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Culture Change in Multi-Facility Systems
Mary Tess Crotty, MAGenesis HealthCare
Ed McMahon, Ph.D.Golden Living
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What do Culture Change and Quality Have in Common?
In small groups, introduce yourselves, and identify one or two things
CultureChange
Quality?
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CFMC, the Medicare Quality Improvement Organization for Colorado, under contract with CMS
Culture Change Concepts
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Baldrige Concepts
•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?
Workforce Focus – Engagement
•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?
Voice of the Resident
•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?
Resident Focus – Engagement
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Culture Change & Baldrige Criteria
Focus on the resident Employee engagement Strategic planning Process Improvement It’s all about culture!
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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
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Right-Sizing Your Approaches
Genesis HealthCare Approximately 220 nursing homes and assisted
living centers, in 13 eastern seaboard states operates in three geographical areas – 5-7
operations groups within geographical area
Collaborative Learning model – primarily by Area; monthly Conference Call companywide
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Right-Sizing Your Approaches
Golden Living Approximately 360, 22 states, 4 Divisions Started with pilots and structured training Integrated into companywide Performance
Management System
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Genesis Story
Collaborative Improvement Model PCC materials developed by QIOs Learning Sessions: area level Center team
conferences, on-site learning sessions Skill Development: Coaching
Supervision (now The Partner Approach), Respectful Workplace Training, Neighborhood Training
Leadership Development
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Genesis HealthCare
The culture change story
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Collaborative Improvement Model
Common goals and definitions Learning sessions Conference calls during “Collaborative
work” periods Final Congress
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CMS/QIOs Collaborative
Pain Collaborative (Multi) Workforce Retention (Multi)
Continued same format with Person-Centered Care (Culture Change)
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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
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Culture Change Assessment Areas
People2. Consistent
Assignment3. Respectful
Workplace/ Coaching Approach
3. Learning Circles
4. Orientation
5. Language
Environment12. Neighborhood
Concept13. Noise reduction14. Safety and
Independence
Care2. Medication
Reduction
3. Bathing
4. Night-time Routines
5. Alarm reduction
6. Dining Choices
7. “Get to Know Me”-I Centered Care Plans
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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:
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Culture Change Conferences
Sample Themes… Individualizing Daily Routines Leading for Change Patient Safety through Person-Centered
Care Creating Neighborhoods The Spirit of Neighborhoods
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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.
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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
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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
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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
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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
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Northeast Area 3 Yr Results
Coaching Supervision training >1,800 completed 2-day training
Family Satisfaction 1% increase to 90% would recommend
Employee Satisfaction 9% increase to 70% would recommend
Occupancy .6% decrease to 91.7%
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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.
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Golden Living
The Culture Change Story