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So you are asking – how do we get started? We often say that Culture Change is "a journey"
and the goal is to move from institutional to individualized care. You may have heard about innovative
things that other organizations are doing and you are wondering how they did it. Culture change has three
components:
- The values held by the organization
- The artifacts or evidence of culture change
- Empowering decision-making at the lowest practical level in the organization
You may be tempted to start with an in-service on resident-centered values. Nothing wrong with that –
but often an abstract discussion doesn’t translate into a change in behavior. Or you may have a great
idea and tell the staff what needs to be done and write a policy and procedure for the implementation.
That might work. However, in order to ensure that the transformational changes you desire are enduring,
you need to start by empowering decision-making at the lowest level that is practical in the organization.
To get started, you need to "Be the change you want to see in the world." In other words,
model the principles of person-centered care. You can do this by choosing a care practice that you want
to implement in a more person-centered way, for example, meal service, bathing or morning wake-up.
Then form a team of six to ten people to consider all the implications of the change for the nursing
home. Select staff from all levels of the organization that will be affected by the change – not just the
department heads. Make sure that residents serve on the team. And pick at least one of two people who
are "naysayers" -- the ones that say "that will never work here" or "we don’t
have the resources to do that here." Their input is very valuable in thinking through all the
challenges. And if they are part of the solution, they will be less likely to sabotage the change during
implementation.
Let the team figure out the implementation steps. When they determine how the problem is to be solved,
they own the problem and the solution. Many innovations lend themselves to being done in stages, or in one
area of the facility, so consider "piloting" the change on a small scale to begin with and see how it goes.
Your role as the leader is to monitor the progress, ensure there is adequate time and space for the team to meet,
and to reassure them that they don’t have to get everything right. Whenever you implement anything new, there
are bumps along the way. Teams get discouraged when things don’t go well. Then the temptation is to abandon
the changes and fall back on the old way of doing things. Your role as a leader is to encourage the team to
reconsider the plan in light of the challenges and come up with the necessary modifications to make it work
better. And a leader celebrates the successes and acknowledges the mistakes and breakdowns and finds a
constructive way to move past them without being punitive.
There are a lot of resources available. We recommend two to get started:
"In Pursuit of a Sunbeam"
by Lavrene Norton and Steve Shields
$45.00 |
Order it here |
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The "Artifacts of Culture Change Tool"
Co-authored by Carmen S. Bowman and Karen Schoeneman for CMS |
Download it here |
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