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CHAPTER 11
FUTURE PULL Understanding the Culture in Culture Change by LaVrene Norton
personally and professionally, advance in their critical thinking skills and careers, and actually enjoy coming to work each day.
Home is like a physical extension of oneself, where we go to retreat, regroup, and find strength to face life’s adversities. It is where we host and nurture loved ones. How can we possibly integrate meaning and purpose into our lives and uphold our commitments to fam- ily, friends, and society without a home? It is in the rethinking of those questions that has compelled Action Pact to develop the Household Model.
To shape their own organization’s vision, long-term care providers must rethink their purpose. They must listen to what their board, staff, the local community, and, most importantly, their residents and residents’ family members hold dear. In the struggle to bring all the divergent perspectives together, a vision begins to emerge that is most appropriate for that particular or- ganization.
Next, the vision must be articulated and broadly shared. Having helped shape the vision, each person understands it and has a stake in it. Once we have clar- ity about where we need to go, we have a natural ten- dency to step on the road and go there. Like cells in a body, we each are programmed to achieve our shared purpose, and gravity pulls the organization toward the vision in a far more powerful way than if we were pushed toward it.
Of course, there will be disagreements and difficul- ties. But our shared understanding of the vision and new skills in communicating and resolving conflicts will moderate those differences. Rather than derail- ing the change process, our differences will ultimately make us stronger.
There is no denying it takes hard work to reach that level of understanding. You will never see the myths and functional realities that keep the organiza- tion bogged down if you do not look beyond the polite platitudes and 85% approval ratings on surveys. We must be patient and resolved in helping people express their deeper, broader desires and in observing what de- fines them as individuals. Take the time to sit in learn- ing circles and ask staff as well as residents, “What does ‘home’ mean to you? How do you want your daily life to be? What daily pleasures did you enjoy at home be- fore you came here? If you could snap your fingers and
have anything you wished, what would it be?” All this becomes the organization’s vision as you learn what is most important to residents and staff.
RESTRUCTURE: SHARED LEADERSHIP AND SELF-LED TEAMS
No matter how clear the vision and strong its pull, we cannot get there via our existing organizational struc- ture and by doing things the way we have always done them. It requires a complete restructuring, a new para- digm crafted on shared leadership and self-led teams.
Self-led teams consist of staff from all disciplines and the residents they serve. Ideally, as they close in on the vision, participating staff are cross-functional and cross-trained to the extent of their licenses and cer- tifications, and together they are responsible for the care of and services for a small group of residents. The residents are the central part of the team and the direc- tors of their own lives. Their needs and wants serve as the guidebook for the team’s work. The self-led team uses this resident direction to create their own mission, then plans and carries out strategies to achieve it.
For example, after moving into households at Per- ham Memorial Hospital and Home in Perham, Min- nesota, residents are going on more outings into the community than ever before. Previously the outings were planned by the activity department for the entire nursing home. Now they are planned by small teams of residents and staff within each household. As a re- sult, the nursing home’s bus is racking up the miles at a much greater rate as households alternate use of it throughout the week (Bowman &
Norton, 2011).
And at the Madlyn and Leonard Abramson Center for Jewish Life in Horsham, Pennsylvania, a resident ac- tion team was convened to redefine menu and recipe selections to meet the specific dining needs of its resi- dents: “In what was later termed as ‘breaking the menu’ nursing and assisted-living residents collaborated, dis- cussed, voted, defined and implemented menu offerings that honor resident preferences while remaining true to kosher dietary standards” (Palmieri, 2008, p. 16).
Self-led teams replace the departmental hierarchy (there will be no need for departments once this re- organization is complete). They become the norm at all stages of the change process—study, planning, de-
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