Page 42 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
DEEP ORGANIZATIONAL CHANGE
- Individual household budgets encourage responsible stewardship as money is spent on the household in ways that are most appreciated and useful and at the same time lessen waste.” (Norton, 2008, p 6)
Deep organizational change facilitates true resident choice in dining by honoring resident- directed care, putting the resident in charge, and putting the decisions closest to the resident with the hands-on caregiver when the resident is not able to express choices independently. Residents who cannot verbally express preferences express them clearly, food by food, to those assisting them in dining!
As a practical matter, deep organizational change does eliminate “it’s not my job,” as noted by Norton. It also works to eliminate the negativity of “we/they” in an organization, and, as Shields noted In Pursuit of the Sunbeam, “It’s not that ‘they’ can’t do it. It’s really that ‘we’ can’t. The truth is, when ‘we’ and ‘they’ become ‘us’ and align around a common purpose, great things happen...a self-led team broke through two barriers that 99.99 percent of health care executives in America couldn’t pull off.” (Shields and Norton, 2006, p 61)
Deep organizational change creates “places where elders feel at home, family members enjoy visiting, staff are respected, listened to and appreciated, the care is good, life is worth living, and legal action is unnecessary,” according to the vision expressed by Dr. Bill Thomas in Evolution of Eden. (Thomas, 2003)
DINING SYSTEM CHANGES IN DEEP ORGANIZATIONAL REDESIGN
While many of the policies, procedures, protocols and systems of dining in a traditional facility are continued in deep culture change, the context of these systems changes dramatically from institution to resident-directed and to home. These deep dining system changes are successful when guided by the organization’s vision and values, framed by the principals of the Pioneer Network, the Eden Alternative and Shields and Norton’s Essential Elements of the Household. (See Appendix E) One example of deep system change is detailed in the Household Matters Toolkit. This system transformation is achievable but is complex as the implementation of new dining systems interfaces with systems in almost all other departments. In Pursuit of the Sunbeam (Chapter Nine, “Organizational Transformation”) details many of these complexities, at the same time noting, “We often start with dietary because it allows for incremental shifts in resident service that often lead to highly visible and positive results and creates those ‘ah-ha’ moments that energize teams and the process of change. There are seemingly endless opportunities for change in dietary, and each requires the development of a system to support it.” (Shields and Norton, 2006, p 141)
Deep organizational change and moving away from the old ways of directing individuals is critical in achieving an environment where resident choice and excellence in dining is possible. With eight commercial kitchens at Pennybyrn at Maryfield, the pride that each of our lead homemakers in each house takes in their home and their kitchen is the driving force for all that the household teams have accomplished. Flexibility and the ability to deliver an exceptional dining experience while meeting all regulations is dependent on knowledgeable and empowered staff and leaders. Each house has a lead homemaker . . . (all) from various backgrounds and (who) worked together to all become certified dietary
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