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Culture Change in Multi-Facility Systems


Culture Change in Multi-Facility Systems Mary Tess Crotty, MA Genesis HealthCare Ed McMahon, Ph.D. Golden Living What do Culture Change and Quality Have in Common? – PowerPoint PPT presentation

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Title: Culture Change in Multi-Facility Systems

Culture Change in Multi-Facility Systems
  • Mary Tess Crotty, MA
  • Genesis HealthCare
  • Ed McMahon, Ph.D.
  • Golden Living

What do Culture Change and Quality Have in Common?
  • In small groups, introduce yourselves, and
    identify one or two things

CFMC, the Medicare Quality Improvement
Organization for Colorado, under contract with CMS
Culture Change Concepts
Baldrige Concepts
Resident Focus Engagement How do you identify and innovate healthcare service (and other) offerings to meet the requirements and exceed the expectations of your residents and their families? How do you create an organizational culture that ensures a consistently positive resident and family experience?
Voice of the Resident How do you listen to residents and their families to obtain actionable information and to obtain feedback on your healthcare (and other) services? How do you determine resident and family satisfaction and how do you use this information to improve your organization?
Workforce Focus Engagement How do you foster an organizational culture that is characterized by open communication, high-performance work and an engaged workforce? How does your workforce performance management system reinforce a resident focus?
Culture Change Baldrige Criteria
  • Focus on the resident
  • Employee engagement
  • Strategic planning
  • Process Improvement
  • Its all about culture!

Organizational Definitions of Culture Change
  • GHC since 2004 A great place to be to
    visit, live and work
  • Person-centered care
  • Practices organized by People, Care and
  • Golden Living since 2002 Living Life to the
  • Resident-directed care
  • Practices organized by Resident-Driven Systems,
    Creating Community, Staffing, Self-Managed Work
    Teams, Environment

Right-Sizing Your Approaches
  • Genesis HealthCare
  • Approximately 220 nursing homes and assisted
    living centers, in 13 eastern seaboard states
  • operates in three geographical areas 5-7
    operations groups within geographical area
  • Collaborative Learning model primarily by Area
    monthly Conference Call companywide

Right-Sizing Your Approaches
  • Golden Living
  • Approximately 360, 22 states, 4 Divisions
  • Started with pilots and structured training
  • Integrated into companywide Performance
    Management System

Genesis Story
  • Collaborative Improvement Model
  • PCC materials developed by QIOs
  • Learning Sessions area level Center team
    conferences, on-site learning sessions
  • Skill Development Coaching Supervision (now The
    Partner Approach), Respectful Workplace Training,
    Neighborhood Training
  • Leadership Development

Genesis HealthCare
  • The culture change story

Collaborative Improvement Model
  • Common goals and definitions
  • Learning sessions
  • Conference calls during Collaborative work
  • Final Congress

CMS/QIOs Collaborative
  • Pain Collaborative (Multi)
  • Workforce Retention (Multi)
  • Continued same format with Person-Centered Care
    (Culture Change)

Integrated into Quality Dept.
  • Common goals and definitions
  • Culture Change Self-Assessments
  • Learning sessions
  • Range from 350 - with direct care teams
  • Small pilots and on-site visits
  • Conference calls during work periods
  • Monthly Conference Calls (35-80 Centers)
  • Final Congress
  • Goals integrated into Customer Satisfaction,
    Employee Satisfaction/Retention, and Census

Culture Change Assessment Areas
  • People
  • Consistent Assignment
  • Respectful Workplace/ Coaching Approach
  • 3. Learning Circles
  • 4. Orientation
  • 5. Language
  • Environment
  • 12. Neighborhood Concept
  • 13. Noise reduction
  • 14. Safety and Independence
  • Care
  • Medication Reduction
  • Bathing
  • Night-time Routines
  • Alarm reduction
  • Dining Choices
  • Get to Know Me-I Centered Care Plans

Self-Assessment Example People
  • 1. Consistent Assignments
  • 1.1 Consistent Nurse Assistant assignments are
    in place for
  • M-F day shifts on (All/Most/Some/None) of the
  • M-F evening shifts on (All/Most/Some/None) of the
  • S-S shifts on (All/Most/Some/None) of the units.
  • 1.2 The Center has a float/back-up system to
    provide consistent replacements. (Yes/No)
  • 1.3 A team composed primarily of nurse
    assistants meets to discuss and oversee
  • (Weekly/Monthly/Quarterly/Never)
  • 1.4 Over the course of a month, a resident
    receives personal care from
  • (No more than 10 NAs/Between 10 and 20 NAs/Over
    20 NAs/Have no way of knowing)
  • 1.5. Other Notes

Culture Change Conferences
  • Sample Themes
  • Individualizing Daily Routines
  • Leading for Change
  • Patient Safety through Person-Centered Care
  • Creating Neighborhoods
  • The Spirit of Neighborhoods

Staff Directed
Staff Centered
Person Centered
Person Directed
Staff make most of the decisions with little
conscious consideration of the impact on
Staff consult residents or put themselves in
residents place while making the decisions.
Resident preferences or past patterns form basis
of decision making about some routines.
Residents make decisions every day about their
individual routines. When not capable of
articulating needs, staff honor observed
preferences and lifelong habits.
Staff begin to organize their routines in order
to accommodate resident preferencesarticulated
or observed.
Staff organize their hours, patterns and
assignments to meet resident preferences.
Residents accommodate staff much of the timebut
have some choices within existing routines and
Residents accommodate staff preferences are
expected to follow existing routines.
Continuum of Customer Orientation
Developed by Mary Tess Crotty, Genesis HealthCare
Corp, based on the model by Susan Misiorski and
Joanne Rader, distributed at the Pioneer
Institutes, 2005.
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Conference Call Topics
  • I-Centered Care Plans
  • Noise Reduction
  • Bathing Options
  • Dining Approaches
  • Strengths-Based Approaches
  • Re-engineering the Med Pass
  • Self-Scheduling
  • Personal Alarm Reduction
  • Neighborhood Development

Skill Development
  • Used PHI (Sue Misiorski and colleagues),
    developed Train the Trainer model
  • Coaching Supervision (now The Partner Approach)
    2 day program for Department Heads and Nurses
  • Respectful Workplace Training
  • Neighborhood Training
  • Pilots (Resident-Staff Learning Circles,
    Approach Coaches for behavior challenges

Leadership Development
  • Rotating through Culture Change intensives by
    Operational Area every other month,
    Administrators and DNSs attend an onsite
    learning session within the company.
  • Integrating into our long-term care strategy for
    customer experience

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Northeast Area 3 Yr Results
  • Coaching Supervision training
  • gt1,800 completed 2-day training
  • Family Satisfaction
  • 1 increase to 90 would recommend
  • Employee Satisfaction
  • 9 increase to 70 would recommend
  • Occupancy
  • .6 decrease to 91.7

  • Cultivate early adopters then recognize and
    reward them
  • Integrate into your discipline support
  • Bring leadership teams on-site to see and ask
    about change processes
  • Choose your framework everyone needs to change
    that takes time
  • Give concepts time to take root in your
    organizations language
  • Be ready to adapt and connect culture change to
    organizations priorities.

Golden Living
  • The Culture Change Story