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CHAPTER 11
FUTURE PULL Understanding the Culture in Culture Change by LaVrene Norton
REDESIGN: ENVIRONMENTAL CUES
Homes are territories used to establish bound- aries between families, the outside world and us; they guard privacy and the very character of our lives. (Shields & Norton, 2006, p. 165)
We do not have to live in the perfect or most ex- pensive house to be content at home, for a home is much more than a house. True home gives us a sense of privacy, security, well-being, autonomy, freedom, and self. Without this sense, one is homeless. Within our home, no matter how humble, those feelings are reinforced by environmental cues that we have lived with since birth. A closed door, for example, tells us to knock before entering; the aroma of freshly baked bread emanating from the kitchen stimulates our ap- petites; the walls that we ourselves have decorated and the furniture that we have arranged put us at ease.
Redesigning the physical environment to incorpo- rate these cues is another necessary ingredient for real- izing our vision of creating home. If when I walk into a nursing home it resembles the lobby of a physician’s clinic, then I have not created the environmental cues I need to feel at home. If food is already dished up and carted from a centralized kitchen, the experience of home dining—and my appetite—is lost.
There are universally recognized cues in a home, such as the division of space into semipublic, semipri- vate, and private. There also are cues specific to each person, whether it is the color of the tomatoes in the salad, the company with whom you are breaking bread, or the favorite overstuffed chair you sit in to read the morning paper that is pleasurable to you. Both types of cues are the most important aspects of our physi- cal environment, and they can be achieved in either a mansion or a small apartment.
To achieve them, you have to redesign in a way that takes into account everything you have learned about what is important to the individual residents— the things you learn when you ask them, “What does home mean to you? If you could snap your fingers and bring about one thing you would like as part of your daily life, what would that be?”
The physical design is only one part of what makes a home, but it is an important ingredient that intercon-
nects with all the others. Integrating physical design discussions into the transformation of the organiza- tional structure offers an additional opportunity to rec- reate a shared culture. As residents, families, boards, and staff sit down together to work through a facili- tated process with the designers, new avenues to rela- tionships are opened.
Through our Action Pact Development work, we have witnessed deep acknowledgment of the pain of in- stitutional life and new commitments to vision and its requisite efforts. One example is Inglis House, a skilled nursing home for 297 people living with quadriplegia and paraplegia in Philadelphia, Pennsylvania. In the midst of facilitated design discussions, residents atypi- cally youthful and disabled acknowledged that Inglis was a good place to live but said they still felt powerless and lacked the independence they craved. Caregivers, too, said they sometimes felt disrespected, frustrated, and angry in the institutional climate. It was suddenly very clear to the board members and executive leaders that this profound consensus would help catapult them toward their vision. “We realized none of us would choose to live in the current environment,” says Gavin Kerr, president and CEO of Inglis Foundation.
They then talked about what home means to them and how households might look, feel, and function at Inglis. Together with other stakeholders, they ham- mered out project goals and design principles.
REAFFIRM: GROWTH AND LEARNING AS CENTRAL TO THE DAILY LIFE OF THE PEOPLE WE SERVE
Just as continuous growth and learning are central to staff’s change journey, they must also be central to the daily life of the people we serve if we are to provide them with home rather than simply a place to wait to die. Therefore, the vision we create must give residents a continued sense of progress in their lives, a sense of moving toward their own personal meaning and pur- pose.
As with Miss Lib, described earlier in this chapter, their uniqueness and potential to contribute to society must continually be reaffirmed in our hearts and ac- tions and in each resident’s reflection of self. Human interest stories in local newspapers have always high- lighted the few residents who defy the institutions they
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