines and establish a common vision.
The more successful you are in getting
ular area of study. What is learned is brought back and shared at regular meet- ings with the entire, ever-expanding cir- cle.
Get out of your offices and follow the leaders at Providence Mount St. Vincent. Devote a week or two working the floor. If you have certification as a CNA, work as a caregiver. If not, get what in-house training you need to fill open shifts as a house- keeper, dietary aide, or activity aide. Let direct care staff know that you want to learn from them. Journal your experiences and your thoughts each evening. Write a summary for the Study Circle, not just to report back but to help you think through
your learning critically. You’ll want to contact long-term care associa- tions, visit innovative pro- grams at other nursing home sites, read books, surf the internet and attend workshops to investigate con- cepts like person-centered planning, res- ident-directed care, self-directed work teams, The Eden Alternative and other
social and household models.
Don’t restrict your search to nursing
homes, but look at other environments like residential settings for children, the mentally ill and developmentally dis- abled. Study community development and culture change in industries unrelat- ed to group living.
Invite someone from outside of the circle each time you tour another nursing home or undertake a new area of research. This begins the excitement of High Involvement.
Assess Readiness for Change
While you are looking at alternatives outside your organization, look inward to assess its readiness for culture change. This is the time to examine your Quality
Get Ready for a Wild Ride!
the stakeholders in your organization on board and involved, the smoother will be your culture change journey. Ultimately, it should include all of your staff and as many residents, family members and community as you can engage.
The process of high involvement begins with the first step of the journey, the study circle.
Though it can be done in less time, plan to spend up to a year assessing your organization and investigating the types of social models that are working inside and outside the profession. Be thought- ful. Don’t rush to the answer—your goal is deep culture change, not just another quick fix.
Begin by creating a study circle with a small group of leadership and gradually increase its membership to include your board, staff and informal leaders among the residents, families and community. The idea is to break the circle into small- er groups with each assigned to a partic-
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©2008 Action Pact, Inc. This article is reprinted with permission from Culture Change Now! Magazine, Volume One.