< Culture Change

The 3 R’s: Reframing

On the road to culture change, like any road, it is good to have a guide who knows the road, who walks it everyday. That person can help you navigate turns, tell you where a branch has blocked the road, and point out the most spectacular views. This is why re-framing, or flattening out the organizational structure and moving the leadership closer to the elders, puts the movement toward change on the right path. Staff and elders know better than anyone else what works well in their lives and what they would like to see changed.

"The management structure has flattened out quite a bit to include those who have to support the decisions that are made," says Brett Dewolf of Halcyon House, where he is Director of Environmental Services. "The staff, in many ways, manage themselves." Meetings at Halcyon House include CNAs, CMAs, activities staff, maintenance and a mix of all departments. With everyone involved, Dewolf says that the staff now understands money issues and how things need to be budgeted. With everyone taking part in the decision making process, he admits the process has slowed somewhat but once decisions are made, they are fully supported by everyone. So, it works out better in the long run.

Raeline Evenson, Executive Director at Dorchester Health and Rehab, agrees. "It's much more than managers trying to make changes. It's staff looking out of the box and working through problems."

Understanding elders' needs is a key ingredient for successful decisions. At Perham Memorial Hospital and Home, each household has a "household coordinator," much like "house mothers" on college campuses. This person's job is to really know the residents and to keep a focus on quality of life. "All the staff were enthusiastic about change," recalls Marilyn Oelfke, Perham's Senior Director of Long-term Care Services. "They knew the key was that they knew the residents well enough to make the model work. That said to me that they understood the process."

"I told everybody, 'We're not backing away. We're going to do this'," Oelfke says. It's this sort of commitment that keeps the process going.

The universal or versatile worker is a staff member who takes on many facets of the work in the facility. CNAs will often take on dietary, activity and/or housekeeping responsibilities while the staff who hold those jobs often get CNA training. Many facilities are moving toward this model as a means to help their staff do what needs to be done to maintain the home while freeing them up a bit to have genuine relationships and give better quality of life to the residents.

At Perham, staff takes on the role of "homemaker," cleaning house, ensuring the kitchen remains stocked and the elders are happy and engaged. "You can work the way you would at home," Oelfke says. "You pick up as you go along, throw a load of laundry in as you go down the hall. The staff doesn't have specific assignments. They all work together to make it work."

Staff getting assigned to work with the same residents all the time is a necessity in this new world and results in deep familiarity among the caregivers and elders. Everyone is more comfortable and residents and staff have an opportunity to give genuine caring to each other.

Dewolf has found that staff are happier with their jobs as versatile workers. "You can be more than a CNA. You don't have to just come to work and go home," he says. "People have seen that their jobs can be so much more."

As an example, Dewolf tells a story of Dave, a maintenance worker at Halcyon House. Dave was on call one weekend and ended up working primarily in dietary. "How do we produce more Daves?" Dewolf asks. "He is a universal worker. His job is taking care of the residents, not just doing his work in maintenance."

Of course, some staff members are apprehensive about moving to the universal worker model. "It's scary to go off into the unknown. There were nurses who had been here 30 plus years [in the old system]," Dewolf says. However, there are often unforeseen benefits once the bridge is crossed.

"The staff is more relaxed now," Oelfke says. "CNAs were stressed out before they even walked in the door before. Now they have more time to enjoy the residents because the routine has been spread out." There was concern that some of the fun the staff and residents had would be lost with the change. But, Oelfke says it hasn't proven true at all. A CNA who has worked at Perham for over 25 years was nervous about the change. She has really blossomed in the new model, wearing crazy hats and getting more involved with the elders. Oelfke concludes, "We've found in terms of what needs to be done, we can not only get it done, but actually do it better."