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Long Term Care Culture Change: An Uprising

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  1. Long Term Care Culture Change: An Uprising Debra Fournier, RN-BC, MSB, NHA Vice President Elder Care Services St. Mary’s Health System April 2009

  2. Objectives • Define Culture and Culture Change • Recognize the benefits of embracing the culture change movement • Relate learning to your own work environment • Take away ‘tools you can use’ to assist you on your journey

  3. What is Culture? Culture is a way of life for a group of people—the behaviors, beliefs, values, and symbols that they accept, generally without thinking about them, and that are passed along by communication and imitation from one generation to the next. Hofstede, G (1997). Cultures and Organizations: Software of the Mind. New York: McGraw Hill

  4. Long Term Care: Old Model Institution Centered

  5. Long Term Care: Old Culture • Institutional Model Norms • Daily activity patterned after hospital model of care • Individuals conceived of as sick and in need of care • Nurses Station is the hub of activity • Decisions are made by the nurse and physician • Staff rotate assignments • Survey results determine facility success • Semi-private rooms with shared bathrooms are the norm • Over head paging is an active form of communication • Systems are organized for operational efficiencies

  6. Culture Change: New Model • National Ombudsman Resource Center • “Transform long term care facilities through Person-Directed values and practices where the voices of the individual residents and those closest to them are honored and respected.”

  7. What Does Culture Change Look Like? • Care and resident related activities are directed by the resident. • A living environment is designed to be a home rather than an institution. • Close relationships exist between residents, family members, staff and community. • Work is organized to support and empower all staff to respond to residents’ needs and desires. • Management enables and supports collaborative and decentralized decision-making. • Systematic processes are comprehensive, measurement-based, and are utilized for continuous quality improvement. Commonwealth Fund and CMS Expert panel, January 2006

  8. CMS Artifacts of Culture Change A tool intended to help providers measure their success with implementing culture change in six broad categories. http://siq.air.org/PDF/artifacts-cc.pdf

  9. CMS Artifacts of Culture Change • Care Practices: • Snacks available at all times • Environment: • No traditional nurses station • Family and Community: • Children interact with residents at least twice a week

  10. CMS Artifacts of Culture Change • Leadership • Nursing assistants attend resident care conferences • Work place Practices • Primary assignments • Outcomes • Turnover & Satisfaction

  11. Opportunity for Change • Pioneer Network Reports: • 70% of seriously ill older adults are unwilling to go to a long term care facility • 30% state they would rather die than go into one • Demographic Projections: Aging of the Baby Boomers • Grew up during anti-authority times • Hard working • Believe they can make a difference • Developed new ways of doing business

  12. We did the best we could with what we knew, when we knew better, we did better. Maya Angelou

  13. Way of Inquiry Phase 1: Irritant An annoyance based on a belief, behavior or practice that becomes a tolerated part of the culture. Phase 2: Catalyst An external influence suggesting news of a difference that change is possible and necessary. Phase 3: Awakening A heightened sense of awareness creating a tipping point in one’s personal sense of understanding and responsibility in changing the believe, behavior or practice. Hope Gives rise to growth, action, & our greatest humanity VS. Despair Produces resignation & surrender Phase 4: Action Step Now ready to create action Immobilization Continue the current process TMF Health Quality Institute

  14. Inter-related Areas of Activity resulting in Culture Change Continuous Quality Improvement Person-Centered Focus Worker- Centered Focus HIGH INVOLVEMENT

  15. Person-Centered Focus Old Culture vs. New Culture Institutional driven systems vs. Individual driven systems Solution: Create Systems within which individual preferences is honored and defended. TMF Health Quality Institute

  16. Person-Centered Focus Resident Centered Care Old Culture vs. New Culture • Dignity and Respect • Information Sharing • Participation • Collaboration Institute of Family-Centered Care

  17. Continuous Quality Improvement Old Culture vs. New Culture Authoritarian change process vs. empowered, informed integrated change process. Solution: Seek to create opportunities where individuals are given the opportunity to better the home and their lives by offering their voice to make empowered decisions, take greater responsibility and provide their thoughts and ideas. TMF Health Quality Institute

  18. Continuous Quality Improvement Segregated departments vs. integrated work teams that influence care. Old Culture vs. New Culture Solution: Formulate integrated teams that will guide the organization into the best possible care, work and environmental practice. TMF Health Quality Institute

  19. Worker Centered Focus Old Culture vs. New Culture Exclusive, impersonal work practice vs. inclusive, relationship-based practice. Solution: Hold as paramount an environment where relationships are placed at the forefront of all practice. TMF Health Quality Institute

  20. Beware! The trappings and superficial displays of culture change: Mailboxes and front doors yet no one knocks Fin, fur and feathers Food line buffet Memory boxes

  21. Change Model Knoster/Mosby

  22. Decision Making TestDoes this system or change we are considering…. • …allow for greater power or input to be exercised by the resident or those closest to them? • …heighten the quality of life, experience, or lifestyle of the resident and staff?

  23. National Movement Values and Principles: Relationship building is the fundamental building block of a transformed culture. Loneliness, Helplessness and Boredom account for the for the bulk of suffering among our elders. PHI’s goal is to ensure caring, stable relationships between consumers and workers, so that both may live with dignity, respect, and independence.

  24. “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.” ---Margaret Mead