Culture Change – An Inside Job!

The following heart-felt piece illustrates what often happens to folks during their time at one of Action Pact’s intensive educational offerings.  Karmen Payne, of Fair Haven Retirement Community in Birmingham, AL, recently attended the Nurse Leader intensive, and a fire was lit.  These are her thoughts as she headed home.


The journey to understanding household models is more than learning a management style or philosophy to me. The vision is unique, individualized and as alive as the people living and working in the households. The characteristic “schedules” of the nursing home are absent and the resident is the driver of the pace, style and atmosphere in the home. The critical attitudes, noise and tension are gone. The hierarchy of departments melts away. Rather than entering a “hall,” households truly seem to offer residents, families, staff members and visitors like me, a piece of their home for a time.

At first, I expected to attend a nurse leadership intensive and get a “how to” experience. I had my pen, paper and standard three ring binder at the ready. I quickly put most of that away in favor of walking the hallways, sitting at tables and engaging with members of households to discover what made their household tick. The atmosphere was so shockingly different from my own experiences. The quiet, peaceful interactions were personal and calm. There was no running about by anyone. The residents of each house I visited seemed to come and go at leisure. Everyone was joyful and attentive from the nursing assistants to the licensed dietician serving at the grill. Even the families I encountered were happy!

Returning to the classroom for reflection and discussion, I discovered I was not alone in my shock. There were others on the same journey as my building. That is a trek to finding our pathway to creating home for our residents — the way the residents want home to be. However, rather than a “ten-step plan to compliance and home,” I discovered a guide to self-examination that challenged me to change. If we are to become a household, I was going to have to think differently, respond differently and lead differently. Ten steps were not going to fix the problem on the “floor.” No. The changes I needed were an inside job that would become contagious as we build homes, teams and families to care for our residents’ needs as our residents desire us to.

So,Heart inside person I am beginning the journey with a change of heart and a renewal of spirit. I want to serve my residents and my team by honoring them, empowering them and getting out of their way while motivating them to do what only they can do. Create home. Pursue life. Honor the spirit of each individual in each household in their own unique way. I realize the standard I have lived by for the last 20 years is going to change. I am not the decision maker. Every water pitcher won’t be sanitized on Tuesday any more. Yet, every resident will be honored, fulfilled and respected every single day. I am losing nothing and they gain everything, especially their right to pursue life in their later years on their own terms.

This change will not come without pain. There will be less gossip and more accountability. Confrontation and discussion will replace accusation and blame in our lives. I will have to be brave and bold. Trust will grow as a foundation and control will crumble under its weight. Character and principle will replace compliance and enforcement. Our number will shrink to only those with a heart to serve at first. However, in the end we will become a stable team of servant-leaders dedicated to our calling.

Each home will be different. Each schedule will not follow my best-laid plan. No longer will “my” team spend half their day meeting with me and others like me anymore. Silo jobs will die out. Assignment sheets may well vanish into the abyss with shower schedules and get up lists. Yet, at the end of this pathway of curves, valleys, laughter and tears, maybe we will have created something valuable and lasting to leave as a legacy. Maybe we will have transformed our facility into a home.


Would you like to Hear the Voice of Households? Click here to watch video clips with stories, testimonials and great ideas! 

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