Transition Health Services Experiences Unprecedented Culture Change Success
DiariesPosted on Tue May 09, 2006 at 11:03:27 AM EST
From the diaries...Thanks to Allison Lantieri and the folks at the Institute for Caregiver Education for making culture change happen -- joe
Eldercare professionals are increasingly being made aware of the growing philosophy of Culture Change and how the concept is actively creating environments in which elders and caregivers alike are able to take pride in where they live and work. Organizations across the country are deeply embedded in this concept; however, many practicing organizations falter in one similar aspect: leading change.
The key to successful Culture Change lies in the ability of the management team to learn how to lead, manage and sustain the movement. To do this, team members must first look to themselves as change agents, and truly evaluate for themselves their leadership abilities with regard to flexibility, trust, creativity and their overall level of comfort with periods of change.
In the spring of 2002, The Institute for Caregiver Education began what would become a healthy partnership with Transition Health Services, a long term care management organization based in Flower Mound, TX. This relationship, initially emerging out of a contractual agreement to provide 16 Texas nursing homes with education programs, soon grew to become a proving ground for eldercare's hottest and most challenging shift in care--Culture Change.
Now, four years later, Transition Health Services is one of the leading culturally transformed provider organizations in the country. These homes have embraced liberalized dining, I-Format care plans, individualized bathing practices, full-time live-in animals, and neighborhood teams. Additionally, the outcomes in these Texas homes have been astonishing, and include improved surveys, increased census, reduced employee attrition and increased overall elder and team member satisfaction.
Eldercare professionals are increasingly being made aware of the growing philosophy of Culture Change and how the concept is actively creating environments in which elders and caregivers alike are able to take pride in where they live and work. Organizations across the country are deeply embedded in this concept; however, many practicing organizations falter in one similar aspect: leading change.
The key to successful Culture Change lies in the ability of the management team to learn how to lead, manage and sustain the movement. To do this, team members must first look to themselves as change agents, and truly evaluate for themselves their leadership abilities with regard to flexibility, trust, creativity and their overall level of comfort with periods of change.
In the spring of 2002, The Institute for Caregiver Education began what would become a healthy partnership with Transition Health Services, a long term care management organization based in Flower Mound, TX. This relationship, initially emerging out of a contractual agreement to provide 16 Texas nursing homes with education programs, soon grew to become a proving ground for eldercare's hottest and most challenging shift in care--Culture Change.
Now, four years later, Transition Health Services is one of the leading culturally transformed provider organizations in the country. These homes have embraced liberalized dining, I-Format care plans, individualized bathing practices, full-time live-in animals, and neighborhood teams. Additionally, the outcomes in these Texas homes have been astonishing, and include improved surveys, increased census, reduced employee attrition and increased overall elder and team member satisfaction.
In addition to providing a career path structure for nursing assistants, personal growth programs for all employees, in-services solutions and mentoring programs to these homes, the Institute for Caregiver Education also provided Culture Change training. This training has taken place in the forms of annual conferences, onsite home visits and periodic regional meetings.
Recently our team was looking back at the progress that these homes have made on their Culture Change journey--trying to pinpoint exactly what it was that made it "work." We wanted to understand--when most providers say that the biggest obstacle to successful Culture Change implementation is cost--how these homes could be so successful in a state that receives the third-lowest Medicaid reimbursement rate in the nation.Was it a clear vision of what a social model home could look like? Was it tremendous support of the regional administrators that kept these homes on track? Was it the annual conferences bringing new and innovative practices to their attention? Perhaps it was that "can do" Texas spirit that we haven't always observed in other states.
To find out, we developed a survey, asking the administrators in these homes to sit with their staff and answer a few questions. Overwhelmingly, we found, the reason that Transition's homes are so successful with Culture Change comes down to one key difference--LEADERSHIP. And not just administrator leadership in the homes, either. In many instances, we found that the most successful homes are those in which the Administrator "lets go of the reins" and entrusts initiatives to their staff.
Examples of leadership at all levels of staff emerged from these questionnaires:
To address this concern, we started to work on a project to downscale the enormous parking lot and replace it with a beautiful front lawn with seating areas, walkways, trees and gardens. We told our Regional Director, Dawn Chaney, what we were planning, and admitted that we were starting the project before we actually had the funds in place. This represented a total leap of faith on her part and on the company's part to give us the permission to go ahead, but they did. We were able to raise funds for the project, and the city of Floydada was generous with donations of labor and materials.
Today, we have a beautiful front yard that our entire community is able to enjoy. One resident in particular now spends time gardening, whereas before that opportunity did not exist."
Undoubtedly, this art of leadership, exhibited at the regional level, has had a profound effect on the success of Culture Change in these homes. When we teach repeatedly that it is our goal to break down hierarchy and departmental silos to create community, there is no better way to demonstrate this than when you have regionals who will get in there and roll up their sleeves.
In our surveys, we asked the administrators to share some of the things that they had learned while implementing social changes in their homes. Again, answers pointed to a special type of leadership--that of embodying a vision, letting go of the reins and helping to demonstrate the commitment to "make it happen."
Keri Powell, Brownfield Care and Rehabilitation's Administrator wrote, "Most of the time the staff does have better ideas and ways of doing things. They are with the residents more and know them better sometimes than we do. So they are better at introducing change to our residents."
We asked Administrators to share with us some of the most important lessons that they learned during their homes' transitions to Culture Change, and what they might tell another administrator just beginning the journey. We were pleased to see that all of the responses really focused on building a sense of shared responsibility.
Jennifer Parrish, administrator at Texoma Specialty Care, offers these words of advice, "Be patient, it won't all happen overnight. Involve the residents from the beginning. Go and observe a home with Culture Change. Ask questions of other staff that have implemented culture change. Keep their telephone number handy."
Dalworth Nursing and Rehabilitation's Administrator, Jim Gross says, "The way you treat your employees is the way they will treat the residents. Be open-minded. Be willing to let go. Demonstrate enthusiasm. Be willing to believe in the impossible. It IS possible."
The nuggets of Culture Change success stories that we have heard through this process have been truly wonderful. A combined result of leadership, flexibility, open-mindedness and risk-taking, these successes remind us daily of why we are doing this work. Jesse Barragan, PhD and Administrator of Richland Hills writes, "When I visited one of our residents in the hospital last month, she told me `I want to go home.' I thought that, as she was 94, she probably did not realize that she would be going back to a nursing home. I asked her if she knew where her home was and she replied, `Well yes, Richland Hills is my home.' "
Transition Health Services is an organization that truly embodies an effective style for leading and sustaining innovations in Culture Change. For more information on this organization, or on their partnership with the Institute for Caregiver Education, please contact the Institute at 717-263-7766.
Institute for Caregiver Education
Recently our team was looking back at the progress that these homes have made on their Culture Change journey--trying to pinpoint exactly what it was that made it "work." We wanted to understand--when most providers say that the biggest obstacle to successful Culture Change implementation is cost--how these homes could be so successful in a state that receives the third-lowest Medicaid reimbursement rate in the nation.Was it a clear vision of what a social model home could look like? Was it tremendous support of the regional administrators that kept these homes on track? Was it the annual conferences bringing new and innovative practices to their attention? Perhaps it was that "can do" Texas spirit that we haven't always observed in other states.
To find out, we developed a survey, asking the administrators in these homes to sit with their staff and answer a few questions. Overwhelmingly, we found, the reason that Transition's homes are so successful with Culture Change comes down to one key difference--LEADERSHIP. And not just administrator leadership in the homes, either. In many instances, we found that the most successful homes are those in which the Administrator "lets go of the reins" and entrusts initiatives to their staff.
Examples of leadership at all levels of staff emerged from these questionnaires:
- At Texoma Specialty Care in Denison, when the concept of "Bathing without a Battle" was introduced, it was the CNA Team Leaders that wrote the policy and procedure for it, not the Director of Nursing.
- The Housekeeping Supervisor at Lockney spearheaded the initiative to redecorate all of the resident bathrooms.
- The department heads at Richland Hills in Fort Worth have a saying, "If you have a plan, execute it."
- Direct caregivers at Kirkland Court in Amarillo facilitated a "Sunshine Squad" and they are given their own budget for employee appreciation efforts.
In numerous instances, RDOs can be found in the homes, dressed in jeans and t-shirts, painting hallways, wallpapering, landscaping--in contrast to the all too common practice of organizations that will "talk the talk" but seldom "walk the walk."
One such example of positive transition occurred at Floydada Nursing and Rehabilitation in Floydada. Sandra Seago, Floydada's Administrator writes, "When we began to introduce Culture Change and make some definite changes in our physical plant, a resident stated that she loved to sit outside on the front porch but, since the parking lot was directly in front of the building, all she had to look at was the front of cars.To address this concern, we started to work on a project to downscale the enormous parking lot and replace it with a beautiful front lawn with seating areas, walkways, trees and gardens. We told our Regional Director, Dawn Chaney, what we were planning, and admitted that we were starting the project before we actually had the funds in place. This represented a total leap of faith on her part and on the company's part to give us the permission to go ahead, but they did. We were able to raise funds for the project, and the city of Floydada was generous with donations of labor and materials.
Today, we have a beautiful front yard that our entire community is able to enjoy. One resident in particular now spends time gardening, whereas before that opportunity did not exist."
Undoubtedly, this art of leadership, exhibited at the regional level, has had a profound effect on the success of Culture Change in these homes. When we teach repeatedly that it is our goal to break down hierarchy and departmental silos to create community, there is no better way to demonstrate this than when you have regionals who will get in there and roll up their sleeves.
In our surveys, we asked the administrators to share some of the things that they had learned while implementing social changes in their homes. Again, answers pointed to a special type of leadership--that of embodying a vision, letting go of the reins and helping to demonstrate the commitment to "make it happen."
Keri Powell, Brownfield Care and Rehabilitation's Administrator wrote, "Most of the time the staff does have better ideas and ways of doing things. They are with the residents more and know them better sometimes than we do. So they are better at introducing change to our residents."
We asked Administrators to share with us some of the most important lessons that they learned during their homes' transitions to Culture Change, and what they might tell another administrator just beginning the journey. We were pleased to see that all of the responses really focused on building a sense of shared responsibility.
Jennifer Parrish, administrator at Texoma Specialty Care, offers these words of advice, "Be patient, it won't all happen overnight. Involve the residents from the beginning. Go and observe a home with Culture Change. Ask questions of other staff that have implemented culture change. Keep their telephone number handy."
Dalworth Nursing and Rehabilitation's Administrator, Jim Gross says, "The way you treat your employees is the way they will treat the residents. Be open-minded. Be willing to let go. Demonstrate enthusiasm. Be willing to believe in the impossible. It IS possible."
The nuggets of Culture Change success stories that we have heard through this process have been truly wonderful. A combined result of leadership, flexibility, open-mindedness and risk-taking, these successes remind us daily of why we are doing this work. Jesse Barragan, PhD and Administrator of Richland Hills writes, "When I visited one of our residents in the hospital last month, she told me `I want to go home.' I thought that, as she was 94, she probably did not realize that she would be going back to a nursing home. I asked her if she knew where her home was and she replied, `Well yes, Richland Hills is my home.' "
Transition Health Services is an organization that truly embodies an effective style for leading and sustaining innovations in Culture Change. For more information on this organization, or on their partnership with the Institute for Caregiver Education, please contact the Institute at 717-263-7766.
Institute for Caregiver Education
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