What's Needed Now
CommitmentPosted on Tue Jun 06, 2006 at 05:04:34 AM EST
We did a quick on-line survey of over a 100 leaders from organizations that have begun the culture change journey, and as usual the open-ended responses were most interesting. Here's a sampling:
As a leader, what one area (besides reimbursement) are you most concerned with as you seek to sustain your culture change journey?
* balancing safety with independence
* communication between facilities and regulators and families
* Family response to changing environment
* The need for corporation understanding and support to help finance and encourage all facets necessary for culture change.
* Sustaining the momentum.
* Lasting change, not only as good as the current administration.
* Regulatory and legal aspects. State and Federal regulations need to be mroe open and accepting of the diversity of change. (We cannot all fit into or under ONE set format for Culture Change...do we all have the same Lives????? no)
* Legal - tort reform and family education and understanding that life has risks, we cannot remove risk, unless we take away all choice; thus adding more choice = more risk...but the upside is beautiful.
* Achieving stabilization of workforce while teaching skills to enhance clinical outcomes.
* Find the appropriate people for the jobs
* The fact that CMS and other state regulatory entities have not fostered education and passion for culture change among all it's ranks
* TA for options or networking for ideas
* Getting staff understanding and 'buy-in'.
* Buy-in from everyone
* Workforce instability, such that teams in the early stages of their journey are most vulnerable to loss of staff and/or loss of key leadership, such the the replacement is not supportive of the culture change momentum
* people, turnover and retention of what is put into place, and overall teamwork
* Any turnover affects the team and creates new challenges
* ownership of the program by all staff.
* The continued growth and development of this process in order to sustain growth and flourish.
* Keeping the journey growing
* Including the culture change ideas and concepts in the interview, hiring, and orienatation of all new staff. Also, continuing to break down the departmental silos.
* resident/elder satisfaction/quality of care
* That true systems are in place so that when a leader leaves the culture change momentum does not falter.
* Sustaining the journey itself, is of great concern.
* The development of self-directed employees, and especially teams, who will take sustain cultural change without constant supervision.
* Creative and realistic input from the outside relative to developing culture change for a very advanced dementia population of elders.
* Nurses (not CNAs) seem to be less likely to 'Get It' when it comes to culture change. Task oriented work has been the norm and it's a tough sell.
* Leadership turnover
* Resistance to change by the dominant culture within the building.
* Getting the buy-in of the hands-on staff.
* Re-organizing staffing in the neighborhoods.
* Developing leadership skills that support and sustain change - in self and others the increasing movement away from resident outcomes in the regulatory process e.g. the new surveyor guidlines coming out rapid fire that are punative rather than assistive, causing additional staff time for documenting
* Employees motivation and sustained efforts to get there in a large way.
* Regulatory surveyors
* How to get staff to buy in to the change.
* Without a doubt, continuance. I have always been concerned about creating a self-perpetuating leadership model when it comes to culture change. This movement is bigger than me, bigger than my leadership team, bigger than my facility. This movement HAS to continue at XXXXXX if and when the current leadership team isn't here any longer.
* Maintaining momentum and creativity
* Nursing structures
* keeping the staff on target and the ability to lead while transferring the empowerment while working with the regulatory environment we have in this state
* Embedding the 'learning organization' skills deeply enough into the culture so that when the administration changes, the organization can't change back to the old paradigm.
* survey process
* the work load we expect of our CNAs and LPNs
* Orientation for new staff and ongoing support for experienced staff.
* Keeping the excitement alive
The Household Matters toolkit is designed precisely with these sustainability concerns in mind.* balancing safety with independence
* communication between facilities and regulators and families
* Family response to changing environment
* The need for corporation understanding and support to help finance and encourage all facets necessary for culture change.
* Sustaining the momentum.
* Lasting change, not only as good as the current administration.
* Regulatory and legal aspects. State and Federal regulations need to be mroe open and accepting of the diversity of change. (We cannot all fit into or under ONE set format for Culture Change...do we all have the same Lives????? no)
* Legal - tort reform and family education and understanding that life has risks, we cannot remove risk, unless we take away all choice; thus adding more choice = more risk...but the upside is beautiful.
* Achieving stabilization of workforce while teaching skills to enhance clinical outcomes.
* Find the appropriate people for the jobs
* The fact that CMS and other state regulatory entities have not fostered education and passion for culture change among all it's ranks
* TA for options or networking for ideas
* Getting staff understanding and 'buy-in'.
* Buy-in from everyone
* Workforce instability, such that teams in the early stages of their journey are most vulnerable to loss of staff and/or loss of key leadership, such the the replacement is not supportive of the culture change momentum
* people, turnover and retention of what is put into place, and overall teamwork
* Any turnover affects the team and creates new challenges
* ownership of the program by all staff.
* The continued growth and development of this process in order to sustain growth and flourish.
* Keeping the journey growing
* Including the culture change ideas and concepts in the interview, hiring, and orienatation of all new staff. Also, continuing to break down the departmental silos.
* resident/elder satisfaction/quality of care
* That true systems are in place so that when a leader leaves the culture change momentum does not falter.
* Sustaining the journey itself, is of great concern.
* The development of self-directed employees, and especially teams, who will take sustain cultural change without constant supervision.
* Creative and realistic input from the outside relative to developing culture change for a very advanced dementia population of elders.
* Nurses (not CNAs) seem to be less likely to 'Get It' when it comes to culture change. Task oriented work has been the norm and it's a tough sell.
* Leadership turnover
* Resistance to change by the dominant culture within the building.
* Getting the buy-in of the hands-on staff.
* Re-organizing staffing in the neighborhoods.
* Developing leadership skills that support and sustain change - in self and others the increasing movement away from resident outcomes in the regulatory process e.g. the new surveyor guidlines coming out rapid fire that are punative rather than assistive, causing additional staff time for documenting
* Employees motivation and sustained efforts to get there in a large way.
* Regulatory surveyors
* How to get staff to buy in to the change.
* Without a doubt, continuance. I have always been concerned about creating a self-perpetuating leadership model when it comes to culture change. This movement is bigger than me, bigger than my leadership team, bigger than my facility. This movement HAS to continue at XXXXXX if and when the current leadership team isn't here any longer.
* Maintaining momentum and creativity
* Nursing structures
* keeping the staff on target and the ability to lead while transferring the empowerment while working with the regulatory environment we have in this state
* Embedding the 'learning organization' skills deeply enough into the culture so that when the administration changes, the organization can't change back to the old paradigm.
* survey process
* the work load we expect of our CNAs and LPNs
* Orientation for new staff and ongoing support for experienced staff.
* Keeping the excitement alive
* Continually creating choice for residents
* "Management philosophy/ownership support: this support seems to fluctuate based on board direction, cash flow, staffing vacancies, etc. driven by operation. When I resist in support of culture change, I am not a team player."
* Getting started on the right foot. Rolling out the concept, getting buy in, gap analysis of both people resources and living within physical plant limitations.
* Growing additional leaders to initiate, sustain and spread change.
* Sustainable ideas and transference of the ideas to new staff - and keeping seasoned staff from going back to 'old' ways!
* time is a huge barrier, as we need time above and beyond what we already do to plan and educate and develop teams
* Understanding from local/state surveyors so that they can/will support the changes facilities are attempting to make for their residents and employees.
* "Management philosophy/ownership support: this support seems to fluctuate based on board direction, cash flow, staffing vacancies, etc. driven by operation. When I resist in support of culture change, I am not a team player."
* Getting started on the right foot. Rolling out the concept, getting buy in, gap analysis of both people resources and living within physical plant limitations.
* Growing additional leaders to initiate, sustain and spread change.
* Sustainable ideas and transference of the ideas to new staff - and keeping seasoned staff from going back to 'old' ways!
* time is a huge barrier, as we need time above and beyond what we already do to plan and educate and develop teams
* Understanding from local/state surveyors so that they can/will support the changes facilities are attempting to make for their residents and employees.
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