Page 40 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
DEEP ORGANIZATIONAL CHANGE
DEEP ORGANIZATIONAL CHANGE FACILITATES TRUE RESIDENT CHOICE
THE WHY AND THE HOW OF DEEP ORGANIZATIONAL CHANGE
In Culture Change in Nursing Homes: How Far Have We Come?, the authors note: “In general, nursing homes have been most successful at increasing residents’ involvement in decision- making, and there is some evidence that management is accommodating collaborative and decentralized decision-making to empower direct-care workers. However very little organizational redesign has penetrated the field and very few homes have changed their physical environment to support culture change. (Doty, Koren and Sturla, 2008)
Yet organizational design is recognized by leaders in cultural change transformations as key to creating a vibrant meaningful life for residents. In Pursuit of the Sunbeam, authors Shields and Norton, state:
If you have to choose between changing your organization and creating a pretty space, change your organization. One thing worse than traditional nursing home service in a traditionally designed building is a traditional nursing home service in a building designed as a Household Model. It simply doesn’t work.” (Shields and Norton, 2006, p 153)
The importance of organizational redesign is affirmed by Deborah Heath, DON (Clinical Mentor) at Lenawee County Medical Care Facility:
“You can change the physical environment all you want, but if you don’t do all the work ahead of time to change the culture, it’s never going to work. Education, team building and trust, that’s what makes culture change -- not the multi-million dollar renovation.” (Norton, 2008, p 19)
Organizational Design Gives Life to Culture Change, asserts Norton. She unequivocally states, “The Household Model works only if decision-making and all care-related systems are decentralized and brought close to the elders. This means flattening the top-down hierarchy and dispersing departmental staff into the households. Rather than reporting up the chain of command to the Administrator, caregivers in the new culture report to local, self-led work teams and are more directly accountable to those they work with and serve.” Realistically, Norton also acknowledges the challenge, “This shift from top-down decision making to household-based authority and operations is the most wrenching aspect of deep culture change for staff...”
Norton further details the strategies for successful organizational design as:
- Involve everyone in planning: Encourage all stakeholders to contribute questions,
concerns and ideas; strive for 100% involvement.
- Flatten the departmental hierarchy: Decentralize departments; cross-train staff and
permanently assign them to households where they report to the Household Leadership 37