What is culture change?
How did you first come across culture change and why did it sound appealing?
I first started to hear about culture change when we received grant money
from the Retirement Research Foundation. A lot of us didn’t even
know what we were talking about. It wasn’t until the Pioneer Network
conference in Chicago a few years ago that I had an ah-ha moment and realized
what we were truly talking about. It was thrilling and scary all in the
same breath. We had no idea how we were going to do this, or what we were
going to do, or how we’d even convey what we’re envisioning
to others to get them excited about it. But I knew that if I never wanted
to end up in a nursing home the way they look today, I was personally going
to have to do what I could do to change the way that care is delivered,
in 99.9% of nursing homes across the country.
What steps did you take to start the process?
When we came back from The Pioneer conference, to really get the process
started we held small sessions with groups of 10-15 people and really posed
the question “If you were in an accident today, and you did not recover
from that accident, and you had to spend the rest of your life in a nursing
home, what would you most miss?” Then we listed all the things that
people miss, all the things that get taken away from you when you move
into a nursing home. You lose your privacy, you lose when you eat, what
you eat, when you bathe, the things you wear, the things that are important
to you, creating your day. We’ve just described institutional living
like prisons, dormitories, hospitals, nursing homes. Then we said, “In
almost every one of these scenarios you’re going to leave. You’re
going to get better and leave a hospital, you’re going to graduate
from college and move out of a dormitory, unless you’ve done some
heinous crime you’re going to get out of prison and go back to society.
But a nursing home, in many situations, is a life long sentence. Then we
asked them, “How many of you want to spend the last years of your
life in a nursing home?” Out of about 130 people, only six said that
they wanted to but only because they didn’t want to be a burden on
their families. And we said, “We give some of the best care in the
state of Wisconsin, and if none of us ever want to be here then we owe
it to ourselves to change what is currently going on.” That lesson
was really what planted the seed in many employees heads about what change
could look like or just the idea that we needed to do something different
because none of us wanted to end up in the current system. What was really
startling is that some of the employees were already well into their 60s,
and they looked around like “oh my God this could be me someday.” And
I was thinking, some of these residents aren’t any older than some
of our employees. There’s no one in this building who ever said,
I want to get old and live in a nursing home. No one ever plans it. It
could be each and every one of us at some point in our lives.
How was the transition into culture change?
Too much planning went into thinking about how employees would react to
situations versus letting employees decide situations. We spent too long
behind the scenes talking about the “what ifs” and “how
are we were going to do this” before getting out to the floor.” Once
we did, it became really clear that employees had the answers. We had been
spending all of this time behind the scenes trying to solve what they were
going to figure out in a matter of days. I brought laundry to the floor and
said, we need to talk about the challenges of this. Within 48 hours staff
had figured it out, had it in place, had it up and running smoothly. If we
had all sat in a classroom to try and figure it out the process would have
taken weeks or months. We just over thought every detail. That was our fear
of the unknown that we had to battle. We really didn’t have a whole
lot of models to draw from and say “ok, let’s contact this other
facility and see how they did it.” It became a huge struggle. Another
struggle was getting upper-level management to really have true “buy-in” to
what culture change is. They’re onboard today, but for some of them
it was really difficult for them to comprehend what we were even talking
about because so much of it was intangible. It’s kind of like faith;
you either have it or you don’t. Nobody has a blue print called “here’s
what culture change is.” You’re creating it as you go and it’s
hard for people to see and to understand.
What challenges do you continue to struggle with?
We still struggle with working through the “med pass” to the
point where it really is person first; where we truly don’t have a
medication cart, where we know the resident’s timing and we can distribute
meds in their rooms while they’re getting ready versus in the dining
room. That’s the most difficult piece because it really would require
time studies. I would say that we’re really only 50% of the way there.
That has been ongoing and the longest struggle.
We also struggle with sustaining it. Once you’ve done culture change, how do you sustain it, and what does deeper change look like? We’ve let people sleep in, and pick their own food during meals, and have voice and all of those things, but what’s next? Two and half years into this, you take a breather and say, ok, how do we keep this going? It’s so easy to slide back into what fits our routines better than the residents. So, what would be next? What would we envision as the next layer or re-empowering the employee and re-instilling choice and giving residents a voice? So the hardest struggle at this point is sustaining it.
Why do you personally think culture change is important?
People with dementia are not given enough credit for who they are. They are
labeled and dumped into a category. We think they are not able to make
any decisions in their lives, and so they need to have their care delivered.
This is simply not true. None of us want to be ruled and regulated and
have our spirit taken from our bodies. There’s a better way to deliver
care that’s not all measured on medical outcomes. There’s a
whole element of quality of life that is hard to measure, and people haven’t
spent a lot of time understanding that, yes, you can take care of the physical
needs of someone incredibly and still have them be a shell of a body because
you don’t know who they were, or you don’t engage them. They
aren’t feeling part of a community or a family, there’s nothing
in their environment that resembles home, there’s nothing that’s
familiar to them. You’ve really in essence stripped them of who they
are completely because you’ve created this sterile environment. This
escalates the dementia process; it rips the souls from their lives and
it shortens them because they give up the will to live.
What have you done in your own job to be a 'culturally changed' professional?
Early on, there was a core group of administrators who had to work as the
team leaders, which we traditionally wouldn’t do. I worked as a pseudo
team leader until one evolved. Culture change gets into who you are. When
someone asks you questions about culture change, before you know it you’ve
gone on for twenty minutes. We feel passionately about why this is the
right thing to do. We want people to see that if they don’t ever
want it to be them then we need to do something differently. People I’ve
talked to about culture change don’t, well this makes sense, why
isn’t everybody doing it? A few people who have been in the industry
a long time have been really opposed to it. They don’t think it makes
money, they don’t think it would work in a different environment.
It’s very hard to envision their facility doing it based on St. John’s.
One of the downfalls is that we have a nice facility, we have a nice clientele
and other facilities say, well this would never work in a facility that
was primarily Title 19, or this would never work because we are a Union
facility. They like to find reasons why it can happen at St. John’s.
The reality is, we didn’t use very many financial resources to make
culture change happen. In fact, most of that went into training and development,
and by blending job duties we easily recouped all of that money. And so
it actually hasn’t cost us anything. We’ve actually saved in
food cost and reducing personnel based on job efficiency.
When you walk down the halls, what differences do you see in the facility?
I see it most when I go to other facilities. I am so in this environment
all the time and I begin to think that this is how it is everywhere. When
I enter other facilities, I am struck with how different it is and how
I immediately want to get up and say, why are you doing this? What is the
purpose of people being corralled to a breakfast table at eight o’clock
in the morning while everyone gets the same food, no one is talking to
each other, and the C.N.As are in these ugly colored uniforms not addressing
residents? That’s when I realize the differences most, because it
strikes me how far we’ve come, and how far other organizations need
to go.
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Pioneer Network, a culture change organization