Culture Change
to
Person Centered Care
Robyn I. Stone, DrPH
Executive Director, Center for Applied Research (formerly IFAS)
Senior Vice President, LeadingAge (formerly AAHSA)
The Oklahoma Association of Homes and Services
for the Aging (OKAHSA) Annual Meeting
Midwest City, OK
March 8, 2011
Three Inter-Related Areas of
Activity
PersonCentered
Care
Continuous
Quality
Improvement
Workforce
Improvement
What is Person Centered
Care?
"Culture change" is the common name given to the
national movement for the transformation of older adult
services, based on person-directed values and practices
where the voices of elders and those working with them
are considered and respected. Core person-directed
values are choice, dignity, respect, self-determination
and purposeful living.
-Pioneer Network
What is Person Centered
Care?
Person centered care is a philosophy of care that
requires thinking about and planning with and for
people who require assistance in their daily lives and
providing that assistance in such a way that the
person is honored and valued and is not lost in the
tasks of care giving. The emphasis of care is on wellbeing and quality of life as defined by the person.
-Better Jobs Better Care, Institute for the
Future of Aging Services, AAHSA
How is Person Centered
Care Different?
A person centered care approach acknowledges and
accepts each resident as a whole person, and
provides moral and ethical development of staff.
Person centered care can transform the work place
into a positive enriching social and learning
environment that enhances the quality of life for
staff, residents and family/support system.
Culture
• The uniqueness of an organization or an
institution
• Its “personality”
• The way an organization/institution does things
• The values, the lifestyle, the goals which are
peculiar to an organization or an institution
A Thought
I've learned that people will forget what you said,
people will forget what you did, but people will
never forget how you made them feel.
-Maya Angelou
It’s all
about…..Relationships
Relationships
People who had close relationships with their
caregivers retained more mind and brain function
over time than people who were not close to their
caregivers. It is unclear why – further research is
planned – but closer caregivers may provide better
supportive and overall health care. Also, Alzheimer’s
patients whose caregivers feel closer to them may be
less prone to depression and have a better quality of
life.
-Constantine Lyketsos, MD, MHS, Elizabeth Plan Althouse
Professor in Alzheimer’s Disease Research and director, Johns
Hopkins Memory and Alzheimer’s Treatment Center
Person Centered
Community
A person centered community
is a place where:
 residents want to live
 personnel want to work
 both choose to stay
Person Centered
Communities
Person centered communities foster a culture that
supports:
Autonomy
Diversity
Individual choice
Person Centered
Communities
•Leadership:
 cultivates relationships among residents,
families/support systems, and personnel
 commits to responsiveness, spontaneity, and continuous
learning and growth.
•Residents and Personnel:
 celebrate the cycles of life
 connect to the local community
 continue relationships
 nurture the quality of everyday life
Person Centered
Communities
• Residents:
experts regarding life in their home
participate in deciding about:
• rhythm of their day
• services provided
• issues that are important to them
family/support systems are welcomed
Person Centered
Communities
• Personnel:
partner with residents and their
families/support systems
understand:
• what services residents want
• how the services should be delivered
• how they can help in their home
Elements of Person
Centered Care
•
•
•
•
•
•
Personhood
Knowing the person
Maximizing choice and autonomy
Quality care
Nurturing relationships
Support physical and organizational environment
Stage Model of Culture
Change in Nursing Homes
I. Institutional Model
II. Transformational Model
III. Neighborhood Model
IV. Household Model
Leslie Grant and Laverne Norton
Changes in ResidentDirected Decision Making
• More dependent on group process
• Decisional control more resident-centered
• Input is real, not symbolic
Changes in Staffing Roles
• Staff assignment becomes more permanent and
consistent
• Staff works autonomously in smaller
multidisciplinary work teams
• Hierarchical structure is flattened
• Cross-trained staff with blended roles
• Universal worker
Changes in Physical
Environment
•
•
•
•
Size of functional areas become smaller
More personalized and self-contained
Common dining room for household
Elimination of nursing station & med carts
Changes in
Organizational Design
•
•
•
•
•
Elimination of departmental silos
Traditional structure disappears
Empowerment of frontline staff
Shared decision making
Choice prevails
Changes in Leadership
Practices
• Composition of leadership team changes – not top
down
• Leadership is decentralized, autonomous,
multidisciplinary
• Conflict management skills fully operationalized
• Empowerment of indigenous leaders
• Supervisors = Coaches
• Learning organization
Person Centered Care
Implementation
• Provides flexibility according to residents needs,
desires and preferences
• Staff at all levels from all departments engages in
design
• Viewed as part of core mission, not as a project
• Systems to support practice changes (ongoing
education, policies & procedures, job descriptions)
Best Practice Initiative
(BPI)
• Partnership between OHSU & the state of Oregon
• Technical team with expertise in person-centered
planning
• Periodic education retreats
• Individualized coaching for each facility
Exemplary BPI Facilities
• Incorporated person-centered care into policies
and procedures
• Changed job descriptions
• Changed assessment tools and care plans
• Emphasis on communication with individuals
Exemplary BPI Facilities cont.
• Family members enlisted
• More flexibility in care to honor individual
preferences and rituals
• Full direct care staff involvement
Infusing our Philosophy Into
Every Interaction
• Leadership:
 Chief Culture Officer
 Administrator
 Household Coordinators
• Processes Support our philosophy, not a substitute
• Emphasis on Employee Education
• Peer to Peer interaction: Evidence-based
programs
Challenges to
Culture Change
• The “We’re Already Doing It” Syndrome
• Restructuring the Workforce
• Maintaining Momentum
“A calm sea never makes a skilled sailor.”
» Anonymous
Tips
• Keep it very simple
• Get staff on board with how this can help
• Measure before you begin, during and after you
implement quality improvement efforts
• Don’t collect more data – take a hard look at what
you collect to ensure that it brings value
• Integrate business and service delivery
• Set realistic/achievable targets
State Motivation
• States reactive rather than proactive
• Concern about shortage of workers and growing
older adult population
• Introduction to culture change models
• Reaction to negative press about poor quality of
care in nursing homes
Types of Magnitude of
State Investments
•
•
•
•
•
CMP dollars
Legislative funding
Medicaid
Discretionary grants
In-kind time
Approaches to Culture
Change Initiatives
• Workforce improvement
• Person-centered care
• Continuous quality improvement
Workforce Improvement
Activities
• Legislative action – mandated studies, appropriated
funds and task forces
• Training, career ladders/career lattices
• Incentives or recognition to improve the workplace
• In-kind time on coalitions, committees and task
forces
Person-Centered Care
Activities
• Education of surveyors or the review of regulation
related to culture change
• Training and education on person-centered care
• Rewards and recognitions to providers that
initiated person-centered care
• Grants or financial incentives to providers to
implement culture change activities
• Coalitions/committees
Continuous Quality
Improvement
• Use of survey data to inform decisions
Cross-Cutting Themes
• Integration of activities & coordination across
departments
• Perceived regulatory barriers & review of
regulations; consultation
• Expanding relationships across stakeholders
integral to culture change
• Obstacle – uncertainty about funding
• State legislators less directly involved than executive
branch
Moving Toward “Smart”
Regulation and Partnership
Model
• Balance between traditional regulatory approach
and a more partnership model
• Organizational structure for partnership model and
providing technical assistance
• Training to prepare surveyors & providers
• Regulatory agency staff, nursing home staff,
consumer advocates and residents and families brought into process and assume responsibility for
implementation
Strategic Planning
“We did the best we could with what we knew,
when we knew better, we did better”
-Maya Angelou