Page 46 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
WHAT MAKES NEW IDEAS DIFFICULT
A note of limitation: Recommendations in the following pages are offered from the practical perspective of providers’ experiences and are not intended to meet the rigors of the more professional policy, research and educator perspectives. They are offered in the sincere hope that they may provide useful insight into the current perceived and real barriers met by providers working to honor the rights of and create home for our elders, and as a result, assist all in working together, from each of our personal and professional
perspectives, toward these lofty OBRA ’87 goals.
HISTORICAL BARRIERS
In Culture Change in nursing homes: How far have we come? Findings from the Commonwealth Fund 2007 National Survey of Nursing Homes, the authors note that cost, regulation and staff resistance are often cited as barriers that must be addressed or dispelled before more nursing homes adopt the principles of culture change and resident-directed care. Then they offer observations and evidence that these traditional barriers are diminishing in importance.
Cost: “As in any new venture, there is an upfront investment but increasing evidence shows that considerable saving accrue as a result of culture change in terms of reduced staff turnover, decreased reliance on agency staff, and increased revenues from high occupancy rates...”
Regulation: “CMS...has been in the forefront of the movement to promote culture change. Likewise, the Quality Improvement Organizations...provide technical assistance to nursing homes. Part of their work includes measuring several performance areas that reflect a culture change philosophy.”
Staff Resistance: “...Among nursing homes that have embraced culture change, staff members say that once they have experienced working in a culture change nursing home, they could never go back to the old way.” (Doty, Koren, Sturla 2008)
Their conclusions are supported by a growing body of information derived from the observed success of early culture change adopters and from customer and workforce satisfaction surveys. In Elements of a Quality Job for Caregivers – Key Research Findings, the Paraprofessional Healthcare Institute (PHI) describes nine essential elements that comprise a quality job and notes that culture change initiatives are a recognized approach in three of them. “Consistent scheduling” is noted as an example of staffing and scheduling practices shown to improve the stability of hours and income and achieve balanced workloads. “Combining clinical and interpersonal education with organizational culture change initiatives and/or payment incentives” is linked to positive impact on workforce stability and on care quality. “A culture that promotes worker’s participation in workplace organization and care planning” is linked to better care quality and increased workforce stability. In addition, a “coaching and mentoring approach to
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