Why Did the Staff Cross the Road?

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Sarah Brown, RN, LNHA, BS
Executive Director of Empira

We have all heard the classic joke about why the chicken crossed the road. But why did the chicken really cross the road? Perhaps the most classic answer of all is to get to the other side. What was so enticing about the other side of the road? The answer lies within the psychology of the chicken. There was something within that particular chicken that motivated him to move, to change. For example:

  • The grass was greener on the other side.
  • He saw an opportunity on the other side.
  • Someone pushed him to the other side.
  • He saw his friends on the other side.
  • He saw another chicken that needed his help on the other side.
  • The side he was on was on fire.

In the chicken scenario there many reasons which could have motivated the chicken. The metaphor above has essential parallels to culture change and engaging staff. There are a dozen motivation theories. The key is to find ones that work for the people in your organization.

In 2011 Empira, a collaborative of aging service providers in Minnesota, successfully implemented a culture change program to improve restorative sleep in over 20 rural and metro nursing homes through a grant funded by the Minnesota Department of Health and Human Services. The Restorative Sleep Program combined nationally recognized evidence-based, sleep hygiene research studies and the application of cutting edge practices to enhance residents’ sleep. In this program Empira challenged some of the standards of practice and operational procedures for providing cares and services in skilled nursing communities. The program recognized that restorative sleep is a vital part to keeping us healthy and in turn is one of the most important gifts we can give residents to promote quality of life. With sleep in mind, practices were changed to consider all 24 hours of the resident day and how it impacts their sleep.

Undertaking a program such as the Restorative Sleep Program that extended into operations and workflow processes for all 24 hours of the day, required all staff engagement. To create a place that provided active engagement during the day and restful restorative sleep at night, all staff needed to “cross the road.” For example, several operational changes were necessary that personally affected the staff such as changes to hours, job duties, learning new technology and unlearning engrained practices.

Creating operational changes to promote restful restorative sleep meant that policies, procedures and workflows needed to be reviewed to align with the desired outcomes.  The current policies, procedures and workflows were impeding the ability for staff to change.  Staff was motivated by how their performance was measured. Changing the performance expectations meant aligning work instructions with performance measures. For example, the nursing assistants having everyone up by 7:00am and in the dining room for breakfast was no longer applauded, instead supporting residents to wake at will was.  Task-oriented Nursing Assistants needed permission and recognition of a job well done as they started to do things the new way.

Another one of the most successful motivational strategies for the Restorative Sleep Program was demonstrating WIIFM (What’s in in for me?). The program kicked off with staff education at all levels to understand the reason we needed to change. Staff gained a wealth of knowledge on how they could improve their own and their families, sleep experience. Several communities bought an actiwatch, the gold standard assessment tool for monitoring and assessing sleeping patterns, specifically for their staff to help them better understand their own sleep experience. Increasing staff awareness of the value of sleep in their own life ignited an inordinate amount of passion that resulted in creative and innovative solutions to benefit the residents.

Further more as staff became educated altruistic motivation became evident. It was great reminder of the kind of people who work in aging services. Empira often references Maya Angelou’s quote, “I did then what I knew, when I knew better, I did better.” It was humbling to see staff “do better” even when it meant they had to make personal sacrifices (i.e. changes to the hours).  Staff became some of the strongest advocates for protecting resident sleep.

Motivating and engaging staff in culture change initiatives helped to achieve outcomes far beyond initial aspirations of the program and have aided in program sustainment.