Jumpstart Your Culture Change Journey

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Jumpstart Your Culture Change Journey

• Tiffany Langham, RN, BSN
• Quality Improvement Consultant
• TMF Health Quality Institute

This material was prepared by TMF Health Quality
Institute, the Medicare Quality Improvement
Organization for Texas, under contract with the
Centers for Medicare Medicaid Services (CMS),
an agency of the U.S. Department of Health and
Human Services. The contents presented do not
necessarily reflect CMS policy. 8SOW-TX-NHQI-07-57
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Disclosures

• TMF Health Quality Institute has no relevant
  financial relationships to disclose
• TMF Health Quality Institute does not accept
  commercial support from other organizations or
  companies for the development of Continuing
  Medical Education activities

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Objectives

• At the completion of this conference the
  participant will be able to
• Understand quality improvement methodologies for
  improvement of culture in Long Term Care
• Begin to evaluate the culture of your nursing
  home(s) utilizing an assessment tool.
• Review the importance of testing change ideas.

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The Culture Change Journey
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Steps to Implement Culture Change

• Making significant
• and
• Sustainable changes

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Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
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Q 1 What are we trying to accomplish?

• A Goal Statement
• A written statement of accomplishments expected
• from each pilot teams improvement effort.
• Contains useful information
• A general description of the goal
• A specific population
• Numerical goals
• A general description of spread

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Q 2 How will we know that a change is an
improvement?

• A Measurement
• Each PDSA cycle
• Each monthly key measure
• Each spread measure

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Q 3 What changes can we make that will result in
an improvement?

• A Specific Improvement Strategies
• Identified through
• Artifacts of Culture Change
• Resident input/ideas
• Satisfaction surveys
• Chart audits
• Brainstorming

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Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
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The PDSA Cycle for Learning and
Improvement
Act
Plan

• What changes are to be made?
• AdApt?, AdOpt? or Abandon?
• Next cycle?

• Objective
• Questions and
• predictions (why)
• Plan to carry out the cycle (who,what, where,
  when)

Study
Do

• Complete the
• analysis of the data
• Compare data to predictions
• Summarize what waslearned

• Carry out the plan
• Document problems and unexpected observations
• Begin analysis of the data

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Repeated Use of the Cycle
Changes That Result in Improvement
DATA
Spread
Implementation of Change
Wide Scale Tests of Change
Hunches Theories Ideas
Follow-up Tests
Very Small Scale Test
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Family and Community
Leadership
Environment
Workplace Practice
Care Practices
Develop Strategies for Each Component of the Model
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Concept D
Concept C
Concept B
Concept A
Change Concepts, Theories, Ideas
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Goal Move Inward
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Person Directed Care Model
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Transformative Care Practices
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Transformative Care Practices

• ADLs
• Activities
• Rituals celebrations
• High quality clinical care with resident, family,
  staff input
• Innovative, creative care solutions
• I format care plans
• Community mourning

• Resident-inclusive choices
• Waking and Sleeping
• Meals-Service, Delivery, variety
• Food Preferences
• Daily routine
• Bathing-frequency, time, method

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Transformative Practice in the Environment
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Transformative Environmental Practices

• The creation of sanctuary, shelter and peace that
  provides a sense of community, safety and free of
  unwanted intrusions
• The creation of beauty and comfort
• De-institutionalize the common rooms (bathrooms,
  living areas)
• Design for accessibility

• Attention to adequate lighting
• Provide for nature
• Demonstrate affection, validation and support
• Encourage personal items that reflect
  individuality personal space, shrines
• Shift towards neighborhoods, communities

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Family

• Family inclusion
• Care conference
• Committee
• Councils
• Volunteers
• Invite families to make a commitment to become
  part of the community
• Recognition

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Community

• Porous nursing homes
• Offer services
• Provide space that benefits all
• Provide support by sharing talents, gifts and
  skills

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Leadership Practice
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Leadership Practice

• Leadership and management mirror a sense of
  vision, optimism, trust, openness, and generosity
• Instill an attitude that places elders and
  caregivers at the heart of all decisions and at
  the heart of the home
• Provide consistent recognition
• Demonstrate a deep sense of meaning and mission
  both personally and organizationally

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Leadership Practice

• Offer and receive regular and constructive
  feedback
• Recognize the value of all staff
• Support the full empowerment of workers allowing
  them to grow, direct, and effect the care of
  elders
• Create an inclusive non-hierarch decision making
  environment

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Transformative Work Place Practice
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Transformative Workplace Practices

• High Performance Human Resource Policies
• Motivational Work Organization and Care Practices
  
• Sufficient Staffing Ratios and Support for High
  Quality Care

• Establish relationships as the number one
  organizational priority
• High Quality Leadership
• A Culture of Valuing and Respecting Caregivers
  and Their Needs

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Government Regulations and Financial Resources

• Bring regulators into your culture change story
• Develop collaborative that creates inclusive
  opportunities for SSA, Ombudsman, Trade,
  families, other key state groups into the culture
  change process.

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Person Directed Care Model
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Beware!

• The trappings and superficial displays of culture
  change
• Having mailboxes and front doors yet no one
  knocks or takes seriously the privacy it is meant
  to offer.
• Fin, fur and feathers
• Food line buffet
• Memory boxes
• Brag board

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Relationships are the heart of the CC Model

• Relationships among co-workers
• Relationships with residents families
• Relationships across departments
• Relationships with supervisors
• Relationships within outside the organization

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Are You Up To A

• Challenge ??

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DFW Coalition Resource

• http//www.tmf.org/nursing homes/DFWcoalition