ABOUT THIS MODULE Included here you will find 6 pages of a 41 page educational module which is intended for use by nursing homes who wish to promote more social, nontraditional models of long-term care. The intent of the PEAKED project is to assist organizations in implementing progressive, innovative approaches to care that should make a significant difference in the quality of care and the quality of life for those living and working in long-term care environments. To receive the module in its entirety, please send an email to gerontology@ksu.edu with the following required information: # Name of Individual and title # Name of Organization/Facility # Complete mailing address including zip code # Telephone number # Email address A CD (or email attachment when possible) will be sent with the module along with forms to complete which will enable our project to track the number of people and hours spent reviewing/implementing these ideas. CD's will be sent free of charge to any nursing home in Kansas, and will be sent to those outside Kansas for a fee of $24.00 to cover costs of materials, postage and handling. For further information on the PEAK-ED project please email gerontology@ksu.edu. Pioneering Change Strengthening Staff Education Module to Promote Excellent Alternatives in Kansas Nursing Homes Table of Contents Strengthening Staff Course Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Pretest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Strengthening Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Understanding Relationships and Their Role in Culture Change . . . . . . . . . . . . . . . .6 Understanding Relationships Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Permanent and Consistent Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Improved Relationships Begin with Permanent Staffing . . . . . . . . . . . . . . . . . . . . . .10 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Future Wheels for Permanent Staffing Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Implementing Permanent Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Replacing Agency Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Shorthanded Staff Can Lead to Shortchanged Residents . . . . . . . . . . . . . . . . . . . . . .14 Methods for Recruiting Permanent and Consistent Staff . . . . . . . . . . . . . . . . . . . . . .14 Methods for Recruiting Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Hiring the Right People for the Job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Retaining and Maintaining Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Self-Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Flexible Scheduling Activity: The Pros and Cons . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Administration and Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Flattening Organizational Hierarchy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Strategies for Implementing Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Managing Realignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Managing Realignment Group Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 “Being Green” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..32 Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Post-test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Pretest and Post-test Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..39 Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..40 Course Objectives: 1. To foster a better understanding of culture change as relationship-centered. 2. To foster an appreciation of the benefits of permanent staffing as a central component of building an improved relationship-centered culture. 3. To help administration develop some basic theories for hiring, training, and maintaining effective and empowered staff. 4. To provide models for bridging cultural divides between administration and staff in order to create more stable working environments. Strengthening Staff Introduction I knew the nurses by their hands. There was one with such delicate fingers that I cried a little when I heard her come on duty. She made me feel like she had all the time in the world. The others made me feel like a lump of flesh, like they had to get me out of the way as fast as they could. But those hands! I knew it was going to be a good day when she squeezed my arm in the morning. She would put a fresh gown on me and brush my hair with such tenderness and patience. You can’t imagine how much it meant to me, there in that strange place, to be touched like that (Lustbader, 1991, p.52). The opening passage is really at the heart of resident-centered care. Quality care is all about relationships. According to Bill Keane (Mather LifeWays) and Anna Ortigara (Life Services Network) “the successful organizational culture in service to our elders is one which is person-centered and relationship-based, maximizing the opportunity for elders to have meaningful relationships in eight areas: self, God/spirit, family, friends, staff, organization, community and environment” (Keane & Ortigara, 2004). Effective culture change in long term care for the aging centers on changing relational behaviors. Helping residents to maintain and/or develop the types of relationships listed above is a crucial responsibility for nursing home staff. Traditional models of managed care focus on providing food, shelter, and medical attention. They lack purposeful, proactive interactions between residents, their families and staff. The development of deeper, relational bonds among all of these participants can ultimately create a more enriching experience for all. In order for residents to feel valued and maintain meaningful, constructive relationships in their lives, permanent staff must be hired, trained, and encouraged to participate in the development of those positive interactions. New models of managed care should center on learning, growth, and relational development through interactions between staff and residents. “It’s about relationships. It’s about separating the person from the task. It’s about sharing a moment with a resident. I was talking to a resident the other day and she said that the housekeepers were her favorite person to see during the day. I asked why and she told me because ‘they don't want anything. Nurses and aides come in and they always want something (to take my pulse, or give pills, or give a shot). Housekeepers come in like my friend.’” (R. Grace. personal communication, December 2, 2004). A long term care facility’s commitment to culture change will be channeled to individual residents and their families through the actions and interactions of staff. However, for staff to consistently embrace culture change they must first receive effective guidance from their organization’s leadership. For effective culture change to occur, leadership must first be committed to implementing change. Culture change flows from the administration throughout an organization. The purpose of this module is to provide models, examples and activities designed to help effectively incorporate culture change constructs into staffing. It will provide insight into how staff can learn to help residents grow through enhanced relationships. The module provides general guidelines for employee development and is not meant to be a one-size-fits-all program or a quick fix that will solve all staffing issues. It, in conjunction with the other PEAK modules, is part of an overall recipe for implementing culture change in long term care. Understanding Relationships and Their Role in Culture Change The ability to help residents foster relationships is a skill that needs to be taught, role-modeled and reinforced. This module is about strategies that can be implemented to help staff become more empowered to make decisions with and about residents. When that happens, the residents themselves will experience the positive, residual effects of that empowerment through new and strengthened relational models of interaction. It is assumed that leadership and staff have completed earlier modules on culture change and measuring change, that they understand the philosophies that culture change is based upon, and that culture change in staffing practices is one part of an organizational strategic plan that supports the care philosophy. Another assumption is that an ongoing shift to resident- or person-centered care is taking place within the organization. Residents, their families and staff should all be involved in the process of change from the planning of changes through implementation and evaluation of those changes. As in previous modules, this module on culture change and staffing includes information based on the Pioneer Network objectives. These objectives include: committing to permanent and consistent staffing, eliminating middle layers of management, enabling CNAs to set their own schedules and supporting team development. We will also be including information on leadership and modifying recruitment and hiring procedures. Understanding Relationships Activity The following activity is designed to help participants better understand both the existence and inherent importance of maintaining strong personal relationships. This activity was developed by Bill Keane of Mather LifeWays and used with his permission. For more information contact Bill at Bkeane@MatherLifeWays.org. This activity is appropriate for all staff. Administration could use this to evaluate their own perceptions regarding staff and residents in the nursing home. As we will see later, administration bears significant responsibility for developing, nurturing and maintaining relationships within long term care. Put a checkmark in the boxes below the “me” column if you feel you have developed strong relationships in the area listed to the left. Now think about a resident at the nursing home. Check the boxes that you feel apply to that resident. RELATIONSHIP ME RESIDENT X Self God/Spirit Family Friends Staff Organization Community Environment Now compare the two columns. Do you have more checkmarks than the resident you selected? Why? How might you help the resident improve his or her relationships? Not all of these categories need to be present or apparent (for instance, not all residents will or need to embrace concepts of spirituality, and for some that do it may be deeply personal and not observable), but fostering and strengthening relationships in as many relevant areas as possible can improve and maintain the quality of life for those receiving care. By extension, their improved outlook can have a positive influence on the overall organizational culture of a given facility and, over time, can dramatically improve the environment of a long term care facility. In the following pages we will consider some of the basic ground rules for improving the work culture within long term care facilities, with the ultimate objective being improved care through strengthened and sustained relationships.