Tag: cross-training

When Hierarchy Reigns, Culture Change Efforts Flounder

Published on by LaVrene Norton3 Comments

TraditionalOrgChart

We can create homey spaces, offer elders more choice and change long standing institutional practices, but culture change and the Household Model will not be effective unless we flatten the organization. As long as hierarchy reigns, elders will not be in control of their own lives. And as long as departmental silos dictate the way things are done, staff closest to elders will not be able to do what they can to help elders live a meaningful life in a place that truly feels like home. A nursing home can have a warm appearance, a friendly atmosphere, do fun and interesting things with its residents, but unless the decisions of daily life are made by elders and those closest to them, the culture is still one of one-size-fits-all-this-is-just-the-way-it’s-done.

Elders can’t make choices in the moment when what they want needs to be OK’d by three different people, one or two of whom may not even know them. One of the things we all enjoy about being in our own homes as opposed to work, a hotel or even at a friend or family member’s home, is the freedom to make spontaneous decisions, to have things the way we like them and go about our day according to our own schedule.  A household or neighborhood team comprised of staff from all disciplines that makes decisions together and is responsible to one another can most effectively meet elders needs. Cross-training and versatile workers within the team allow more people within the team to respond to the elder in front of them instead of having to go find someone else who can do the job. It can also be a great benefit at the busiest times of the day when extra help is needed in one particular area.

Only when the household or neighborhood teams have the responsibility, authority and flexibility to make decisions can they reach their full potential for giving individualized care and creating true home for the elders they serve.

The process of flattening the organization is not something that is done overnight. I suggest 3 steps to move forward with this process.

  1. Make your organization one of Shared Leadership.
  2. Use Learning Circles to help staff communicate.
  3. Create an environment of High Involvement.

We will go into more detail about each of these steps in upcoming blog posts. Please share your own challenges and successes in flattening the organization in the comment section.

LaVrene Norton is the founder of Action Pact, an organization devoted to changing the culture of care environments for elders – making it possible to live in a homey place & have a good day every day, no matter how frail one becomes.  Action Pact has assisted care organizations on their journey to households since 1997. Norton is co-author with Steve Shields of In Pursuit of the Sunbeam, and publisher of a variety of educational books, workbooks and videos focusing on the Household Model.

What Makes a Rehab Household Different from the Traditional Short-Term Unit?

Published on by Action PactLeave a comment

Written by Bev Cowdrick

Photo by Samantha Whitefeather

As an organization begins to dig into culture change and the Household Model, we often hear the question “What about our short-term rehab unit? It’s different!”

It’s true. We’re not trying to create a home for people who come to us for rehab. People are with us to do the work and go home to somewhere else, not to cozy into a household. It’s a fast-paced environment with people coming to us for only a few weeks.

And yet the principles of person-directed care and self-led versatile work teams are as critical in the rehab environment as they are in the long-term care environment.

The following are three of the pitfalls of the institutional model in short-term rehab, and how culture change adds value for our guests.

Knowing the Person, Working Seamlessly

Institutional approach:
Staff members work in departmental silos and assignments may vary from day to day. CNAs, medication aides and floor nurses rarely know a guest’s rehab goals or full plan of care. Rehab therapists rarely know all the concurrent conditions that person is experiencing, how they are sleeping, or what social, emotional and spiritual needs might be impeding progress.

Culture change antidote:
Everybody belongs to a small-size rehab house. A permanent team is in place in each house. Everyone participates in knowing the guests and following their progress. CNAs cross-train as rehab aides, assist with assessments, follow guests into the gym, and help continue the plan of care 24 hours a day. Household teams work to understand and meet the needs of the whole person. Therapists and the rest of the team work shoulder-to-shoulder with each other and the guest as care managers.

The Environment for Friends and Family

Institutional approach:
The rehab unit rarely has adequate space or hospitality for family and friends to join a guest for a meal or visit outside the guest’s bedroom. The support of family and friends is often critical to the speedy recovery of a guest, and often there has been little thought to making room for this to happen.

Culture change antidote:
Create space at the table for family and friends. Make 24-hour hospitality centers with coffee, juices and snacks. Build in living room spaces for gatherings outside the bedroom. Have homemakers in each rehab house who are trained as certified dietary managers and hospitality specialists. Have household coordinators who assure that a welcoming and convivial environment is maintained.

Promoting an Upward or Downward Spiral

Institutional approach:
Practices used for the convenience of staff often do not promote independence and recovery of function. This includes unnecessary assistance with bathing, dressing and other activities of daily living, as well as the use of wheelchairs for staff convenience to speed transport of guests. Interrupted sleep also prevents optimal recovery. This includes loud paging systems and bells, late-night treatments and medications that could be given on other shifts, third shift entry into rooms to restock supplies and clean equipment, and frequent turning on of lights to check for guest safety and feel for urinary incontinence. Exhausted guests do not do well during gym workouts!

Culture change antidote:
Reorganize so that administrative nurses, recreation/life enrichment staff, social workers and administrative staff spend at least part of their time attached to one house to help with household duties. They sometimes cross-train in another job to free up CNAs and nurses to take the time to allow guests to “do for themselves.” Work to eliminate the use of wheelchairs as much as possible, and reassess this on a daily basis. Eliminate all unnecessary nighttime disturbances and practices.

Bev Cowdrick received her Masters in Public and Private Management from Yale and is a licensed nursing home administrator. While a consultant for Action Pact, Bev guided many nursing homes through their transformation to households. She is currently the Associate Director at Glenaire, a continuing care retirement community in North Carolina.