Refining the Household Model is an endless journey of challenge, personal fulfillment

By Dr. Matthew Bogner*

We all want to feel a sense of meaning and purpose in our lives – to be part of something bigger than ourselves and aspire to a higher moral purpose. Many of us find this meaning in our work and implementing the Household Model enables us to do just that because even on difficult days we feel fulfilled knowing we are enabling a better life for our most vulnerable.

Nursing staff members feel this innate desire for meaning especially keenly, maybe because they work so closely with the elders we serve. Indeed, both licensed nurses and nurse aides are usually strong advocates for change. They often grow excited when the Household Model is described to them for the first time. But, it is natural for them to also experience mixed emotions including fear and anxiety in the face of deep change, and to become resistant to certain aspects of implementing households. I found this to be the case while leading Household Model development in two large retirement communities over the last 10 years and reaching a better understanding of nursing staff members’ reactions was the basis of my doctoral dissertation research.

The experience taught me it is important not to simply label negative staff members as “resistant to change.” Instead, leaders must commit to continually refining the Household Model and identifying challenges and opportunities for improvement. And while there is immediate quality of life benefits for residents, changes also present difficulties for staff members, at least initially.

Make no mistake, change is hard and it is counterproductive to paint a utopian picture for staff in terms of the challenges ahead in making such a dramatic paradigm shift. For example, telling staff members that cross-training or system changes will not result in more work may cause some to lose trust in leadership because many will find that, indeed, it is more work at least initially.

Instead, it is important to say that it will take time to refine the model and work through issues, and at first it will be challenging. But the end result will be worth it and they will be a part of something special. In addition, staff perceptions may improve over time as the model evolves. This message needs to be repeated continually, both throughout implementation and thereafter. Ongoing training, strong household leadership, and regular use of communication tools such as learning circles also are essential. Time studies can be employed to understand the impact of new system changes and to evaluate demands on nursing staff members.

In addition, I believe it beneficial for a senior leader to interview a sampling of staff members from all nursing roles after the first full year of implementation. This will help leadership to better understand staff member perceptions and identify opportunities for improvement. This is not to duplicate or undermine decentralized household leadership or communication circles, but to enable nursing staff members to be heard in an environment where they might feel more comfortable expressing their private thoughts. I personally found this was very beneficial to my organization when I did it as part of my doctoral research. I discovered that staff members shared rich, detailed information that was not being shared in the households at the time.

The takeaway from my last 10 years is that culture change work is fulfilling, morally uplifting, and hard – it is especially difficult for direct care givers. But there is no doubt it is “worth it” in the end. The best transformational leaders not only will inspire staff members initially, but also commit to refining and improving the model over the years as equal partners. This requires continual effort as new employees come and go to ensure improved quality of life for both residents and staff.

*Dr. Bogner is the CEO of Kansas Masonic Home in Wichita, KS. You can read more about him and KMH HERE. 

The households at Kansas Masonic Home were designed by Action Pact Design, and Action Pact Consulting provided consulting and training in the Household Model.