Page 6 - The Phases of Culture Change

persons, long-time staff described how services were provided 20 years ago, while others presented the need for cul- ture change and explained the concept of self-directed work teams.
In the background was a bridge. On one side, a nurse representing the past was dressed in white next to a resident restrained in a wheel chair. Symbolizing the future on the other side of the bridge was a CNA dressed in bright, colorful scrubs reading a book to a resident with a dog sitting nearby. The nurse and CNA held out a vine across the bridge. The vine was cut, signifying that they were letting go of past traditions and heading in a new direction, describes Tom Schumate,
Administrator.
Strategic Change Events also are appropri- ate ways of chris- tening an organi- zation’s new mis- sion or vision statement (Phase II), or marking your nursing home’s commit- ment to under- take the culture change journey (Phase I).
New care plans
may have to be
devised, and resi-
dents may occa-
sionally have to
be moved to
accommodate
remodeling. Plan
for a Moving Day when residents and staff begin living and working in the new household model. Then, plan for another six weeks to three months of adjustments and problem solving to deal with the myriad of unforeseen issues that inevitably arise.
The implementation phase is when all of the innumerable questions that were not dealt with in the design phase will come back to confront you. Following is a sample of decisions that may have to be dealt with.
Terminology:
Language takes awhile to be shaped in a culture change, but it is imperative and should be carefully decided upon. For example, what will you call the small environment of residents who share a common dining room, kitchen and living room? A neighborhood? A community? A household?
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And for that matter, what do you call the people who live there? Elders, resi- dents? Definitely not “patients”. What do you call the people who work there? Employees? Associates? Caregivers? Resident Assistants? Or CEOs as the care- givers at Lakewood Care and Rehab Center of Milwaukee, WI are titled.
Neighborhoods take on a variety of forms in nursing homes. Sometimes hall- ways or wings are renamed neighbor- hoods to make them feel friendlier, but little is actually done to restructure the work environment. Neighborhoods may be more spirit than structure, centered on the sharing of celebrations and fun.
Deep culture change can be about
ship, to become CNA certified?
Nursing: Will RNs be integrated into the household or shall you use a visiting nurse model? Will nursing services be centralized with each nurse having a pri- mary role such as MDS, Infection Control or Clinical Services? Or, will they be decentralized so that each RN has responsibility for each of these roles?
Will LPNs have leadership responsibili- ty? Who will the CNAs and LPNs report to? What does your state’s regulations and Nurse Practice Act require about reporting?
Dietary: Which meals will be prepared in the main kitchen and which in the household? Where will dishes be done? Will you offer 24- hour dining? Open meal times? Will breakfasts be served whenever residents arise? Will break- fasts be made to order? Will menus be restaurant style? Select? Will service be family style, wait service, buffet ser- vice? Will salads and desserts be pre- pared in the house- holds or the main kitchen? Will diets be liberalized? Will you individualize nourishment of choice and fortified foods replace sup- plements? Will snacks be prepared in the households? Will the fellowship of shar- ing food be extended to staff and fami-
lies?
Non-Nursing Care Services: What posi- tions will serve more than one house- hold? Will they be centered in one house- hold, yet be responsible for others? Will you blend and cross-train social service designees and activity aides so that one may be assigned to each household? Will household staff perform assessment and documentation or will it be performed by lead staff.
Ancillary Staff: Will business, office, maintenance and other ancillary staff choose or be assigned to a particular household? What will be their responsi- bilities to the households and in the households?
“I want to show you something...”
Photo by Shari Brown
those things, but it also requires restruc- turing to flatten the organization, and to bring the work stream and decision-mak- ing closer to the resident. Consequently, we have chosen to use household as our description because it implies small, home, autonomy and resident-directed. Whatever words you choose, define them specifically and use them always, dis- couraging the use of the old terminology.
Job Descriptions: Will you implement a universal worker model or blend roles? If you opt for blending roles—for example, combining dietary and housekeeping into a “homemaker” position—what per- centage of time will be devoted to, say, dietary and how much to housekeeping? What other positions will be combined and cross-trained? Will you grandfather in all existing staff and motivate them to become cross-trained? Will you expect or encourage all staff, including your leader-
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©2008 Action Pact, Inc. This article is reprinted with permission from Culture Change Now! Magazine, Volume One.
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