Why Change?

1. Developing the Cornerstone of Person Centered Care Culture Change in Long Term CareJamie GitzingerUniversity of KentuckyMartin School of Public Policy and AdministrationMasters of Health AdministrationCapstone PresentationSpring 2008

2. Why Change? • Acute Care Model • Public Perception • Intense Regulation • Quality Issues • Misuse of Medical Treatment • Resident Satisfaction • Labor Shortages

3. Definition of Homelessness the negation of home, where the relationship between the individual and the environment loses its intimacy and becomes severely damaged. Judith Carboni, 1987

4. Definition of Home: a fluid and dynamic, intimate relationship between the individual and the environment Judith Carboni, 1987

5. 483.15 The Quality of Life (a) Dignity “The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.”

6. 483.15 (b) Self-determination The resident has the right to: Choose activities, schedules and health care consistent with his or her interests, assessments and plans of care…. and The resident has the right to: Make choices about aspects of his or her life that are significant to the resident.

7. Culture Change Medical Model Social Model • Develop a relationship. • Know the person. • History, routines, needs, likes, dislikes • Individualize care. • Give control back to the person. • Learn how to “guide” and get them to “yes.”

8. Methodology • Models of Change • Gustafson Change Model • HATCH Model • Core Leadership Group • Use Internal Talent • Communication Plan • Education Plan • Small Group Work • Tools & Systems • Managing Problems • Celebrating Progress

9. Gustafson Change Model • Tension for Change • ■ Mandate • ■ Change agent commitment • ■ Tension level • ■ Data on severity (collected & communicated) • Feedback • ■ Measures (outcome & intervening variables) • ■ Pilot test • ■ Safety • Change Attempt • ■ Pilot tests • ■ Individual actions • Decision & Plan • ■ Troubleshoot • ■ Commit to change • Superior Alternative • ■ Benchmarking • ■ Multiple options • ■ Evidence of superiority • ■ Complexity • ■ Radicalness Ability Skills ■ Assess qualifications ■ Training plan Self efficacy ■ History of change ■ Perceived chance of success ■ Change agent prestige • Support • SocialProcess • ■ Power group ■ Simplify • (involvement & endorsement) ■ Funds • ■ Middle management ■ Instructions/Rules • (involvement & endorsement) ■ Materials • ■ Respect for change agent • ■ Relative threat to supporters and opponents

10. HOLISTIC APPROACH TO TRANSFORMATIONAL CHANGE (HATCH) Government & Regulations Family Leadership Community

11. HATCH Model Mission Statement Vision Driven Care Practice Workplace Practice Environment Transformational Practices and Procedures in three domains A commitment to change that is values driven

12. Steering Committee(Change Agents) Work Place Practice Team Care Practice Team Resident Speech Therapist Training Coordinator Charge Nurse Hydration Aide Dietary Manager Asst. Director of Nursing Quality Assurance Nurse Director of Nursing CNA Team leaders Environment Team Administrator Staff Development Nurse Team of innovators and opinion leaders using learning circles to clarify the mandate

13. Care Practice • Operational Strategy – (Superior Alternative) • Person centered and directed model of care • Social model: “celebration of life” perspective • Consistent assignment of caregivers • De-emphasizing departments/cross training to allow caregivers to be involved in all aspects of care (Simplifying Process) • Create a specialty position: Coffee Shop Server (Agent Prestige) Mission Statement Vision Driven Care Practice Workplace Practice Environment First Domain

14. Workplace Practice • Sustainability through Abilities • Continuous flow of policy education and communication • Lattice training component (Training Plan) • Empowered, informed, integrated • Change process (Social Support) • Learning Circles, Team Leaders, • Team Member • Stressing/urgency (Tension Level) • Steering Committee • Standardization and built-in control: (Assessing Qualifications) • Apprenticeship models Mission Statement Vision Driven Care Practice Workplace Practice Environment Second Domain

15. Environment Mission Statement Vision Driven • Developing the Social Support • Environmental Issues to be considered: • Home improvement strategies • Open up a coffee shop (Superior Alternative) • Offer specialty iced beverages • Include sweets for NAR residents • Foster a Sense of community • Preparation procedures and equipment-cross training (Instructions) • Volunteer recruitment • Revenue avenue created (Funds) Care Practice Environment Workplace Practice Third Domain

16. Tools & Systems How to apply Person Centered Care Model with a continuous quality approach.

17. Cause & Effect Diagram(How projects will be selected) Causes Faulty Equipment Temperature Unauthorized Persons Supervision Burn from Hot Beverage Inadequate Training Non-Policy Transport Devices Service Methods

18. Nominal Group Techniques(weighted multi-voting technique)

19. Driving Forces Restraining Forces Force Field Analysis(cooler temperature considerations) Burn potential Resident choices Liability Fine Dining Delivery Regulations Social environment Accident and hazard risks No Support Individual resident impairment

20. Implementation(Pilot Testing) Plan (Steering Committee) Do (Innovators) Act (Pilot to success then corporate wide) Check (Opinion Leaders)

21. Recommendations • Recommendation One: use a balanced score card to: • Realign mission and vision • Medical Clinical data • Financial pulse • Turnover / Retention • Regulatory success • Company benchmarking • Recommendation Two: transformational process is never ending and requires patience • Recommendation Three: Celebrate successes

22. Acknowledgements …. • Thank you to the following individuals: • Dr. Sarah Wackerbarth • Dr. Joseph Fink • Dr. Scott Hankins • Ruby Jo Cummins-Lubarsky