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CHAPTER 11
FUTURE PULL Understanding the Culture in Culture Change by LaVrene Norton
they do not see for themselves the day-to-day func- tions or listen to workers and residents. Thus, the old way of doing things becomes even more entrenched and meaningful change more difficult to achieve. Like drug addicts, we fall back into comfortable old habits even though we know intuitively that they lead to fail- ure and disappointment. Our deep indoctrination to the structures and systems of nursing homes is not so different from addiction in how it pulls us back into ruinous behavior.
WHY DOES NURSING HOME CULTURE NEED TO CHANGE?
All organizations, whether retail, manufactur- ing, or service, need to continue to change and grow to remain vital. Without ever-changing respon- siveness to the customer, the business will simply not sustain itself in the free market. But more than most, the nursing home world needs to change because, put bluntly, it does not satisfy the consumer: the resident. There are limited opportunities for a good daily life there, and one must relinquish control of much that provides one’s sense of personhood. So, of course, no one wants to go to the nursing home. Alternatives to nursing homes are welcome relief to older adults and their families seeking solutions to frailty and dementia. But many have no other option. Therefore, the nurs- ing home itself needs to change. To accomplish that change in vision and in operations, the organization and its culture must be profoundly reinvented.
Make the world a better place by living according to shared values. (Land & Jarman, 1992, p. 176)
THE VISION OF A GOOD DAILY LIFE AND CONTINUING IN THE DRIVER’S SEAT OF ONE’S LIFE
When you, the stakeholders, determine the cul- ture best suited for achieving your purpose and can see it in your mind’s eye, speak it, and write it, it becomes the vision. If you work in long-term care, your purpose is to create a better life for older adults and disabled people. That purpose should sum- mon a vision of a good daily life where residents re- main in the driver’s seat of their lives rather than
at the closet or buffet, choosing the blue sweater over the red, the oatmeal over the eggs. Your vision also must take into account that what constitutes a good daily life varies from one resident to the next as widely as it varies between you and your neighbors and your friends. So the question becomes, how do we create a culture where everyone, including staff, can have a good daily life as they define it?
Can you visualize it happening in a long, crowded hallway with 64 residents orbiting around an enormous nurses’ station? No, neither can we. Keeping everyone safe, properly medicated, fed, and clean under such circumstances is very difficult on all counts, but keep- ing everyone happy and in the driver’s seat is virtually impossible.
It is so much easier to see if you think small, with 24 or fewer residents to a unit, preferably a household, served by permanently assigned, self-led work teams who come to know the wants and needs of each person. When it comes to creating home for residents, small is more efficient. For example, the Household Model can be accomplished without more staff or money when all the variables revealed by an Integrated Prefeasibil- ity AnalysisTM are considered and addressed (Shields, 2008).
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