Page 7 - The Phases of Culture Change

Household Coordinators: Will you have household coordinator positions, and if so, will they be open to non-nurses in order to strengthen the social aspects of daily life? Will household coordinators perform other roles as well? If so, how much of their time will be devoted to coordinating? Who will report to whom?
Department Directors: What will hap- pen to the traditional department direc- tor position? Will some be blended into the household coordinator role while maintaining some responsibilities as director? For example, an activities director may become a household coor- dinator, but contin-
ue to teach, mentor and monitor activity workers in other households.
We have seen busi- ness managers and directors of activi- ties, social services, dietary and human resources in these shared roles.
Depending upon the size of the orga- nization, there probably is not a director level posi- tion that could not be blended with the household coordi- nator role.
Phase VI:
Evaluation
The final stage of culture change, the Evaluation Phase, returns you to the very beginning of your journey, the Study Circle. That was when you established baseline data for all of your Continuous Quality Improvement indicators and against which you now compare new data that you have been tracking in clin- ical outcomes, infection control, cus- tomer satisfaction, human resources, regulatory compliance, safety/risk man- agement and financial management indi- cators. Data you will want to include in your Continuous Quality Improvement program monitoring are:
Clinical outcomes for pressure sores, weight loss, infection control, medica- tion errors and rates for use of nine or more medications, laxatives, nutritional supplements, little or no activity and anti-anxiety and hypnotic medication and other MDS, census and roster data; infection control measures of attack
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rates; regulatory compliance outcomes including survey deficiencies by number and scope, OSHA complaints and defi- ciencies, OHFC complaints, JCAHO sur- veys, life safety code surveys; Satisfaction surveys of residents, fami- lies and staff including the traditional assessment of quality of care and service, with additional indicators of quality of life for residents and staff. These quality of life indicators may include considera- tions of dignity, safety and security, rela- tionships, staff, meaningful activity, responsiveness and privacy; Human resource indicators of staffing, open FTEs, turnover, retention, education, satisfaction, absenteeism-including call-
holds, you are diverting from the tradi- tional medical model nursing home structure where the major (and some- times sole) responsibility falls on the Director of Nursing or a designated assis- tant. In the neighborhood model, every- one shares in the responsibility for all the outcomes of living and working together. Everyone will, in some way, play an important role in the previously nursing focused indicators like pressure sores, infections, weight loss, range of motion and the like. This new sharing of respon- sibility brings with it an automatic addi- tional accountability to all staff for out- comes, but also carries the obligation to the organization to ensure that all staff
“I grew this.”
Photo by Shari Brown
are adequately educated and continually sup- ported in their new responsibili- ties.
One pioneer- ing example comes from Wellspring Innovative Solutions, Inc., a Wisconsin alliance of 11 nursing homes that developed a quality improve- ment model incorporating the shared ser- vices of a geri- atric nurse prati- tion-er who leads an extensive training program for interdiscipli-
ins, sick leave and no-shows, workers compensation; Safety and risk manage- ment indicators of safety committee processes, incident and accident reports; Financial indicators of census, revenue, level of care, cost per resident day, cost per meal; Organizational recommenda- tions from strategic planning docu- ments, marketing studies, corporate and internal documents.
Anticipate, ultimately, a positive response in all indicators of quality from your commitment to culture change and make a priority commitment to correct and improve any deficient areas as they are identified. There is no compromise on quality inherent in this journey.
This is a perfect time to consider strengthening the interdisciplinary nature of your organization’s quality improvement process. Remember that as you flatten the organization hierarchy, empower staff and break into house-
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nary “care resource teams”, applying national recognized clinical guidelines, involving all departments in member facilities and empowering all staff to review performance data and make deci- sions that affect quality of care and the work environment. Preliminary empiri- cal evidence suggests that the Wellspring model may be producing improvements in quality as it addresses the need for improved clinical practices as well as a strengthened frontline workforce. (Web site address: www.wellspringis.org)
In the neighborhood model, the RAI documentation process that generates much of the clinical data monitored for quality outcomes may be changed to reflect nursing and support staff assess- ment and documentation closest to the resident. The involvement of new staff in these processes will also require addi- tional organizational commitment to training and to monitoring accuracy of
article is reprinted with permission from Culture Change Now! Magazine, Volume One.
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