Page 4 - The Phases of Culture Change

service house. In this model, LPNs, Trained Medication Aids and CNAs pro- vide not only traditional nursing care (according to the limits of their certifica- tion or license) but also help with meal preparation, laundry, cleaning, activities and social care. Groups of 2-3 generalists work with equal responsibility to serve 4- 5 residents.
Eliminating, merging or “blending” department heads to position them closer to the elders results in better continuity of care and greater familiarity and trust between the elders and staff, says Janet Hagfors, former Service House Administrator.
Flattening the staff hierarchy proved to be a critical turning point at Providence Mount St. Vincent, says Charlene Boyd. A number of middle management positions were eliminated and many of those employees moved into direct service jobs and positions of neighborhood coordina- tors. The result was greater support for workers and better care for residents:
“Managers worked on the floors to teach by example and show employees that it was okay to accept risks: when a resident wanted ice cream in the middle of the night, it was served...”
“Managers worked on the floors to teach by example and show employees that it was okay to accept risks: when a resident wanted to sleep in, he or she could; when a resident wanted ice cream in the middle of the night, it was served... A position called “neighborhood coordi- nator” was created to serve as a “mini administrator” in every neighborhood. Having 24-hours-a-day responsibility, neighborhood coordinators...have full authority over daily operations. They are responsible for staffing, budgets, hiring, and firing—all aspects of management and operations.” (Resident Directed Care, Providence Mt. St. Vincent, www.provi- dence.org/longtermcare/themount).
Non-nursing personnel in household coordinator roles.
Think about the impact of placing recreational therapists, social workers, dietary personnel and other disciplines in coordinator roles where they have com- bined responsibilities. This would enable key skill sets to be maintained, bring department heads closer to the residents and families, and give nurses help with scheduling, resolving family problems and planning for the residents’ needs.
ARTICLE REPRINT
Flexible Staffing Patterns
Consider changing work schedules away from traditional 8-5, Monday – Friday time slots. Be sure that life on the weekends has at least the same chance for pleasures of daily living as weekdays.
Finally, rewrite your organization’s job descriptions and determine the skill lev- els and training that will be required.
Phase III: Skills
Assessment and Development
Lay a solid foundation for culture change by ensuring that everyone in your organization has the necessary skills and attitudes to bring the vision to fruition. The key is to create a learning climate where leaders are inspired to help others develop and grow. This not only gives people the tools to succeed, but helps dis- pel apathy and opposition to change.
Phase III should begin as soon as pos- sible, even before the Design Phase is completed. Include everyone—staff, resi- dents, families, board, volunteers and individuals from the broader communi- ty—in your skills development strategy, and budget for at least one year of train- ing. Also determine how the job respon- sibilities of CNAs and other front line staff will be covered while they are in training sessions.
Consider some means of assessing the skills and interests that already exist in your organization, and begin to define and articulate the competencies that will be needed in the new world you are cre- ating. Assessment tools can be purchased with scoring done in-house, either manu- ally or with computer software, or by off- site services.
You will need to acquire training mate- rials, either from outside consultants or by developing them from resources you may have already. Training for culture change happens in all formats: in class- rooms, small groups and one-on-one using adult education techniques, group dynamics and QI tools.
In implementing The Eden Alternative at Lakeland Continuing Care Center in St. Joseph, MI, leaders try to reach out to all different kinds of learners.
“There is always something tactile, always something auditory...visual... (and) participatory in each of the ways we present. We make all our trainings fun,” says Sandra Place, Administrator.
Devise a means to evaluate the training and measure your organization’s growth in skills development. This will focus everyone on growth - working to con- stantly improve your learning climate.
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Basic Knowledge and Skills Needed
Here are some areas of knowledge and basic skills needed to establish a philosophy of person-centered care and identify institu- tionally mired behavior that needs to change:
Person-centered care philosophy and skills – everyone in the organization needs to willingly struggle with this phi- losophy and ruthlessly review their cur- rent practices. This is often painful and requires sensitivity and support of the developing culture.
Conducting Learning Circles – everyone should have the ability to facilitate learn- ing circles and understand their value in promoting high involvement and prob- lem solving.
Building Teams – Based on the model you have chosen in the Design Phase, knowledge about teams and how to form and participate in them is essential.
Critical Thinking – Skills enabling analy- sis (i.e., rounds, assessment, understand- ing the big picture, cause and effect), good judgment and decision-making are important for all staff. There is a differ- ence between doing what one is told and being empowered to think critically, decide what to do and then take action.
People Skills – Listening, speaking clear- ly, giving and receiving feedback, provid- ing empathic support and constructive criticism, managing and resolving con- flict are all part of a smooth transition to culture change.
Self-aware Leadership Skills – Know the difference between job titles and true leadership. Visioning, acting as a role model, sharing leadership and helping develop others are attributes of real lead- ers.
Creating Learning Climate – Through- out the organization look for and create growth opportunities for elders, families, staff, community.
Group Process – Understand group dynamics. Learn how to facilitate, listen and encourage others to listen, resolve third party conflicts, set agendas and oversee a team leadership model.
A plan for obtaining the knowledge and developing the skills should be created for each individual staff person and consistent- ly adhered to.
©2008 Action Pact, Inc. This article is reprinted with permission from Culture Change Now! Magazine, Volume One.
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