Kansas State University November 2007Center on AgingPEAK Project Newsletter RESOLUTIONS AND CHANGE Every year just after the Christmas holiday people start to think about New Years' resolutions. Below are three steps which can be used to help insure success with resolutions. These steps can also be applied to the process of culture change. Be committed You must think through what you want to change and commit yourself to the long-term process it usually takes to achieve change. You then need to come up with a realistic plan to help you reach your goals. If your friends or colleagues are supportive, tell them about your goals. They can provide encouragement and reinforce your commitment to change. If necessary, seek professional help to assist you. Be prepared for setbacks Don't think of them as complete failures, don't dwell on them, and don't let them make you give up your goals. After a setback, try to get back on track to reach your objective. Plan ahead on how you'll deal with setbacks. Or you may want to review all the reasons you have for wanting to make the change and why reaching that goal will make you happy. Track your progress Motivate yourself by celebrating your successes and by getting positive feedback from others. A good approach is to evaluate yourself every week or two weeks. However, don't over-monitor yourself by doing an assessment every day. That's just likely to end in frustration. Don't compare yourself to others. Accomplish your goal in a way that's best suited to you. BOOK REVIEW Blue Ocean Strategy by W. Chan Kim and Renee Mauborgne In a book that challenges everything you thought you knew about the requirements for strategic success, the authors argue that competition results in nothing but a bloody red ocean of rivals fighting over a shrinking profit pool. Based on a study of 150 strategic moves spanning more than a hundred years and 30 industries, the authors argue that lasting success comes not from battling competitors, but from creating "blue oceans"--untapped new market spaces ripe for growth. Such strategic moves--which the authors call "value innovation"--create powerful leaps in value that often render rivals obsolete. Blue Ocean Strategy presents a systematic approach to making the competition irrelevant and outlines principles and tools any company can use to create and capture blue oceans. The book will direct you to think outside the box, and includes unusual examples such as Cirque du Soleil, Curves, Starbucks and Yellow Tail Wine. It will help you figure out how to capture a new audience for your market. A good leader inspires others with confidence in him; a great leader inspires them with confidence in themselves. Author unknown(Taken in part from http://www.womenshealth.gov/news/english/600330.htm ). The Journey Toward Culture Change Continues Advisory Group Resources Brewster Health Center, Topeka The transformation from a medical model to a person- centered model of care began with opening a new building at Brewster Health Center in 1998. The management decided that there must be a better way to provide health care to elders than the care they had been providing for decades. Staff attended the Eden training, and the experience triggered a genuine soul search for Linda Farrar, the administrator. She started asking herself why she chose to work in the long-term care industry and what kind of legacy she wanted to leave behind after she retired. Linda was aware that it was easier to make physical changes to buildings than to pursue philosophical transformations. But she wanted to make a strong visual statement for a new way of thinking about elders' care. She had a nurse's station removed from the skilled care unit. The absence of the nurse's station was a change that could not be undone, and it symbolized the beginning of major changes affecting the philosophy of health care provision at Brewster Health Center. Before the implementation of the person-centered model of care, Brewster's leaders talked to the elders and their families. Everyone agreed with the philosophy and was very supportive of its implementation. Linda stated that using the PEAK module on culture change principles was very helpful in explaining the philosophy and identifying the benefits for the elders, families, staff and the home. The family council formed a committee to help new family members be educated on person-centered philosophy and answer any questions they may have. The council is instrumental in sustaining the new model of care through family members' passionate interest in maintaining a home, not an institution, for their loved ones. Prior to making any permanent changes, a group of staff members visited the Green Houses in Tupelo, Mississippi. They came back with the vision of a model suitable for Brewster Place and its particular needs. The first important step was forming three neighborhoods. At that time, Brewster Health Center was already a part of the Eden Alternative family, so implementing the philosophy of resident-centered care was a somewhat easier transition. Elders were involved in choosing leaders for each of the three teams by interviewing candidates for these positions and selecting them for their particular neighborhoods. The neighborhoods were staffed with consistent employees for three shifts. Neighborhood workers at Brewster are called Kaizens, a Japanese word meaning "a family working together through change." Each Kaizen works with five elders, and this small unit is considered a family. One of the ways to reinforce a family atmosphere is incorporating Kaizens in eating meals (paid for by the home) with the elders. Buffet style enhances a wide meal choice for the elders and each neighborhood meets with a dietician to design a menu for their particular needs. After a few months of the person-centered model being implemented, Linda became concerned that the inner drive for change was not strong enough among the nurses. She attributed their lack of support to the fact that all nurses at that time were stationed in one building. They were leaving the building to provide care to elders who lived in the other building. This arrangement disconnected the nurses from the residents' daily life and obstructed sight of the benefits of the person-centered model of care. The nurses were brought into neighborhoods to be a part of the elders' daily life, to participate in activities, to interact with them on a regular basis and not just when they needed clinical attention, and as a consequence, to develop meaningful relationships with them. Being an important part of neighborhoods enhances the nurses' enthusiasm for continual improvement of the elders' quality of life and care. Some institutionalized routines were more difficult to remove. The elimination of the bath list created such chaos among staff members that a few of them quit. They just could not deal with the idea that the residents could choose to bathe at any time they wished. Kaizens who stayed through this difficult implementation process are deeply involved in the care of the elders in their family unit. They participate in a Care Pathway to help the elders set up their goals and identify strategies to attain these goals. Kaizens' mission is to help the elders live their lives the way they want. Assisting residents with baths at their chosen time is a small way to acknowledge the importance of their preferences. Linda cautions that it is easy to slide back to the old way of doing things. It takes training and re-training of staff to maintain and continually improve the person- centered model. Staff members need to be alert to what is happening every day. Brewster Place finds the Pioneer Network training resources very useful for training and updating staff on the model. Brewster Place decided not to maintain their membership with the Eden Alternative, as other resources such as the Pioneer Network and the PEAK-ED modules are equally effective. Everyone working at Brewster Place continuously looks for ways to improve. Satisfaction surveys of residents, their families and staff are scrupulously studied. The results are shared to enhance discussions and identify solutions to problems. Since the implementation of culture change, the Brewster Place staff turnover rate has gone down 35%. Linda acknowledges that people who work in nursing homes do not do it for money. They are there because they want to help residents improve their quality of life. Asking the elders about their needs and meeting those needs is the core of the person-centered model of care. The value of people is a very important mission of Brewster Place, and for its success in this area, the home was recognized with a PEAK award in 2007. Receiving state recognition has not stopped the staff from exploring innovative ideas. Linda and her staff are already looking into the future. The sustainability of the model is very important to all staff. They have developed a successions plan, so that when a staff member leaves, there would be enough time to find the most appropriate replacement and train a new person in their mission and the philosophy of care. Seeing the benefits of culture change for the elders is a strong motivator to maintain and continue to work on improvements on this model of care. Village Shalom, Overland Park, KS About two years ago, the management at Village Shalom started discussing the vision of care for their elders. Team members quickly realized that all of them shared the same belief of providing individualized care and working on consistent improvement of elders' quality of care and quality of life. They also discovered that they all valued all levels of staff and their contribution to the overall wellbeing of residents. They considered staff retention and staff empowerment fundamental factors for a successful model of care. All crucial elements of culture change were there before they realized that it was an innovative provision of care. These elements have constituted their management style for some time. Village Shaloms' health care was already designed to advance person-centered care. All residents have private rooms, and communication with staff is wireless. Front line staff were very instrumental in designing a communication system with each other. They modified the management's plan and redesigned it according to their needs. The serious involvement of direct care staff in the design process marked the beginning of an increase in staff empowerment. All levels of staff are involved in finding solutions to problems and discussing alternatives as a team. Each neighborhood is responsible for solutions that are appropriate for its unit and may be different from another neighborhood's due to its unique needs and culture. The emphasis in problem solving is on collaboration and not on blame. One staff member's idea to assure accountability is that staff "police" each other. Checks on a staff member from a different department are performed to make sure that all tasks are completed. This is a mutual commitment to enhance staff's compliance. Development of person-centered care was met with some staff resistance in the beginning. Nurses had a difficult time adjusting to a system that did not include rigid residents' schedules. They were concerned about staff compliance and residents' well-being. Appropriate education on meal timing and benefits associated with residents' choice helped the nurses be less rigid. Direct care staff supported the new model and were eager to be involved in decisions affecting their neighborhoods. Negative reaction of residents' families to person- centered care was not anticipated. The knowledge of residents' rigid schedule allowed family members to plan their visits. Now, when their loved one decides to sleep until noon, they must call ahead of time to make sure they will come at the time the resident has indicated to have lunch. The management offers ongoing education to family members to ease their adjustment to the change and to help them see the benefits for residents. New families do not question residents' choice and often express support for person-centered care. Village Shalom sent six staff members to training on leadership offered by the Center on Aging at the University of Kansas. In retrospect, they saw that the training was excessively long (six months, two full days per month) and involved many hours of time by staff members whose shifts had to be covered by others. However, these staff members taught their peers and sped up the process of person-centered care implementation, especially in the unit for people with dementia. Leadership training is still offered, but in small groups that have been found to be most effective for learning. LINKS OF INTEREST http://www.suddenlysenior.com/columnlist.html Suddenly Senior - humorous columns about aging http://seniors-site.com/funstuff/burma.html Burma Shave signs http://www.radiolovers.com/ Old time radio shows http://dmarie.com/timecap/ Printable time capsules On this Day in History The world hates change, yet it is the only thing that has brought progress. Charles F. KetteringVillage Shalom supports "In the Moment" training. Problems are evaluated, solutions discussed and the most appropriate one is selected by neighborhood teams. The problems and the solutions are available to all employees via newsletters, so staff can use other teams' successful approaches. Management states that maintaining the staff that they have trained is a big issue. Their campus is within a short distance of many other facilities that compete with each other for a workforce. Several programs are in place to help retain their employees. The home offers all staff members participation in a wellness program to help them work on smoking cessation, weight loss, improved nutrition, stress management, etc. Staff are encouraged to use the spa, a health risk assessment is offered and financial incentives are in place to encourage staff to make good health choices. In person-centered care, it can be more difficult for staff to stay in compliance, so monitoring has been adjusted to make sure that tasks are delivered and completed. The management is adamant that all staff "have to have buy-in" for the change to assure success. If they had to do it all over again, training on leadership would have been offered to all levels of staff prior to the change implementation. HAPPY NEW YEAR!In order to sustain their model of care, appropriate policies and procedures for person-centered care that reflect culture change have been written. The management is convinced that the residents would resist any attempt at going back to the old model, and residents and staff are strong pillars for sustaining the model. For their successes in person-centered care, Village Shalom received a PEAK award in 2007.