Creating Culture Change in Nursing Homes by Joseph J. Tomaino
Creating culture change in nursing homes is a theme you hear throughout the long term care industry. Is it a legitimate
effort to make care more homelike and person centered, or is just a fad that will pass us by? I think it is up to those of
us who are leaders in our skilled nursing facilities to answer that question. The success of culture change requires the efforts
of everyone. It can't just be the vision of the administrator, nor can it only be a grassroots effort by the direct caregivers.
The success depends upon a fully integrated effort from the very top to the very bottom.
Culture change is hard work, and I find that it is easy to be discouraged. But every time I keep pushing through and
sticking with it, I begin to see small gains that say to me that the work is worth it. It might be observing an act of kindness
by a staff member toward a nursing home resident that is beyond their job description, or getting a note from a family recognizing
our efforts, or seeing staff have an "ah ha" moment in a sharing session on making care person centered-- these are the signs
that say keep going.
Our long term care industry is regulated second only to nuclear power, and so much of our energy gets bogged down in
making sure we are always in compliance. Many of the strategies that ensure that compliance are factory-like and run counter
to creating homelike environments. Slowly, I think the regulators are recognizing this as evidenced by last year's changes
in the activities survey guidelines. We need to be careful that we don't hold onto our old paradigm of survey readiness strategies
and loose site that even the regulators are changing. This year's focus on making sure that medications are more person centered
is the next challenge-- are the meds appropriate? were non-pharmacologic strategies attempted? have efforts to reduce meds
been attempted?
This culture change business is hard work, but it is no longer an option. The long term care industry is changing for
the better, and we need to be part of making that change happen. The results may be slow, but that can be good if we make
them stick and not just be a flash in the pan fad. Just like dieting, sometimes the slow, painful route results in more sustained
success.
Joseph Tomaino is a patient care executive, educator, and consultant. Through his exciting web site,
http://www.continuingcareinsite.info, he provides practical and innovative information and products that support the cost effective provision of quality patient
care in acute, sub-acute, long term care, and home care settings. The site includes a section dedicated to promoting homelike
environments.
© Copyright, 2007 Joseph J. Tomaino, 834 Heritage Court, Yorktown Heights, NY
