Visiting and working with nursing homes all around the country on a regular basis gives me the opportunity to appreciate the wonderful, hardworking, and generous staff, who work there. These incredible souls continue to amaze me. Unlike other professions, they function in a dynamic and constantly changing environment lending their hearts, hankies, and expertise to comfort and care, soothe and support. On a daily basis, the constant in their lives is change.
The nature of change affects who their co-workers are from day to day, the residents – health status or earthly status, the systems of care that are being constantly tweaked and improved upon, regulations, technology, the leadership that guides; and, in some cases, even the philosophy and general ethos as new corporations take ownership of their organization. On a micro and macro level they stare change in the face and adapt to the daily mutating environment in which they serve. How do they do it?! How do they thrive in such an environment?
Watching these heroes in action provides a rather remarkable education in change and change management. The following are a list of elements that are frequently evident among those organizations and people, who seem to laugh in the face of change and face the current challenging climate with a sense of cautious optimism and excitement. These are folks with a special knack and ease with the process, who are adept at gently and firmly moving their organizations into new and changing frontiers of quality and care. Let’s take a look.
“Change Adept Settings”
It has been my observation that change seems to come more easily in settings where there is a palpable sense of purpose and deep emotional connection to the people and the work. In these settings, residents are cherished by staff and mutual affections develop making for a warm and caring climate. Call-outs and absenteeism are low because people have a sense of accountability to their friends both, residents and staff alike. Staff are proud of their accomplishments as they pursue higher levels of knowledge and skill, climb career ladders, and take on new responsibilities. In these nursing homes, you will frequently hear staff regard themselves as being part of a family.
In these “change adept settings” there’s an open regard for everyone that allows all voices to be, not only heard, but also, acted upon. People speak, voice concerns, and share better ways of doing things. There are purposefully designed structures in place that tease out these voices –learning circles and huddles, resident committees and family gatherings. Elders and their families are considered key voices in crafting meaningful daily lives and thriving organizations. The very act of creating this openness allows for creative, thoughtful, and brilliant ideas to rise. This is the change we seek! These are the ideas and brilliance that transforms organizations and care. The ethos of these settings is one of energy, inclusion, and warmth, and beats the “chaos culture” off with a stick. With its reliable, pleasant, and steady presence in place, organizations are able to move on to deep and meaningful change.
When it comes to change management, the above elements seem to be the rich soil into which the process of change can take root. This climate becomes so important to the ongoing ability to create meaningful, lasting, positive change.
The Process & Management of Change
Many organizations across the nation have a critical concern about staffing and find themselves competing, not only with the healthcare settings in their zip code, but also with the fast food restaurants, retail stores, and whatever new place just opened down the street. How can they compete, they ask?
This is where great change management skills become your secret weapon. What makes you different from the lovely, new, air conditioned, remodeled and fabulous venue with which you compete is your ability to create an environment where staff and families can be architects and co-creators of the organization. What does it take?
- Honor your Pain Points!
Pain points can be anything that gets in the way of the “Change Adept Setting” described above. Whether it’s your quality measures, staffing, or relationship with the hospital, begin to explore the data and supporting feedback so you and your team have a great sense from exactly what and where your pain is derived.
- Get input from those closest to the action!
Whatever method you use, whether learning circles, huddles, or family night, use these opportunities to hear from those who are most affected. Find out why? Keep asking the question until you have an in-depth understanding of the issues.
- Share a clearly articulated vision of what the change will look like. The vision isn’t the plan and all of the bells and whistles. The vision is what it could look like and how it can make things different.
One reason people resist change is because they are fearful of all that they will have to give up instead of being shown what they have to gain. Maybe your team has recognized that the Plexiglas wall you keep running into is the result of having reached the limits of your current organizational model. Perhaps, you have outgrown the Transformational Model in which your organization currently exists and it’s time to move to the Neighborhood Model (See Les Grant & Lavrene Norton’s awesome work: A stage model of culture change in nursing facilities http://actionpact.com/resources/articles_and_papers). Sharing a vision where people can see a better way, a better future, and an easier way to work, not only provides a sense of hope, but also recognition that we’re always searching for a way to make things better for our residents, family, and staff.
- Numerator of One
Dr. David Gifford, Sr. VP of Quality and Regulations at AHCA, would admonish us to create change in small bites. His famous quote, “start with a numerator of one –when you get better take on more.” This meant, when creating change that affects residents (e.g. letting them sleep through the night, trying new approaches for pain reduction), do it with just one person first. “Numerator of One” became a valued lesson because it offered the opportunity to tweak our systems and respond to the feedback the person or process offered.
- Celebrate your Gains
I often work with organizations that have generated astonishing, successful changes within their organizations. Invariably, they will share a long laundry list of things they have accomplished and successes they have achieved over the last few months. When I point out to them how much they did, how amazing the work, and that they have a good reason to feel exhausted, it seems to be the first time they reflected on their success. I suggest every organization have a “Wins” Board prominently placed where people can see the enormous amount of work and success that is happening, the “wins” and energy. It provides a sense that people are working on change, are committed, and care! Celebrating success is vital to change management. In fact, it carries as much weight as any other step in your change process and provides you with one more great opportunity for staff to take a bow for their hard work and efforts in creating a better life for your community.