What is Culture and Why Change?

1. What is Culture and Why Change? 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

2. Disclosure to Participants Conflict of Interest: • A conflict of interest occurs when an individual has an opportunity to affect or impact educational contact with which he or she may have commercial interest or financial relationship. All planning committee members and presenters are required to disclose any potential or actual conflicts of interest with any commercial entity that may have an interest in the activity’s educational content. • The planners and presenters of this CNE activity do not have any relevant financial relationships to disclose. Non-Endorsement of Products: • TMF does not endorse any product, service, or company displayed at or referred to at this educational event. Off-Label Product Use: • This educational activity does not include any information about off-label use of a product.

3. Refreshments Compliments of: • Nexion • Priority One Ambulance • Walson Respiratory Care • Texas Healthcare Association

4. Criteria for Successful Completion To receive credit for this program, participants must: • Sign in • Attend the entire activity • Complete the on-line evaluation form • Once successful completion is verified, a Certificate of Successful Completion will be awarded

5. CEU Instructions • Written CEU Instructions will be given to participants at the end of the event. • At that time, the CEU authorization code will also be announced. • Please make sure you get this information if you wish to be awarded CEU credit.

6. Objectives • At the completion of this conference the participant will be able to: • Define culture change in long-term care. • Describe the process for culture change in long-term care. • Implement team building strategies that will assist in implementing a QI process to test changes that would improve the work environment and culture of the nursing home.

7. Daily Pleasures • What are those items, habits or events that on a daily basis provide you with comfort, joy, a sense of identity, security or delight?

8. Daily Pleasures What are some of yours?

9. Daily Pleasures • How would you feel if you could no longer experience that daily pleasure? • Do you think our residents are missing any of their daily pleasures?

10. Morning Routine

11. Underlying Question • How do we organize our systems around the people who live & work in nursing homes to bring quality of life?

12. The Culture Change Journey

13. What is Culture Change? • Culture change in long-term care is an ongoing transformation in the physical, organizational and psycho-social-spiritual environments that is based on person-centered values. Culture change restores control to elders and those who work closest with them. • Pioneer Network

14. The Culture Change Journey • Person Directed Care • Resident choice directs lifestyle, care, systems, • daily routine. • Staff choice influences the way the home is run. • Institutional Care • Task oriented • Schedule driven • Medical model driven • Person Centered Care • Resident choice in planning care. • Shows movement in culture change journey. JOURNEY

16. According to a national study . . . • 70% of seriously ill older adults are unwilling to go into a long-term care facility. • 30% state that they would rather die than go into one. Elders with Illness, April, 2000

17. So…. • 100% of the people in YOUR nursing home DON’T want to be there!

18. Person Directed Care Model

19. Old Culture vs. New Culture1. Institutional-driven systems vs. individual-driven systems Solution: Create systems within which individual preference is honored and defended

20. Old Culture vs. New Culture 2. Perception of nursing homes as a place to die or “last stop” vs. nursing homes that nurture an individual’s ability to thrive, flourish & grow Solution: Establish an environment where all are given the opportunity and provided the resources to thrive, flourish & grow

21. Old Culture vs. New Culture3.Iatrogenic helplessness vs. individual accepts appropriate degree of risk, challenge and choice Solution: Promote the abilities and optimal level of function for all people

22. Old Culture vs. New Culture4. Medical model focus vs. focus on an integrated, holistic model Solution: Support and integrate quality of life with quality of care by focusing on the Holistic Model -spirit, mind and body.

23. Old Culture vs. New Culture5.Quality Assurance vs. Quality Improvement Solution: Provide an organizational understanding that quality is a continuous process that is driven by consumer needs & desires; therefore expands beyond regulatory practices and assurances through education, modeled behavior and satisfaction.

24. Old Culture vs. New Culture6.Exclusive, impersonal work practice vs. inclusive, relationship-based practice Solution:Hold as paramount an environment where relationships are placed at the forefront of all practice.

25. Care vs. Treatment

26. Old Culture vs. New Culture 7. Authoritarian change process vs. empowered, informed integrated change process Solution: Seek to create opportunities where individuals are given the opportunity to better the home and their lives by offering their voice to make empowered decisions, take greater responsibility and provide their thoughts & ideas.

27. Old Culture vs. New Culture8. Segregated departments vs. integrated work teams that influence care Solution: Formulate integrated teams that will guide the organization into the best possible care, work and environmental practice.

28. Old Culture vs. New Culture9. Isolated, change resistant organization vs. open, sharing/learning community Solution: Resolve to be a community open and available to education, change and the sharing of best practices.

29. Old Culture vs. New Culture10. Hospital environment vs. home Solution: Commit to de-institutionalize, wherever possible, providing personal living accommodations, a sense of peace, safety and community, for all.

30. Person Directed Care Model

31. Rule of Thumb • Ask Yourself/Team • Does this system (or the change we are considering) allow for greater power or input to be exercised by the resident or those closest to them? • Will this system (or the change we are considering) heighten the quality of life, experience or lifestyle of the resident and staff?

32. Goal: Move Inward

33. What are your five favorite activities, pleasures, things? • Please write one per piece of paper…

34. Deep Culture Change • Ability to assimilate the domains more and more deeply into the lives of residents • Ability to provide broader and greater opportunity for the people who live and work in nursing homes to have power over their lives and lifestyles • Put into the hands of each individual the opportunities needed to live their best life

35. 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

37. What creative changes could be made to this sensitive process that would put as much power and input as possible into the hands of the resident & those who care for them? Consider the daily pleasures • What are some of the common irritants?

38. CEU Instructions • Written CEU Instructions will be given to participants at the end of the event. • At that time, the CEU authorization code will also be announced. • Please make sure you get this information if you wish to be awarded CEU credit.

39. Challenge! • Live like a resident for 24 hours: • Get admitted (with a diagnosis) • Eat some meals • Take a bath • Spend the night…