Culture Change in Multi-Facility Systems

Mary Tess Crotty, MAGenesis HealthCare

Ed McMahon, Ph.D.Golden Living

What do Culture Change and Quality Have in Common?

In small groups, introduce yourselves, and identify one or two things

CultureChange

Quality?

CFMC, the Medicare Quality Improvement Organization for Colorado, under contract with CMS

Culture Change Concepts

Baldrige Concepts

Resident Focus – Engagement

•How do you identify and innovate healthcare service (and other) offerings to meet the requirements and exceed the expectations of your residents and their families?

•How do you create an organizational culture that ensures a consistently positive resident and family experience?

Voice of the Resident

•How do you listen to residents and their families to obtain actionable information and to obtain feedback on your healthcare (and other) services?

•How do you determine resident and family satisfaction and how do you use this information to improve your organization?

Workforce Focus – Engagement

•How do you foster an organizational culture that is characterized by open communication, high-performance work and an engaged workforce?

•How does your workforce performance management system reinforce a resident focus?

Culture Change & Baldrige Criteria

Focus on the residentEmployee engagementStrategic planningProcess ImprovementIt’s all about culture!

Organizational Definitions of Culture Change

GHC – since 2004: A great place to be – to visit, live and work Person-centered care Practices organized by People, Care and

Environment Golden Living – since 2002: Living Life to the

Fullest Resident-directed care Practices organized by Resident-Driven Systems,

Creating Community, Staffing, Self-Managed Work Teams, Environment

Right-Sizing Your Approaches

Genesis HealthCareApproximately 220 nursing homes and assisted

living centers, in 13 eastern seaboard statesoperates in three geographical areas – 5-7

operations groups within geographical areaCollaborative Learning model – primarily by

Area; monthly Conference Call companywide

Right-Sizing Your Approaches

Golden LivingApproximately 360, 22 states, 4 DivisionsStarted with pilots and structured training Integrated into companywide Performance

Management System

Genesis Story

Collaborative Improvement ModelPCC materials developed by QIOsLearning Sessions: area level Center team

conferences, on-site learning sessionsSkill Development: Coaching

Supervision (now The Partner Approach), Respectful Workplace Training, Neighborhood Training

Leadership Development

Genesis HealthCare

The culture change story

Collaborative Improvement Model

Common goals and definitionsLearning sessionsConference calls during “Collaborative

work” periodsFinal Congress

CMS/QIOs Collaborative

Pain Collaborative (Multi)Workforce Retention (Multi)

Continued same format with Person-Centered Care (Culture Change)

Integrated into Quality Dept.

Common goals and definitions: Culture Change Self-Assessments

Learning sessions Range from 350+ - with direct care teams Small pilots and on-site visits

Conference calls during “work” periods Monthly Conference Calls (35-80 Centers)

Final Congress Goals integrated into Customer Satisfaction,

Employee Satisfaction/Retention, and Census

Culture Change Assessment Areas

People1. Consistent

Assignment2. Respectful

Workplace/ Coaching Approach

3. Learning Circles

4. Orientation

5. Language

Environment12. Neighborhood

Concept13. Noise reduction14. Safety and

Independence

Care6. Medication

Reduction

7. Bathing

8. Night-time Routines

9. Alarm reduction

10. Dining Choices

11. “Get to Know Me”-I Centered Care Plans

Self-Assessment Example: People

1. Consistent Assignments1.1 Consistent Nurse Assistant assignments are in place for …

M-F day shifts on (All/Most/Some/None) of the units.M-F evening shifts on (All/Most/Some/None) of the units.S-S shifts on (All/Most/Some/None) of the units.

1.2 The Center has a float/back-up system to provide consistent replacements. (Yes/No)

1.3 A team composed primarily of nurse assistants meets to discuss and oversee assignments…(Weekly/Monthly/Quarterly/Never)

1.4 Over the course of a month, a resident receives personal care from (No more than 10 NAs/Between 10 and 20 NAs/Over 20 NAs/Have no way of knowing)

1.5. Other Notes:

Culture Change Conferences

Sample Themes…Individualizing Daily RoutinesLeading for ChangePatient Safety through Person-Centered

CareCreating NeighborhoodsThe Spirit of Neighborhoods

Continuum of Customer Orientation

Staff Directed

Staff Centered

PersonCentered

Person Directed

Staff make most of the decisions with little conscious consideration of the impact on residents.

Staff consult residents or put themselves in residents’ place while making the decisions.

Resident preferences or past patterns form basis of decision making about some routines.

Residents make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and lifelong habits.

Residents accommodate staff preferences; are expected to follow existing routines.

Residents accommodate staff much of the time—but have some choices within existing routines and options.

Staff begin to organize their routines in order to accommodate resident preferences—articulated or observed.

Staff organize their hours, patterns and assignments to meet resident preferences.

Low High

Developed by Mary Tess Crotty, Genesis HealthCare Corp, based on the model by Susan Misiorski and Joanne Rader, distributed at the Pioneer Institutes, 2005.

Continuum of Worker Orientation

InstitutionallyDirected

InstitutionallyCentered

PersonCentered

Person Directed

Supervisors make most of the decisions with little conscious consideration of the impact on staff.

Supervisors consult staff or put themselves in staff’s place while making the decisions.

Workers’ make some decisions about how to arrange their routines to meet resident needs.

Workers make decisions among themselves every day about how to arrange their routines to meet resident needs.

Workers accommodate supervisor preferences; are expected to follow existing routines.

Workers accommodate supervisors much of the time—but have some choices within existing routines and options.

Supervisors guide staff to organize their routines in order to accommodate residents.

Supervisors oversee staff systems (hours, patterns, assignments) that workers create to meet resident preferences.

Low High

Conference Call Topics

I-Centered Care Plans Noise Reduction Bathing Options Dining Approaches Strengths-Based Approaches Re-engineering the Med Pass Self-Scheduling Personal Alarm Reduction Neighborhood Development

Skill Development

Used PHI (Sue Misiorski and colleagues), developed Train the Trainer model Coaching Supervision (now The Partner

Approach) – 2 day program for Department Heads and Nurses

Respectful Workplace Training Neighborhood Training Pilots (Resident-Staff Learning Circles,

“Approach Coaches” for behavior challenges

Leadership Development

Rotating through Culture Change intensives by Operational Area – every other month, Administrators and DNSs attend an “onsite learning session” – within the company.

Integrating into our long-term care strategy for customer experience

Northeast Area 3 Yr Results

Coaching Supervision training>1,800 completed 2-day training

Family Satisfaction1% increase to 90% would recommend

Employee Satisfaction9% increase to 70% would recommend

Occupancy .6% decrease to 91.7%

Learning

Cultivate early adopters then recognize and reward them

Integrate into your discipline support Bring leadership teams on-site to see and ask

about change processes Choose your framework – everyone needs to

change – that takes time Give concepts time to take root in your

organization’s language Be ready to adapt and connect culture change

to organization’s priorities.

Golden Living

The Culture Change Story