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Culture Change to Person Centered Care


Culture Change to Person Centered Care Robyn I. Stone, DrPH Executive Director, Center for Applied Research (formerly IFAS) Senior Vice President, LeadingAge ... – PowerPoint PPT presentation

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Title: Culture Change to Person Centered Care

Culture Change to Person Centered Care
  • Robyn I. Stone, DrPH
  • Executive Director, Center for Applied Research
    (formerly IFAS)
  • Senior Vice President, LeadingAge (formerly
  • The Oklahoma Association of Homes and Services
  • for the Aging (OKAHSA) Annual Meeting
  • Midwest City, OK
  • March 8, 2011

Three Inter-Related Areas of Activity
Continuous Quality Improvement
Person-Centered Care
Workforce Improvement
What is Person Centered Care?
  • "Culture change" is the common name given to the
    national movement for the transformation of older
    adult services, based on person-directed values
    and practices where the voices of elders and
    those working with them are considered and
    respected. Core person-directed values are
    choice, dignity, respect, self-determination and
    purposeful living.
  • -Pioneer Network

What is Person Centered Care?
  • Person centered care is a philosophy of care that
    requires thinking about and planning with and for
    people who require assistance in their daily
    lives and providing that assistance in such a way
    that the person is honored and valued and is not
    lost in the tasks of care giving. The emphasis of
    care is on well-being and quality of life as
    defined by the person.
  • -Better Jobs Better Care, Institute for the
    Future of Aging Services, AAHSA

How is Person Centered Care Different?
  • A person centered care approach acknowledges and
    accepts each resident as a whole person, and
    provides moral and ethical development of staff.
    Person centered care can transform the work place
    into a positive enriching social and learning
    environment that enhances the quality of life for
    staff, residents and family/support system.

  • The uniqueness of an organization or an
  • Its personality
  • The way an organization/institution does things
  • The values, the lifestyle, the goals which are
    peculiar to an organization or an institution

A Thought
  • I've learned that people will forget what you
    said, people will forget what you did, but people
    will never forget how you made them feel.
  • -Maya Angelou

Its all about..Relationships
  • People who had close relationships with their
    caregivers retained more mind and brain function
    over time than people who were not close to their
    caregivers. It is unclear why further research
    is planned but closer caregivers may provide
    better supportive and overall health care. Also,
    Alzheimers patients whose caregivers feel closer
    to them may be less prone to depression and have
    a better quality of life. -Constantine Lyketsos,
    MD, MHS, Elizabeth Plan Althouse Professor in
    Alzheimers Disease Research and director, Johns
  • Hopkins Memory and Alzheimers Treatment Center

Person Centered Community
  • A person centered community
  • is a place where
  • residents want to live
  • personnel want to work
  • both choose to stay

Person Centered Communities
  • Person centered communities foster a culture that
  • Autonomy
  • Diversity
  • Individual choice

Person Centered Communities
  • Leadership
  • cultivates relationships among residents,
    families/support systems, and personnel
  • commits to responsiveness, spontaneity, and
    continuous learning and growth.
  • Residents and Personnel
  • celebrate the cycles of life
  • connect to the local community
  • continue relationships
  • nurture the quality of everyday life

Person Centered Communities
  • Residents
  • experts regarding life in their home
  • participate in deciding about
  • rhythm of their day
  • services provided
  • issues that are important to them
  • family/support systems are welcomed

Person Centered Communities
  • Personnel
  • partner with residents and their families/support
  • understand
  • what services residents want
  • how the services should be delivered
  • how they can help in their home

Elements of Person Centered Care
  • Personhood
  • Knowing the person
  • Maximizing choice and autonomy
  • Quality care
  • Nurturing relationships
  • Support physical and organizational environment

Stage Model of Culture Change in Nursing Homes
  • Institutional Model
  • Transformational Model
  • Neighborhood Model
  • Household Model
  • Leslie Grant and Laverne Norton

Changes in Resident-Directed Decision Making
  • More dependent on group process
  • Decisional control more resident-centered
  • Input is real, not symbolic

Changes in Staffing Roles
  • Staff assignment becomes more permanent and
  • Staff works autonomously in smaller
    multidisciplinary work teams
  • Hierarchical structure is flattened
  • Cross-trained staff with blended roles
  • Universal worker

Changes in Physical Environment
  • Size of functional areas become smaller
  • More personalized and self-contained
  • Common dining room for household
  • Elimination of nursing station med carts

Changes in Organizational Design
  • Elimination of departmental silos
  • Traditional structure disappears
  • Empowerment of frontline staff
  • Shared decision making
  • Choice prevails

Changes in Leadership Practices
  • Composition of leadership team changes not top
  • Leadership is decentralized, autonomous,
  • Conflict management skills fully operationalized
  • Empowerment of indigenous leaders
  • Supervisors Coaches
  • Learning organization

Person Centered Care Implementation
  • Provides flexibility according to residents
    needs, desires and preferences
  • Staff at all levels from all departments engages
    in design
  • Viewed as part of core mission, not as a project
  • Systems to support practice changes (ongoing
    education, policies procedures, job

Best Practice Initiative (BPI)
  • Partnership between OHSU the state of Oregon
  • Technical team with expertise in person-centered
  • Periodic education retreats
  • Individualized coaching for each facility

Exemplary BPI Facilities
  • Incorporated person-centered care into policies
    and procedures
  • Changed job descriptions
  • Changed assessment tools and care plans
  • Emphasis on communication with individuals

Exemplary BPI Facilities cont.
  • Family members enlisted
  • More flexibility in care to honor individual
    preferences and rituals
  • Full direct care staff involvement

Infusing our Philosophy Into Every Interaction
  • Leadership
  • Chief Culture Officer
  • Administrator
  • Household Coordinators
  • Processes Support our philosophy, not a
  • Emphasis on Employee Education
  • Peer to Peer interaction Evidence-based programs

Challenges to Culture Change
  • The Were Already Doing It Syndrome
  • Restructuring the Workforce
  • Maintaining Momentum

  • A calm sea never makes a skilled sailor.
  • Anonymous

  • Keep it very simple
  • Get staff on board with how this can help
  • Measure before you begin, during and after you
    implement quality improvement efforts
  • Dont collect more data take a hard look at
    what you collect to ensure that it brings value
  • Integrate business and service delivery
  • Set realistic/achievable targets

State Motivation
  • States reactive rather than proactive
  • Concern about shortage of workers and growing
    older adult population
  • Introduction to culture change models
  • Reaction to negative press about poor quality of
    care in nursing homes

Types of Magnitude of State Investments
  • CMP dollars
  • Legislative funding
  • Medicaid
  • Discretionary grants
  • In-kind time

Approaches to Culture Change Initiatives
  • Workforce improvement
  • Person-centered care
  • Continuous quality improvement

Workforce Improvement Activities
  • Legislative action mandated studies,
    appropriated funds and task forces
  • Training, career ladders/career lattices
  • Incentives or recognition to improve the
  • In-kind time on coalitions, committees and task

Person-Centered Care Activities
  • Education of surveyors or the review of
    regulation related to culture change
  • Training and education on person-centered care
  • Rewards and recognitions to providers that
    initiated person-centered care
  • Grants or financial incentives to providers to
    implement culture change activities
  • Coalitions/committees

Continuous Quality Improvement
  • Use of survey data to inform decisions

Cross-Cutting Themes
  • Integration of activities coordination across
  • Perceived regulatory barriers review of
    regulations consultation
  • Expanding relationships across stakeholders
    integral to culture change
  • Obstacle uncertainty about funding
  • State legislators less directly involved than
    executive branch

Moving Toward Smart Regulation and Partnership
  • Balance between traditional regulatory approach
    and a more partnership model
  • Organizational structure for partnership model
    and providing technical assistance
  • Training to prepare surveyors providers
  • Regulatory agency staff, nursing home staff,
    consumer advocates and residents and families -
    brought into process and assume responsibility
    for implementation

Strategic Planning
  • We did the best we could with what we knew, when
    we knew better, we did better
  • -Maya Angelou