Grow A Culture of Critical Thinking to Calm Survey Angst

This article was written by Action Pact writer Keith Schaeffer for the Pioneer Network, and published on their blog on June 12, 2018

Anxiety over the new Mega Rule survey process that examines caregivers’ critical thinking skills may have some long-term-care providers on edge, but not at Garden Spot Village in New Holland, PA.

“Our focus on critical thinking and empowering staff over the years in working with Action Pact has put us in better position,” says Steve Lindsey, CEO. “Getting everyone involved, not just assigning tasks but helping them understand the big picture, the issues, and how to make decisions has created a high level of critical thinking throughout the organization.”

How to achieve all that is the subject of Action Pact’s intensive session, Navigating the Mega Rule; Building a Highly Involved Culture of Critical Thinkers, at the Pioneer Network’s 2018 Annual Conference in August.  Presenters include LaVrene Norton, MSW, Megan Hannan, MS, Gloria Blackmon, RN, Glenn Blacklock, MS, and Linda Bump, MPH, RD, NHA.

Their purpose isn’t to tell attendees how to develop critical thinking among their staff, says Hannan, but to give them the information and understanding needed to chart their own course.

“We really appreciate that Action Pact’s is not a cookie cutter, pre-formulated approach,” says Lindsey. “It’s a journey of learning together and shaping something that is different for each organization’s culture.”

Garden Spot Village operates six skilled nursing households, each with its own culture shaped by those working and living there. Staff’s critical thinking abilities enable them to weigh carefully what they want to do while understanding it within the context of the regulatory environment and the lives of the people they serve, says Lindsey.

But most care homes leave critical thinking to the leadership,middle management, and nurses, says Norton. CNAs and others are simply told what to do, often without understanding the importance or context of their tasks within a person-centered, resident-directed culture.

But now, CMS expects hands-on caregivers to be critical thinkers, as well. Brains

All staff must know about the new survey requirements and their organization, residents, and services provided, and how to use that knowledge to better serve the residents. Do they know what to do when an incident occurs … that pudding should not be offered to Vivian because she is allergic to eggs … or that serving George dinner in his favorite nook outside the usual dining areas still requires proper hand hygiene and food safety practices?

Nurses develop critical thinking in college and in clinical training while going through a process of study, discussion, practice, feedback, reflection, further study, and more discussion. CNAs and other hands-on caregivers rarely get the opportunity.

“If we really expect them to think things through, know how to collaborate as a self-led team, and make decisions, then let’s give them the time, information, and education to develop critical thinking,” says Norton.

Person-centered environments with permanently-assigned, cross-trained staff working in teams to serve small groups of residents naturally enable caregivers to know the elder’s needs and desires well.

But staff’s capacity to contribute becomes much higher when they also are taught critical thinking skills … how to analyze, develop good judgement, and make decisions, says Norton.

For instance, CNAs know to inform the nurse when something doesn’t seem right. But what if the nurse fails to follow up after being told?

Rather than letting the matter drop or complaining to peers that “I told the nurse but nothing was done,”a CNA trained in critical thinking understands it’s important to follow up to ensure the nurse got the message.

“A sense of responsibility grows along with a more integrated understanding about how to serve the resident, and thoughts and actions toward her become more accurate,” says Norton.

As information is shared, the whole work team gains a deeper understanding and capability. They think through challenges as they arise, day or night, “determining whether to take the initiative and deal with it in the moment, or knowing when they shouldn’t take the initiative and call in resources from outside their team,” says Norton.

“It bubbles up in different ways in how life is lived and the sense of empowerment that residents and staff have … to live life on their own terms,” says Lindsey.  That and a CMS Five-Star rating has come from growing critical thinking skills at Garden Spot Village, he concludes.

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Manor Park Sees Greater Staff Retention with New Households

The “Wall of Fame” at Manor Park, Inc. is likely to get a lot more crowded now that person-centered care and the Household Model are leading to less staff turnover.

The wall is lined with photos of staff members who have worked five years or longer at the Life Plan Community (LPC) in Midland, TX. With turnover plummeting from 44 to 30 percent for all employees over the past four years, more photos are sure to be added as more staff reach the five-year threshold. Continue reading “Manor Park Sees Greater Staff Retention with New Households”

Four Ways to Build the Culture You Want to See in Your Senior Community

I had a conversation with a leadership team recently that was incredibly frustrated by the initiative being taken by aides in the building. The complaint was that they were sitting around at the nurse’s station when they weren’t busy with cares. Leadership wanted them to be engaging with residents. But in most traditional nursing homes, this is not what CNA’s understand as their job. To get to this place we have to create a culture where engaging with residents is everyone’s job. Continue reading “Four Ways to Build the Culture You Want to See in Your Senior Community”

Highlighting High Involvement at The Cedars

The Cedars, a retirement community in Portland Maine, has long held and worked toward a vision for person-centered life. They have been engaged in learning, practicing, stumbling and achieving minor and major feats moving away from institution toward home.

Lately they have been working hard at High Involvement – engaging a Steering Team and several Action Teams, as well as holding a variety of circles — some for fun, some to work step-by-step through large and often complex decisions. One of the action teams focuses on getting the word out. Continue reading “Highlighting High Involvement at The Cedars”

Flying High with Self-led Teams

MARVIN’S PILOT GOT IT RIGHT!

One of the most unifying and powerful accomplishments of self-led teams is realizing that no job and no person is viewed as greater than another. The equation itself is simple: no greater than or less than, only equal to. So every job is just as important as the next. All the jobs that need to be done in a household are done to help the members of that household have a better day. It doesn’t matter if it is wiping the table or taking out the trash or helping with medications. Self-led teams do not get hung up on titles, you simply get in where you fit in that day. Continue reading “Flying High with Self-led Teams”

Life Soars at St. John’s New CCRC in Albert Lea, Minnesota

Eagle crop2Residents will have eagle eyes watching over them when they move into one of the new households at Fountain Lake in Albert Lea, MN – especially if it’s nesting season.

“We didn’t know a bald eagle’s nest was on the property until about a year after we purchased it,” says Scot Spates, Administrator at St. John’s Lutheran Community.

Continue reading “Life Soars at St. John’s New CCRC in Albert Lea, Minnesota”

More Freedom for Staff Means a Better Life for Residents

Thursday, 1:30 p.m., the moment residents in Inglis House’s 3-South neighborhood have been waiting for has arrived. It’s Tea Time. They steer their wheelchairs toward the solarium where snacks, music, companionship, and of course, a wide assortment of tea await.

“It’s my favorite thing we’ve started since I’ve been here,” says Michael Kelly, Neighborhood Life Leader. He latched onto the idea while looking for a way to divert residents from dwelling on their debilitating diseases. Continue reading “More Freedom for Staff Means a Better Life for Residents”