St. Louis Accord
Quality Partners of Rhode Island was assisted by the Pioneer Network in convening the first ever St. Louis Accord on June 8-9, 2005. The Accord brought together over 400 stakeholders from 49 states for a lively and informative meeting focused on spreading the diffusion of person-directed care in nursing homes. The various participants included representatives from the Centers for Medicare and Medicaid Services (CMS), Quality Improvement Organizations (QIOs), state survey agencies, state ombudspersons, provider associations, and consumer advocates.
The meeting was intended to foster coalition building at the state level, and by all accounts it was a resounding success. Stakeholders who had not previously worked together left the meeting with a deeper understanding of person-directed care, as well as action plans for developing their own statewide culture change coalitions. One participant offered this perspective on the value of the meeting: “We’ve got something to work with in our state coming out of this Accord, and we all seem to be on the same page about what needs to happen next.”
The Accord opened with a presentation by Dr. David Gifford, a key architect of the effort to promote culture change in the QIO’s 8th Scope of Work. Rose Marie Fagan followed with an inspiring speech that captured the forward momentum of the culture change movement. She then led the room in a roll call of states in the tradition of past Pioneer Network meetings.
Barbara Frank of B & F Associates, served as the faciltator throughout the two day gathering, and she helped establish the tone early on by sharing a moving “how we got here” story. Karen Schoeneman and Yael Harris of CMS gave spirited presentations that conveyed the federal government’s committment to culture change in long-term care.
Marguerite McLaughlin of Quality Partners in Rhode Island (the QIO that supports all QIOs nationally) presented a framework for person-directed care to illustrate the need for elders to be at the center of transformative care practices (e.g., bathing frequency, time and method), transformative workplace practices (e.g., a culture of valuing and respecting caregivers and their needs), and transformative environmental practices (e.g., the creation of sanctuary, shelter and peace that provides a sense of community and safety, free of unwanted intrusions).
David Farrell of Quality Partners presented the compelling business case for culture change. He shared the latest research on the costs of turnover and the potential for workplace redesign efforts to break the viscious cycle of caregiver strain and turnover that exists in so many settings. The participants then watched the 10 minute Better Jobs Better Care video called “Stand Up and Tell Them,” in which direct care workers describe their work and how it is and is not valued in the communities in which they live. Cathie Brady of B & F Associates and Joanne Rader of Rader Consulting then shared insights about advances in the environment and care practice domains.
The first morning concluded with thoughtful remarks by Elma Holder, founder of the National Citizens Coalition for Nursing Home Reform and the playing of “Look at Me,” an evocative song (presented with photos) about transcending the anonymity that plagues so many elders living in unreformed institutional settings.
The afternoon of the first day involved state teams working together in break-out groups to envision the possibilities for change. The participants then reconvened to hear presentations about successful state coalition activities in Colorado and Massachusetts.
A major highlight of the Accord was an inspiring evening presentation by Barry Barkan of the Live Oak Institute, introduced as the “heart of culture change.” Barry shared his personal story of creating a Regenerative Community in California over 25 years ago, and then described the need to work on culture change at multiple levels. He challenged everyone to become champions for culture change in their own communities – to be community organizers in the purest and most active sense.
Video (Quicktime)
The morning of the Accord’s second day involved a “rubber meets the road” exercise. State teams worked together using a case study of one elder’s experience in a nursing home to identify and transcend the barriers to person-directed care. The larger group then reconvened to discuss the elements of the case, and state surveyors weighed in with their perspectives on how the fictional nursing home could have behaved in a way that was both person-directed and consistent with state and federal regulations.
The meeting ended with a final state workgroup sesssion, whereby state leaders created action plans for 6 month, 12 month and 18 month goals. The action plans were submitted electronically to the organizers. Quality Partners and the Pioneer Network will continue to partner to help facilitate coalition building based on those action plans. The eighth scope of work is due to roll out in August 2005. The Pioneer Network strongly encourages nursing homes and home health agencies to contact their local QIO to learn how to work with their QIO to further their culture change efforts.
