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AN OVERVIEW OF CULTURE CHANGE Presented by The Tennessee Department of Health Carol Mace, BS July, 2008 Carol.Mace@state.tn.us Definitions of Culture: “Culture is a shared system of values, beliefs, symbols, and practices.”

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An overview of culture change l.jpg
AN OVERVIEW OF CULTURE CHANGE

Presented by

The Tennessee Department of Health

Carol Mace, BS

July, 2008

Carol.Mace@state.tn.us


Definitions of culture l.jpg
Definitions of Culture:

  • “Culture is a shared system of values, beliefs, symbols, and practices.”

  • “Culture is the predominating attitudes, beliefs, values and underlying assumptions that characterize an organization.”

    • Eden Alternative Training Manual


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CULTURE CHANGE ADVOCATES

  • Advocates

    • Eden Alternative

    • Pioneer Network

    • Wellspring

    • TDH, BLHCF, HCF & CMS(!)

  • Models

    • Green House

    • Household


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CULTURE CHANGE

  • Brings the spirit of OBRA '87 fully to life

  • Involves the old “keep them safe and healthy” but adds “happy”

  • Emphasizes the resident by:

    • Not making the resident adapt to the institution, but rather

    • The institution adapts to the resident

  • This is the basis of Resident-Centered Care


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CULTURE CHANGE

De-emphasizes the medical institutional model that is:

  • Based on hospital care

  • Takes over for a totally incapacitated patient

  • Takes full responsibility for patient's health

    Emphasizes the Social Model which assumes:

  • Residents are not patients but individuals

  • Residents are not totally incapacitated

  • Resident can make decisions & choices


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Elements of Culture Change

  • Resident-Centered care

  • Empowerment of residents and staff

  • Consistent assignment

    Encourages Growth for

    • Staff

    • Residents

  • Allows/encourages Choices and Risks

    (to a reasonable degree)

  • Universal Workers


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Emerging Culture Change Trends

  • Private resident rooms and bathrooms

  • Flexible dining hours and menu selections

  • Pets welcomed and encouraged

  • Bathing done in private, warm rooms, or in resident’s room

  • Management that encourages resident & staff input

  • Resident & staff empowerment


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RESIDENT CHOICE

  • Not defined, but encouraged, in the federal regulations

  • Also not defined, but encouraged, in the state regulations


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CC FOCUSES ON

  • Consistent assignments

  • Leadership training for direct care workers

  • Includes direct care workers on management team

  • Self-managed work teams‏

  • Staff Self-Scheduling‏

  • Enhanced dining experience

  • Breaking down large units into small


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CC LIMITATION...

  • Culture change can only succeed if the culture surrounding places of LTC also changes. This requires engaging:

    • Management & Direct Care Staff

    • Families

    • Medical Professionals

    • Elders


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CC TRICKLE DOWN THEORY

  • As administration treats management staff, so shall management staff treat frontline staff

  • As management staff treats frontline staff, so shall frontline staff treat residents


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BENEFITS OF CULTURE CHANGE

  • Reduced Staff Turnover

  • Reduced Use of Psychotropic Meds.

  • Reduced Use of Restraints

  • Reduced Training Costs

  • Reduction in Resident Behaviors

  • Increased Census

  • Increased Resident & Family Satisfaction


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NATIONAL CC INITIATIVES

  • CMS Liaison in each CMS Regional Office

  • Advancing Excellence in NH Campaign

    • QIO’s, AHCA, AHSA, SSA

  • CMS-Pioneer Network Conferences

    • AIA Guidelines Re-write

    • NFPA Codes Re-write

    • Requested list of changes to CMS LTC rules

  • RWJ Grant to NCB Capital for Green House Replication Initiative Project


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TENN. CC INITIATIVES

  • LTC Community Choices Act of 2008, PC1190

  • Advancing Excellence in NH State Campaign

    • THCA, TNAHSA, THA, TDH, COAD, TNCARE, NH, Consumers

  • BLHCF Grants first AIA waivers 7/9/08 for home-like duplexes replacement NH

  • TN Eden Alternative Coalition

    • Sponsors CEA & Other Trainings, Research

    • Quarterly Meetings

    • Culture Change Lending Library, free Eden Handbooks

  • 2 Green House Replication Initiative Projects

    • Ave Maria, Memphis

    • Jefferson Co. NH, Jefferson City


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IMPLEMENTING CC

Don’t be afraid to implement changes to enhance resident’s lives! Just remember to:

  • Communicate, communicate, communicate with:

    • SSA RO on planned changes

    • SSA FS & plans review staff on renovations

    • Families, residents & staff

  • Document, document, document in:

    • Resident’s record (choices, personalized activities, etc.)

    • Facility policies & procedures (dining, activities, menus, pets, etc.)

  • And help them dance!


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CULTURE CHANGE WEBSITES

TN DOH Eden Alternative Grant Assistance Program:

http://health.state.tn.us/HCF/eden.htm

Eden Green House Replication Initiative Project: 

http://www.ncbcapitalimpact.org/default.aspx?id=146

Eden Alternative Home Office:

http://www.edenalt.org/

TN Eden Alternative Coalition:

http://www.tneden.org/

Pioneer Network:

http://www.pioneernetwork.net/

Advancing Excellence in NH Campaign:

http://www.nhqualitycampaign.org/

CMS Survey & Certification Online Courses:

http://cms.internetstreaming.com/nologin/


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THE END!

  • QUESTIONS?

  • COMMENTS?

  • CC ACTIVITIES TO SHARE?