Culture change is a topic of growing interest in long-term care, but confusion remains for many about its real meaning, especially if individuals have no firsthand knowledge of this initiative. Some believe culture change requires an increased emphasis on cultural diversity or on adopting a more professional business culture. Others think it requires extensive and expensive structural changes that result in a more appealing environment.

While those things can be part of a journey to improvement, culture change is primarily concerned with a renewed focus on the resident as the center of all activity within the long-term care setting. Initiatives do not have to be expensive or exhausting. What matters most is creating an atmosphere that empowers staff to perform their jobs in a way that demonstrates they believe the resident is the center of everything they do. True culture change is a personalized journey in each setting desiring to provide care that is individualized, respectful, and dignified. It is achieved by the collective heart of those who live and work together.

Start small

When embarking on a culture change journey, it is best to start small rather than taking on too much and becoming overwhelmed in the process. Since change is often resisted, draw in direct-care team members from the start and seek input from all levels of employees willing to share in the generation of ideas. At first our efforts might seem like baby steps, but early successes become a strong foundation for future growth. Inviting certified nursing assistants (CNAs) to participate in interdisciplinary care plan meetings in a meaningful way, not merely through their attendance, acknowledges that frontline workers know a great deal about the needs and wishes of residents. Who can speak better of the daily habits, likes and dislikes, and care needs of residents than the CNA? A first culture change step then may be as simple as arranging staffing coverage that allows a CNA as the caregiver of the resident to join the care conference and share what he or she knows and experiences daily with the individual.

Refocusing

Historically, long-term care facilities have placed their focus on tasks that must be performed and systems designed to ensure the work gets done. Culture change is primarily concerned with a renewed focus on the resident as the center of all activity within the long-term care setting. That may work for patients in a hospital, but who among us wants to spend the rest of our lives in a hospital-like setting? Culture change has generated movement away from the hospital-based medical model that dictates a day to shower, a time for meals, a time for activities, restrictive visiting hours, and a time for lights out. Long-term care facilities are re-creating their focus from the inside out, and performing an internal self-assessment is the place to start.

A baseline self-assessment achieved by an honest look at where your facility’s focus truly lies provides the information needed to begin or strengthen a culture change journey. Walk through your center and actively look at everything as if you are experiencing it for the first time. Active looking goes beyond a walk-through in which things seen daily are accepted as normal. Active looking requires special effort to examine each thing observed, questioning if it should really be that way. When exiting an elevator, see if the appearance is pleasant and homelike or is it hospital-like with medical equipment and posted memos the first things that catch one’s eye? Observe resident-staff interactions. Is there evidence of a caring attitude toward the people who live there, or do you see staff focused on completing tasks, visiting with each other, going on break, or going home? Look carefully at resident rooms, hallways, shower and tub areas, and lounges. Do they please the eye? A committed team can remove clutter and make a big difference. As you practice active looking, do you see a place you would want to live, not just based on eye-appeal, but on the interactions you observe? This initial activity will reveal opportunities for culture change initiatives and education.

‘See the reality’

After you personally complete the active looking exercise, replicate it by having your nurses and your nursing assistants view their work area in the same way. Generate discussion that helps them “see” the reality of the workspace they have helped create. Ask each of them to spend just five minutes on active looking to identify areas needing improvement, and then bring them together to discuss their findings. This activity will help you get their attention so you can begin your culture change journey together. Based on what they identify, start with a small project in an area where the team expects to have success.

Culture change requires a team effort. Nursing administration’s role is not to dictate how it must be done, but rather to encourage and facilitate the development of ideas that come from residents, nursing staff, and other departments, and then to ensure that projects remain within the boundaries of regulation and life safety codes. Regulation in reality strives to drive us to deliver person-centered care. Identify the strengths, needs, and talents of staff and residents, and use that knowledge to create warm and caring neighborhoods within the overall community that is your long-term care facility.

Enthusiasm fuels everyone’s awareness of the benefits of a culture change journey as a few quick-fix efforts create excitement for your team. Transforming the appearance of the nurses’ station from medical to homelike will make a noticeable difference. Accomplish this at minimal cost by removing the posted memos and performing an inexpensive “face-lift” for the space. Relocate medical supplies and equipment to a centralized area, such as a clean utility room, and keep the nurses’ station clutter-free. Fresh paint, wallpaper border, and tastefully hung inexpensive pictures add warmth. Many centers have replaced their nurses’ stations with furnishings that create a living room or den-like feel, yet meet the functional needs for charting space and secure record storage.

Shower and tub areas are another place to achieve an early success, as your team works together with their residents to decorate for a homelike bathing or spa experience.

Review the opportunities identified by your team members during their active looking exercise and work together to choose next efforts. Involve direct-care workers and other staff, and ask for the opinion and preferences of residents who live there. Opportunities for inexpensive initiatives are practically endless. Culture change first and foremost empowers the team to come together by placing a renewed focus on the resident as the heart and central purpose of all they do. Caring attitudes, opportunities for resident choice in daily routines and leisure activities, and empowered staff lead to improved quality of life and quality of work life. From the team’s first success, the excitement keeps the ideas flowing. By empowering staff to think in new ways and to share those thoughts, a vast untapped source of ideas is identified.

If your long-term care facility hasn’t started yet, why not join the culture change initiative by actively looking the next time you make rounds? You may be the change agent who will spark the beginning of a rewarding journey in your own corner of the world.

I Advance Senior Care

I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.

I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.