Page 8 - The Phases of Culture Change

data. Comparison of data from the indi- vidual households is important for assessment of both process and out- comes, but introduces the risk of compet- itive challenges to team and neighborli- ness and must be undertaken with prepa- ration and care.
Evaluation is an essential phase, man- dated by the requirements of OBRA “to maintain a quality assessment and quali- ty assurance committee...to identify issues with respect to which quality assessment and assurance activities are necessary”. Whether evaluation of your culture change journey is conducted with the assistance of an external evaluator (as were the three research projects summa- rized below) or internally within the parameters of your organizational Continuous Quality Management process (as the outcomes reported for Northern Pines Communities in Northern Itasca Health Care Center in Bigfork MN in the article following were generated), the results of your evaluation will provide focused direction to assist you in achiev- ing positive outcomes in both quality of care and quality of life for those who live and work in your facility. The positive outcomes demonstrated through a col- laborative evaluation program will build teamwork and provide ongoing opportu- nities for celebration of your journey.
Pioneering evaluation of the culture change process, in 1994, Providence Mount St. Vincent and the University of Washington Research Group, Seattle WA reported in the research project summary on “Outcomes of De-institutionalization Efforts”:
“The accomplishments and products of the research project have far exceeded the original expectations and outlined goals. Preliminary results indicate that residents in the experimental neighbor- hood are more active than they once were and are more active than their counter- parts in other neighborhoods. In addi- tion, the following improvements have been realized: an 11% reduction in rou- tine medication utilization, a 19% decrease in PRN medication, a 40% reduction in the use of medications for the bowel management program, a 100% reduction in routine anti-anxiety medica- tions, an 87% reduction in PRN anti-anx- iety medications, a 100% reduction in anti-psychotic medications, a 100% reduction in sedative hypnotics, a 73% reduction in incident reports, a 7% increase in the self medication program, a 50% increase in resident activity levels, a greater than 100% increase in social interactions, functional decline as mea- sured by MDS and FIM has been reversed, Battelle scores have been low-
ARTICLE REPRINT
ered and level of care is lighter.” Lyngblomsten Care Center and the University of Minnesota Carlson School of Management, Minneapolis, MN reported in March 2000 on the key find- ings of the “Lyngblomsten Service House Demonstration: A New Residential Model for Nursing Home Care”, a two-year
demonstration project.
“The Lyngblomsten Service House demon- stration implements and evaluates a new ser- vice house model of supportive living for nurs- ing home residents. Service houses were orig- inally developed in Sweden...This new resi- dential model of care bridges the gap that cur- rently exists between skilled nursing facilities stressing a medical model of care and assisted living facilities with an emphasis on residen- tial, non-medical services. Our analysis indi- cates that the service house had statistically significant positive impacts on both residents and family caregivers, while the intervention had few impacts on staff. Experimental sub- jects had better outcomes than controls on four variables: resident autonomy, resident satisfaction, family caregiver satisfaction and family caregiver expectations. These prelimi- nary findings are very encouraging, and par- ticularly so, given the small sample size used in the analysis. The experimental design used here can detect only ‘medium’ effect sizes due to small samples. Any statistically significant difference reported here can be interpreted as an outcome where the service house had a very substantial impact. On other measures experimental and control subjects had similar outcomes.”
Texas Long Term Care Institute at Southwest Texas State University, San Marcos, TX reported the results in May, 2000 of a two-year longitudinal study in six Texas nursing homes replicating the conceptual model of The Eden AlternativeTM developed by William Thomas, MD.
“A preliminary data analysis conducted at the midpoint of the study indicated a 33 per- cent reduction in the use of p.r.n. anxiolytics and antidepressants for anxiety and depres- sion, a 44 percent drop in staff absenteeism and a 60 percent reduction of in-house decubi- tus ulcers..
At the closure of the two-year study period, analysis revealed that in-house Stage I – II ulcers decreased by 57%, Stage III – IV ulcers remained stable at a very low rate of .0152. The cumulative rate of bedfast residents decreased by 25 %...An incident subcatego- rized as behavioral in this study indicates a resident-to-resident alterca-tion...These types of incidents decreased by 60%. The cumulative rate for use of restraints decreased by 18 per- cent. The cumulative rate of chair-bound resi- dents increased by 8 percent.
Cumulative outcomes in staffing revealed an overall reduction in absenteeism of
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48%...all participating homes were below the state averages...The cumulative CNA turnover rates for the homes participating in the Texas Project did not decrease over the full two years of the study...These figures are well below the state averages for the corresponding time period...The total number of employee injuries dropped 11 percent...The number of self-directed work teams maintained a steady upward trend. This trend closely parallels trends regarding numbers of people involved in self-scheduling. An overall increase in resi- dent census among the participating homes occurred over the course of the two years...
Job satisfaction surveys were mailed to all employees...Overall scores were equally divid- ed between those that improved and those that declined. The largest increase (29%) in scores was in response to the statement “My work is performed within a social climate which encourages me to be a self-starter; I can be creative in completing my tasks and in work- ing with my team.” Improved scores also occurred with statements regarding pay and benefits (11%), perceived support of supervi- sors (7%), and opportunities to make sugges- tions for improving the services of the nursing home (9%). Questionnaires were mailed to these (responsible parties for the residents) individuals ...As a whole, scores showed that satisfaction increased over the two year peri- od ...Mean scores...were well into the good/excellent range, with no scores falling into the neutral range. The categories that improved the most involved satisfaction with staff, environment changes, and homeness...
After all the data has been collected, all the numbers counted, and all the analysis com- puted, there remains the fact that real human lives are involved. Some things just cannot be quantified. A radiant smile on the face of an elderly woman who lights up in the presence of a cat cannot be counted. The increase in the presence of laughter in the hallways cannot be counted. The witnessing of two hearts touch- ing as an elder and a child share jellybeans cannot be counted. It is this humanness, this intangible feeling that one senses in a true Eden Alternative home, that really matters...
An entire book could be written about the response of staff and elders to changes brought about by the Eden Alternative. Issues will con- tinue to surface within communities where old ways are entrenched and innovative leaders initiate change. Some residents, families, or staff members may not like animals, children, or plants. Some people will resist and resent changes in management styles. Not all resi- dents will appreciate or be overtly influenced by the Eden Alternative.
However, some lives will be changed pro- foundly. For these dear ones, whether staff, visitors, or residents, the meaning added to their lives has no measure.
Life becomes, once again, worth living.” CCNOW!
©2008 Action Pact, Inc. This article is reprinted with permission from Culture Change Now! Magazine, Volume One.
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