Page 2 - The Phases of Culture Change

Indicators (QI) to evaluate current prac- tices, establish baseline data and consider new possibilities for your organization. This baseline data is critical to demon- strate success to staff and others in chal- lenging times during the Journey.
Existing data you will want to review include: Clinical outcomes – review all quality data available (corporate and internal documents); Regulatory compli- ance outcomes; Satisfaction surveys (res- idents, families and staff) and trends of resident census over the last five years; Human Resource data including staff turnover, call-ins, no-shows, sick leave, exit interviews; Safety and risk manage- ment indicators; Financial indicators of census, revenue, level of care, cost per resident day and cost per meal; Re- commendations resulting from strategic planning or marketing studies, consul- tant assessments, organizational surveys.
ARTICLE REPRINT
Gather Other Data as Needed
This may include interviews or sur- veys with staff, residents and family members to learn their expectations and needs. Rather than focusing on quality of services, ask family members and resi- dents their feelings about “home”: What do you think of when you think of home? What does home mean to you? What do you miss doing since you have been liv- ing here? What gave your mother or father pleasure when they lived at home? Questions for staff might focus on their perceptions about their role in care giving, the organization, teamwork, moti-
vation and leadership.
At Lyngblomsten Care Center in St.
Paul, MN, employees were asked to think of themselves as being 85 years old and having lost a spouse or developed disabil- ities. Would they still want to live at home?
Overwhelmingly, says Paul Mikleson, President & CEO, the employees said they wanted to stay at home, but if they needed to move, they wanted to go some- where more like home. “That really helped us lay the ground work for the change from the medical model nursing home...our own employees said they didn’t want to live (in that model).”
Regroup often throughout the study phase, formally or informally, to share what has been learned or gathered. At some point, ask for a commitment. Should we undertake culture change from the medical model to the social model of care? Are we willing to work together to make this happen?
Phase II: The Design Team
The second leg of your culture change journey, the Design Phase, is when you determine what changes are possible given your financial resources and unique organizational characteristics.
Some organizations will want to include new construction or renovation in their plans. Construction creates excitement, organizes all organizational changes within an uncompromising deadline, and allows serious considera- tion of creating households specific to resident care needs, i.e. a special care household for elders with dementia.
Others will not have these options, but can focus solely on organizational changes to empower staff and bring deci- sion-making as close as possible to the residents.
Restructuring for culture change does not have to be costly. In fact, your goal should be to have a neutral impact on your budget over the long haul.
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Though the mix of design components will be different for each nursing home, there are two general principals that should guide your team in determining the changes to be made: small is better and community is vital. You may have a large nursing home, but you can divide the environment so it feels smaller and brings people together. If at all possible, bring the kitchen back into the daily rou- tine of the residents with opportunities to assist with their own breakfast prepara- tion, in a small homey kitchen.
Your design also must retain regulato- ry compliance. Keep state regulators apprised of your design plans and seek their observations and opinions. In some cases, it may be necessary to request waivers. Regulators are generally very supportive of culture change as long as you keep them informed.
The Design Phase may begin while you are still in Phase I and can take up to a year to complete.
Assemble the Design Team
Once again, strive for high involve-
ment so that all stakeholders are repre- sented on the design team, and that staff, residents and families are informed at all times. Involve program and operational experts, and—if renovating or building— architects and construction contractors.
Do not overlook the experts among your employees, elders and family mem- bers. Include representation from the board, auxiliary as well as community members at large. Change the team’s membership as needed and regularly in- volve others on an ad hoc basis so that many people catch the fever of change.
Shape a purpose for the design team. It should reflect the members’ hopes for the project and their vision of the type of care environment they want for their parents and themselves as elders. Be willing to use heart-based words in those descrip- tions—culture change is a move from a medical to a social model of care; from institution to person-centered; from department to resident-directed; even from professionally to personally com- mitted. Encourage them to be specific so that their heart-based desires can gradu- ally be transformed into concrete organi- zational goals.
Don’t worry about action steps initial- ly. They will unfold as your design takes shape. As they do, formalize them by writing them into your goal document. This will help mark your team’s progress.
Review or Develop Mission and Vision Statements
Mission and vision statements can give great impetus to the culture change
Six Phases of Culture Change
Phase l
The Study Circle
This first step requires high involve- ment to assess your organization and investigate social models that are work- ing inside and outside the profession.
Phase II
The Design Team
On the second leg of your culture change journey, you determine what changes are possible given your financial resources and unique organizational characteristics.
Phase III
Skills Assessment
and Development
The key to success is to create a learning climate within the organization where leaders are inspired to help others develop and grow.
Phase IV
Team Development
An ongoing process, this step gives decision-making authority to self-directed work teams that are closest to the elders.
Phase V
Implementation
The final dividing line between the old way and the new. When you cross that line, you want everyone in your organization stepping over together, hand-in-hand.
Phase VI
Evaluation
The final stage when established baseline data for CQI indicators identified in the study circle is compared with new data you have been tracking.
©2008 Action Pact, Inc. This article is reprinted with permission from Culture Change Now! Magazine, Volume One.
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