What’s culture change got to do with it? Everything!

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Ruta Kadonoff, Executive Director

If you work in or around nursing homes, your world has been buzzing over the last few days with talk of the final rule, the first major revisions to the nursing home Requirements of Participation since the Nursing Home Reform Act of 1987 (aka OBRA ’87).
The final rule includes significant provisions that can have a positive impact on the nursing home experience.  It compels a more person-centered approach, explicitly articulating requirements around engaging residents and direct care staff and calling on nursing homes to honor resident choice in ways not previously detailed in Federal regulations.
Pioneer Network is the leading national champion for provision of care and services consistent with the CMS definition of person-centered care, articulated in the final rule as, “to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives.”  For making this a clear and unambiguous expectation of all nursing homes in the country, incorporating changes we at Pioneer Network have advocated for years, we say, “Bravo, CMS!”
Now, of course, comes what may be the more difficult phase of regulatory change — developing the detailed guidance that thousands of surveyors across the nation will use to judge whether or not each requirement is indeed being met by each nursing home they survey.  The Pioneer Network team looks forward to partnering with CMS to help ensure that the full intent of the regulatory language can be realized in each nursing home, for each resident, every day.
The hard work of implementing practice changes consistent with these new requirements rests on the shoulders of leaders in the 15,000+ nursing homes in the United States.  If you are one of them and are feeling a bit overwhelmed, we are here to help.  Our tools and resources can help you make organizational changes that foster person-centered care.  Stay tuned — in the coming weeks and months, we will highlight specifics of the new requirements and walk you through using our resources to prepare your organization to meet the mandate as these requirements take effect over the next three years.
Now, a few words about an aspect of the final rule that has drawn extensive attention from the media and interest groups.  In a hotly-debated provision, the rule bans the use of “pre-dispute agreements for binding arbitration,” that are often part of admission contracts.  Pioneer Network has not taken a position for or against this provision. However, it presents another opportunity to reflect on the importance of culture change and to highlight one of our core values — “Relationship is the fundamental building block of a transformed culture.”
The topic of nursing home lawsuits sparks strong emotions. While there is little research specific to the nursing home environment, I firmly believe that organizational culture change and person-centered care are among the best risk management strategies any health care provider can employ.  Based on personal experiences with the health care system, as patient and as family member, I would say that the more energy an organization devotes to building positive relationships and an environment of shared goals, compassion and quality of life, the less likely I would ever be to consider legal action in the event something inadvertently went wrong.  Consider your own experiences — does this ring true for you, too?
As human beings, we are more willing to forgive mistakes if we believe the person(s) that made them acted with good intentions.  If we believe that staff, management, and owners or operators know and truly care about us, or our mom or dad, and are doing the very best that they can, we are more likely to accept that bad things sometimes happen to good people.
On the flip side, a culture where leaders and staff are not perceived as caring partners — regardless of how good their underlying intentions may actually be — invites formal complaints and law suits, even when the organization may have done everything considered correct or good practice in a “buy the book” sense.  In an ironic twist, those most vigilant about keeping their guard up and maintaining a defensive posture may be the most likely targets — precisely because that approach erects walls between staff, leadership, residents and families rather than building the bridges to create collaborative partnerships that say “we’re in this together — how can we make it as good as it can be?”

I invite you to consider this perspective as you think about how the arbitration rules may impact your organization’s operations, your expectations of staff, and your relationships with residents and families.  Try it on and see if it fits for you… For more on the specifics of building constructive relationships, check out our October Hot Topics webinar, Family Matters: Creating Person-Centered Care Partners.