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What is Culture and Why Change?

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What is Culture and Why Change? Tiffany Langham, RN, BSN Quality Improvement Consultant TMF Health Quality Institute * This material was prepared by TMF Health ... – PowerPoint PPT presentation

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Title: 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 activitys
    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
15
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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 DONT
    want to be there!

18
Person Directed Care Model
19
Old Culture vs. New Culture 1.
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 individuals
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 Culture 3. 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 Culture 4. 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 Culture 5. 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 Culture 6. 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 Culture 8. 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 Culture 9. 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 Culture 10. 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

36
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37
Consider the daily pleasures
  • What are some of the common irritants?
  • 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?

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
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