The Paraprofessional Healthcare Institute's Coaching Supervision program has been introduced in recent years in a variety of home and residential care settings, including as part of the innovative NC Nova project that has emerged from the Better Jobs, Better Care (BJBC) initiative. I had read through the curriculum online, and felt as though I understood the basic elements, but today I had the good fortune to visit PHI's offices in the Bronx and learn about Coaching Supervision firsthand from those who are using it in their organizations, and training others to do the same. It's a remarkable program.

Seeing is believing, and after watching two scenarios acted out by skilled trainers I think I understand things now at more of a gut level (scenarios can be read in this PHI document -- opens as a .pdf). Coaching Supervision is about supervisors acquiring the skills and growing into a role that has them being in the moment, listening to workers and helping the workers to arrive at answers to challenging situations themselves. It's about bringing a certain presence to each interaction, with the supervisor staying in touch with her own emotions and habitual response patterns.

Re-reading that paragraph above, I realize it may sound a little touchy-feely, as though it could never take root in the stressful reality of many long-term care workplaces. But it is precisely what's needed in that context.

I think I failed to appreciate the extent to which poor responses to problems on the part of supervisors can cascade out into the broader climate of the organization, making those settings more stressful in the process as caregivers feel misunderstand and underappreciated. I also failed to recognize the extent to which supervisors really need these skills to be effective and grow as individuals -- to, as one person put it today, "stop managing others and learn how to manage themselves."

It's a long process, but judging from what I heard today from actual supervisors and direct caregivers who are out there using the techniques, it's worth investing the time in.

I took lots of notes during the meeting which featured more than a dozen folks from around the country. We were brought together to serve in an Advisory Committee role for PHI's newly funded multi-year initiative to implement and test Coaching Supervision (funded by The John A. Hartford Foundation and The Atlantic Philanthropies).

One thing that has stayed with me (as I sit here blogging from La Guardia Airport) is a comment by one participant, a nurse from New Hampshire. She shared a powerful story about how her colleagues are using the techniques in other parts of their lives - in their homes with their families and in other interactions in the community. That's real growth, and it shows how these skills and techniques can affect the broader society outside the immediate context of organizations engaged in culture change.

Finally, I was also struck by how modeling these behaviors among staff can be translated directly into relationships with consumers in long-term care -- creating space for them to assert ownership and direction over their lives. That's the definition of a person-directed culture in action!

You can now pre-order the newest and most comprehensive culture change resource, "Household Matters: A Good Life 'Round the Clock" by Steve Shields and LaVrene Norton.


Thanks to funding from the Commonwealth Fund, the Sunflower Foundation and the Kansas Department on Aging, Meadowlark Hills has worked with Action Pact, Inc. to create an integrated toolkit of materials and systems for use by long-term care providers (and others) with a stake in transforming the culture of long-term care in a sustainable fashion. The developers have generously given the toolkit to the Pioneer Network to distribute, with all proceeds going to further our unique mission as a non-profit organization dedicated to serving the culture change movement.

The toolkit has four major parts: Taken together, the toolkit?s components provide an explicit roadmap for how an organization can shape itself to become a resident-directed service model with a well trained, empowered, and satisfied workforce. It's really a one of a kind resource, and we are very excited at the prospect of reaching those decision-makers who can put these tools into practice and help us transform the world of long-term care.

The toolkit won't ship until August 1, but you can pre-order it HERE.

I've noticed that a lot of people use person-centered and person-directed care interchangably, and so I asked some of the leaders in the culture change world to share their thoughts on this with me.

Sue Misiorski of the Paraprofessional Healthcare Institute sent me a table that I think is very instructive:

LOW -------------- DIRECTION-------------- HIGH
Staff Directed	Staff Centered	Person Centered	Person Directed
Staff make most of the decisions with little conscious consideration of the impact on residents.	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.
Residents accommodate staff preferences and are expected to follow existing routines.	Residents accommodate staff much of the time, but have some choices within existing routines and options.	Staff begin to organize their routines in order to accommodate resident preferences - articulated or observed.	Staff organize their hours, patterns and assignments to meet resident preferences.

What are some examples of care practices in each cell?

Here's a clip from the "Getting Started" pathway at the Pioneer Institute last summer describing the importance of inclusiveness in a learning circle, and how to foster it.

You can learn more about the new activities guidelines for nursing homes today via the web: You can watch the streaming broadcast of it for up to a year by clicking here and registering (for free).