1

Jumpstart Your Culture Change Journey

Jumpstart Your Culture Change Journeywith the Dallas – Fort Worth Coalition

2

What is Culture and Why Change?

Melody Malone, PT

Quality Improvement Consultant

TMF Health Quality Institute

This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-TX-NHQI-07-57

3

Disclosures

TMF Health Quality Institute has no relevant financial relationships to disclose

TMF Health Quality Institute does not accept commercial support from other organizations or companies for the development of Continuing Medical Education activities

4

Objectives

At the completion of this conference the participant will be able to:– Define culture change in long-term care.

– Describe the process for culture change in long-term care.

– Implement team building strategies that will assist in implementing a QI process to test changes that would improve the work environment and culture of the nursing home.

5

Daily Pleasures

What are those items, habits or events that on a daily basis provide you with comfort, joy, a sense of identity, security or delight?

6

Daily Pleasures What are some of yours?

7

Daily Pleasures How would you feel if you could

no longer experience that daily pleasure?

Do you think our residents are missing any of their daily pleasures?

8

Morning Routine

9

Underlying Question

How do we organize our systems around the people who live & work in nursing homes to bring quality of life?

10

Resident Centered

Care

Culture Change Resi

dent Dire

cted

The Culture Change Journey

11

What is Culture Change?

Culture change in long-term care is an ongoing transformation in the physical, organizational and psycho-social-spiritual environments that is based on person-centered values. Culture change restores control to elders and those who

work closest with them. – Pioneer Network

12

The Culture Change Journey

JOURNEY

Institutional Care• Task oriented• Schedule driven• Medical model driven

Person Centered Care• Resident choice in planning care.• Shows movement in culture change journey.

Person Directed Care• Resident choice directs lifestyle, care, systems, daily routine.• Staff choice influences the way the home is run.

13

14

According to a national study . . .

70% of seriously ill older adults are unwilling to go into a long-term care facility.

30% state that they would rather die than go into one.

Elders with Illness, April, 2000

15

So….

100% of the people in YOUR nursing home DON’T want to be there!

16Financial Resources

Government & Regulations

Community

Family

Leadership

Person Directed Care Model

17

Old Culture vs. New Culture 1. Institutional-driven systems vs. individual-driven systems

Solution: Create systems within which individual preference is honored and defended

18

Old Culture vs. New Culture 2. Perception of nursing homes as a place to die or “last stop” vs. nursing homes that nurture an individual’s ability to thrive, flourish & grow

Solution: Establish an environment where all are given the opportunity and provided the resources to thrive, flourish & grow

19

Old Culture vs. New Culture 3. Iatrogenic helplessness vs. individual accepts appropriate degree of risk, challenge and choice

Solution: Promote the abilities and optimal level of function for all people

20

Old Culture vs. New Culture 4. Medical model focus vs. focus on an integrated, holistic model

Solution: Support and integrate quality of life with quality of care by focusing on the Holistic Model -spirit, mind and body.

21

Old Culture vs. New Culture 5. Quality Assurance vs. Quality Improvement

Solution: Provide an organizational understanding that quality is a continuous process that is driven by consumer needs & desires; therefore expands beyond regulatory practices and assurances through education, modeled behavior and satisfaction.

22

Old Culture vs. New Culture 6. 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.

23

Care vs. Treatment

24

Old Culture vs. New Culture 7. 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 & ideas.

25

Old Culture vs. New Culture 8. Segregated departments vs. integrated work teams that influence care

Solution: Formulate integrated teams that will guide the organization into the best possible care, work and environmental practice.

26

Old Culture vs. New Culture 9. Isolated, change resistant organization vs. open, sharing/learning community

Solution: Resolve to be a community open and available to education, change and the sharing of best practices.

27

Old Culture vs. New Culture 10. Hospital environment vs. home

Solution: Commit to de-institutionalize, wherever possible, providing personal living accommodations, a sense of peace, safety and community, for all.

28Financial Resources

Government & Regulations

Community

Family

Leadership

Person Directed Care Model

29

Rule of Thumb Ask Yourself/Team

– Does this system (or the change we are considering) allow for greater power or input to be exercised by the resident or those closest to them?

– Will this system (or the change we are considering) heighten the quality of life, experience or lifestyle of the resident and staff?

30

Goal: Move Inward

31

What are your five favorite activities, pleasures, things?

Please write one per piece of paper…

32

Deep Culture Change

Ability to assimilate the domains more and more deeply into the lives of residents

Ability to provide broader and greater opportunity for the people who live and work in nursing homes to have power over their lives and lifestyles

Put into the hands of each individual the opportunities needed to live their best life

33

Beware! The trappings and superficial displays of culture

change:

– Having mailboxes and front doors yet no one knocks or takes seriously the privacy it is meant to offer

– Fin, fur and feathers

– Food line buffet

– Memory boxes

– Brag board

34

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 under-standing and responsibility

in changing the belief, behavior or practice.

Hope vs. Despair

Gives rise to growth, action, & our

greatest humanity

Produces resignation & surrender

Phase 4 Action Step Now ready to create action

Immobilization Continue the current process

35

Consider the daily pleasures

What are some of the common irritants?

What creative changes could be made to this sensitive process that would put as much power and input as possible into the hands of the resident & those who care for them?

36

Let’s play a game!

37

How are facility routines contributing to the decline in Mr. McNally’s condition?

What clues do you have about Mr. McNally’s strengths and interests?

How can these strengths and interests be used as starting points to a person-directed approach that reverses the decline?

What changes in Mr. McNally’s routine would need to be put in place?

What changes in the home’s routine would need to happen so that Mr. McNally’s personal routine could be restored?

What additional information is needed?

Who else would need to be involved in the discussion?

38

Challenge!

Live like a resident for 24 hours:– Get admitted (with a diagnosis)

– Eat some meals

– Take a bath

– Spend the night…