Kansas State UniversityDecember 2003Galichia Center on AgingPEAK Project Newsletter PEAK-ED Recent Presentations "Quality First: Integrating Human Resources for Success." American Association of Homes and Services for the Aging, Denver, CO, 10/29/03 by Gayle Doll with Angela Dailey & Jo Sumpter from Brewster Place. "10 Effective Expressions of Culture Change Philosophy." American Association of Homes and Services for the Aging, Denver, CO, 10/29/03 by Gayle Doll. "Promoting Excellent Alternatives in Nursing Homes." Partnership for Aging, Tulsa, OK, November 14, 2003 by Gayle Doll. "Complexity and Contradiction in Environmental Gerontology Action Research: A Case Study." Gerontological Society of America, San Diego, CA, November 23, 2003 by Lyn Norris-Baker, Migette Kaup, Gayle Doll, & Steve Shields. "The Evolving Revolution of Culture Change: A Collective Case Study of the Pioneer Movement in Three Long-Term Care Facilities." Gerontological Society of America, San Diego, CA, November 24, 2003 by Gayle Doll & Rick Scheidt. Web site visitors Since April 2003 there have been 901 page views from our PEAK web site. We have had visitors from all across the nation as well as from Korea, Canada, Japan, Portugal, Australia, the United Kingdom and Switzerland. We encourage all our visitors to revisit often as we continually update information and add new links. The staff at the Center is looking forward to celebrating our 1000th visitor soon! Pioneer Network Conference "Comes Home" to Kansas In the movie, "The Wizard of Oz," Dorothy, the Tinman, the Scarecrow, and the Cowardly Lion take a journey not unlike the journey of culture change. The lessons they learn by building relationships together is that home is where the heart is, and that if we work together smartly and with courage, we have it within ourselves to succeed. "There's no place like home" is the theme for the next Pioneer Network Culture Change Conference to be held in Overland Park, Kansas on August 4-7, 2004. The Pioneer Network web site, www.pioneernetwork.net, contains a request for proposal form for presentation submissions. We encourage our partners in culture change here in Kansas to consider developing a proposal. We would be happy to help. Presentations are to be one and a half hours long and are grouped in themes of heart, courage, brains and home. We believe that Kansas has much to share. KDOA RecognitionThe Journey Toward Culture Change As a part of the PEAK (Promoting Excellent Alternatives in Kansas nursing homes) initiative the Kansas Department on Aging (KDOA) recognizes nursing homes pursuing "nontraditional" models of care with progressive environments. The recognition includes a formal award presentation, media publicity, a modest cash award, a proclamation from the Governor, and special ceremonies at statewide professional conferences. Realizing that in most cases culture change is a journey or progression that takes from three to seven years or longer, KDOA decided, for the 2003 awards process, to recognize homes for specific achievements in separate areas. Those areas are: resident control, staff empowerment, home environment and community involvement. Twenty-five Kansas nursing homes applied for the 2003 awards. Of those, ten were selected for site visits. As a new newsletter feature, we will be highlighting two award winners each installment, one from 2002 and one from2003. In this newsletter we will discuss Windsor Place of Coffeyville because they are the only nursing home that won the award both of the years the award has been given. Windsor Place, Coffeyville, 2002 PEAK Award On April 1, 1992 Health Management of Kansas took over the operation of Windsor Place, Coffeyville, a 170 bed skilled nursing facility. Monte Coffman accepted the role of Executive Director. At that time the staff was unionized under two labor unions. The state had demanded that the building be separated into two distinct parts with different management staffs. The receptionist could remember 29 administrators and 41 DON's in the 18 years she had worked there. A culture change was needed from the very beginning in order for Windsor Place to survive. One of the first things Coffman did was put a stop to using agency staffing. He believed that if he focused on providing what his staff needed to do their jobs well and gave clear direction, a sense of community would develop and staff would stay. The building was restored to one management staff in 1994. The employees voted the labor unions out in 1995; today there is a resident admission waiting list and no substandard care deficiencies have been cited since 1995. In 1993, before Windsor Place even thought about culture change, two golden retrievers were introduced into the facility (with mixed reactions by staff and residents). Since that time, numerous animals have been added. The Eden Alternative process became the prevailing model by which Windsor Place evolved. Earning all ten Eden stars, signifying the ten principles, in 1998 Windsor Place became the 15th facility in America to be fully registered as an Eden Facility. Beginning in April 1992 and every month since, all departments and all shifts, in addition to inservice meetings, have their own "workgroup" meetings. The purpose of these sessions are for employees to help identify obstacles to quality care and to participate in solution development. An average of 19 workgroup meetings has been conducted each month during the last 10 years. That is over 2000 sessions with employees. These sessions are now called learning circles and have deeper meaning to them since adopting the ten principles of the Eden Alternative. Because most long term care (LTC) complaints involve bathing, feeding, grooming or other direct care issues,Windsor believes that placing responsibility with the caregiver is the best way to address these concerns. The monitoring and measurement of performance and the giving of appropriate feedback are taught as the two primary leadership skills which must be developed if positive outcomes are expected. One of Windsor Place's key operating philosophies is, "Good enough is never good enough, if better is possible." Face to face communication is practiced with the philosophy that team members need to "talk to the individual and not about the individual." This principle is encouraged and often prompted by leaders at all levels of the organization. To provide a clear vision and build a sense of community with staff, Windsor Place leadership presented a three part education series including: What is Culture, Mindful Aging and The Meaning of Frailty. They played Name That Culture, discussed what is Windsor's culture? and what is the current traditional nursing home culture? Staff wanted safety, trust and relationship to be a major part of culture at Windsor Place. They watched Finding Forester and 12 Angry Men to demonstrate cultures in collision. Another philosophy embraced by the organization is, "What gets measured gets produced." Monte Coffman notes that, "extensive historical data from the facility's operation supports this philosophy." As a result, outcomes from the culture change efforts are easily identified from the data that has been collected and continues to be measured. Work teams develop "shared goals" annually. The quantified progress toward those goals is reported quarterly. The last three inservices each year are devoted to group discussion and goal development by each department and each shift. Coffman says, "There is an ever growing involvement by staff and thereby, an ever increasing interest in becoming 'part of the solution.'" Windsor Place, Coffeyville, 2003 PEAK Award Windsor Place's 2003 application did a good job of chronicling the changes made during the 12 months following their 2002 award and of measuring the outcomes of their changes. The community is divided into neighborhoods. Each neighborhood sets goals for themselves. QIs, staffing and other reports are generated for each neighborhood so they can see how they are improving. Instead of charge nurses they have ADL supervisors (most of whom are CNAs) who organize, monitor, teach and follow-up on ADLs with their teams. After surveying and interviewing residents, families and staff for input about possible dining changes, buffet style dining was implemented in November, 2002. Windsor Place is now able to offer multiple food choices at every meal. They batch cook the food for freshness since times for dining have been expanded so that residents can dine as they wish. They emphasize that it is not just added choices of food but also that residents eat at the time they want and they sit where and with whom they want. Outcomes as a result of the food service changes include: food costs were maintained, supplement costs decreased by 84%, resident satisfaction is higher, employee meals increased 863%, and guest meals are up 311%. Windsor Place residents have experienced no unexplained weight loss since buffet dining began. Another significant change has been in the bathing process at Windsor Place. Implemented in January 2003 fragrant lotions, soaps and shampoo choices were added and shower rooms were renovated into decorated spas with make-up vanity and mirrors. Residents can now decide when, how frequently and what mode of bathing experience they wish. Outcomes from the shower/spa changes include: fewer residents refusing baths, residents bathing more frequently, and enthusiastic bathing staff. In addition to the shower room renovations, changes and redecoration of the dining room were made to accommodate the buffet, woodwork in all public areas was painted to lighten the environment and the beauty shop was expanded and redecorated. Outcomes of these home environment changes include: increased socialization; open seating in dining rooms; and a higher conversation level in the dining rooms. Hair and beauty appointments have increased. One resident remarked, "The other place was so small it was suffocating; this is nice and big and you can watch people come and go, like a real beauty parlor." During the six months prior to implementing these changes every semi-monthly inservice meeting, every monthly departmental and shift learning circle were devoted to the examination of cultures, assessment of the "traditional" nursing home culture and conceptualization of a new culture. Trips were taken to visit other organizations to see first hand how buffet dining, etc. worked for others. Time was spent identifying necessary changes and training staff for readiness to execute the changes. Implementation of changes took place only after a need for change was determined within and by the employees closest to each proposal. The evolution that took place during that six months of preparation led to the articulation of staff empowerment. Front line staff found that leadership not only listened to their dreams and ideas but incorporated them into resident and family surveys and interviews. These same employees helped conduct the interviews with residents thereby increasing the employees' visualization of the changes that would be made. Outcomes from involving employees in decision making include: lower employee turnover (30%), higher retention (75%) and improved level of service. As a result of feeling empowered, some employees thought that Mass would be appreciated by Catholic residents and made the arrangements with Holy Name Catholic Church to have Mass in the conference room at Windsor Place every Thursday morning. Weekly attendance ranges from 25 to 30 and speaks to the spiritual needs of staff as well as residents. Contact is maintained between residents and parishioners who also attend Mass at Windsor Place. Other community partnerships that Windsor Place pursued and that have come to fruition during the past year include the Boys and Girls Club and the Coffeyville Community College Horticultural Department. Residents help prepare food and host about 25 children from the Boys and Girls Club every Thursday after school. This has established some great intergenerational relationships. Horticultural students visit on Tuesday mornings and work with residents in the greenhouse and with planting projects. According to Coffman, "Besides the relationships that have formed, the plants and gardens soften the institutional environment of the facility and a sense of accomplishment and worthwhile work prevails." These community partnerships enhance the activities for the elders as well as enriching the young peoples' experience of elders. Windsor Place started their journey toward a change in culture by starting with leadership then expanding to staff empowerment. They have emphasized education, setting goals and measuring outcomes. As staff has become more empowered, change has escalated because more people comprehend the vision of where they are going and the enthusiasm has grown. Other homes have begun with resident control, home environment or community involvement but it makes no difference where the culture change journey begins as long as a community forms and shares a strong vision about the kind of home they want to become, with the values they want to preserve, and that mission and vision is discussed frequently to keep everyone motivated. Despite the bumps in the road, people getting discouraged, and some who want to change the direction, great things can be accomplished when people work together with persistence and perseverance. Book Report Vision motivates so it is vitally important to culture change. To accomplish change one must clearly describe the vision of the future in terms that everyone in the company can grasp in order for them to move toward it. This may at times seem like an overwhelming task. Here is a book that you might find helpful. Full Steam Ahead: Unleash the Power of Vision in Your Company and Your Life By Ken Blanchard and Jesse Stoner Ken Blanchard is known for taking broad topics and turning them into very readable books. He has done it again with Full Steam Ahead. This is a simple, easy to read (reads like a novel) book (also available in audio book form) that you will find invaluable for helping staff understand the importance of having a vision. The book demonstrates how to achieve three core elements necessary to formulating a vision: significant purpose, clear values and a picture of the future. You may want to check this book out to help you and your teams create an energizing vision that provides direction and focus as you move toward changing the culture of your nursing homes. Multicultural Holidays The holidays at this time of the year remind us to be sensitive to resident cultural differences now and throughout the year. Because Christianity is dominant in this country we may forget that some residents may not have Christian roots and would appreciate having their special days remembered as well. There are also differences in the date of celebrations because of calendar differences. A web search will give a variety sites to gather interesting information. Here are some sites you might find useful: http://www.interfaithcalendar.org/ http://www.calendarhome.com/ http://webexhibits.org/calendars/index.html http://www.earthcalendar.net/index.php http://home.wnm.net/~debi/dates.htm http://aa.usno.navy.mil/data/docs/JulianDate.html Sites with ethnic holiday food ideas: http://www.recipesource.com/ http://www.familytreemagazine.com/articles/dec00/ethnic.html http://directory.teradex.com/Food/Ethnic_Foods