Creating Households Struggles and Successes 4 Years In: Renovation and Change The intent is to help you learn from our successes, struggles, and processes.
Presbyterian Homes Inc.
History 1993 All Private Rooms Medical Model/Hospital
Glenaire Over time Glenaire added more beds in the Health Center. Large nurses stations right in the middle Bustling/Busy hallways Does any of this look or sound familiar?
Culture Change 2011 Glenaire embarked on the journey of Culture Change. Household Model- Action Pact 20 Room Houses, Kitchen-Dining Room Center of the House A system that promotes resident engagement and choice. Emphasize Person Centered Care
Glenaire Bottom Line- Changing Culture doesn t happen over night. Operational, Nursing, Architectural, and Physical Plant/Construction input Question Where do we start??????
Should we embark on culture change? What model? Rebuild or renovate? Pros cons
Prepare for Change Don t overlook the importance of preparing your organization Are we ready/do we have capacity for change Define the vision- design goals, org goals Build a strong coalition Craft a change message Communicate, communicate, communicate Educate, educate, educate
Why does change fail or fall short? Most change management programs initiated by leaders in organizations fail.... They fail fundamentally because it is conceived as an outside-in process, moving about parts of the organization, rather than an inside-out process which focuses on change within individuals. - Kotter
Our Defined Vision & Goals Break the nursing center into households Understand the needs and desires of the people in each home Make those preferences the highest priority Re-think operational systems and architecture Re-think staff roles and functions
Craft a change message Clarify the current vs the desired state. Define what could be improved and why change is needed. Must be compelling Convince people that the change can be successful This is the right change There is support from the highest levels Address the question: What about me?
Create a Powerful Coalition Senior management throughout Middle management CNA s Nurses Housekeepers Dietary Aides Visits
Set short-term goals Eat an elephant one bite at a time Establish new leadership structures and developing new leaders Do away with tray line, implement more choice at point of service Household scheduling
Empower broad-based actions Create action teams Involve people that actually do the work involved
The Result Everyone understood the need to change and the opportunity Everyone understood what we were doing/where we were headed There was clear evidence that this can work and work well. It can deliver the results we want. Everyone knew that this was not a passing phase. This was happening People were excited and eager
What was our change message? Medical model is limiting and in some aspects harmful There is a new way. Its radical. It does work. It can work here. We can improve the lives of the people we serve. Our vision New organizational structure, explained Privacy- no more walking by rooms Deinstitutionalize More choice dining, bathing, medications, etc. Elements of home
GLENAIRE HEALTH CENTER RENOVATION Architectural Changes
Glenaire
Main Building ASSISTED LIVING INDEPENDENT LIVING APARTMENTS COMMUNITY CENTER HEALTH CARE INDEPENDENT LIVING APARTMENTS
Health Care Center 20 SNF 11 SNF 40 MUAHS (20 PER FLOOR) 20 SNF 9 AL COMMON/SERVICES COMMON/SERVICES 20 SNF
Health Care Center Dining 20 SNF 11 SNF 40 MUAHS (20 PER FLOOR) 20 SNF 9 AL SATELLITE KITCHEN TO MAIN KITCHEN 20 SNF DINING LOCATIONS
HOUSEHOLD RENOVATION
The New Households North East Central South
Existing Household Core
Typical Core Renovation Pantry Open Kitchen Living/Dining Charting Activity Room
Front Door
Nurses Station Before After
Nurses Station Before After
Kitchens Back of House Front of House
Dining Before After
Bathing Before After
Bathing Before After
Medications Before After
Resident Room Before After
Resident Bathroom Before After
HOUSEHOLD PRIVACY CHALLENGES AND SOLUTIONS
Health Care Center 20 SNF 40 MUAHS (20 PER FLOOR) 20 SNF 20 AL COMMON COMMON 20 SNF PRIVACY PROBLEM AREAS
Bypass Corridors New Rooms Bypass Corridors Offices
Bypass Corridor 1 Offices Bypass Corridor
Bypass #1 Before After
Bypass #2 Bypass Corridor 20
Bypass #2
THE TOWN SQUARE
Lobby Area Existing Plan
Town Square Activity Room Therapy Room Salon
Building Challenges Determine how to Phase the Renovation Minimize # of Rooms out of Service Optimize the Schedule
GLENAIRE HEALTH CENTER RENOVATION Building Challenges
Building Challenges Develop Phasing Plan Taking into account Interim Life Safety Measures Maintaining Clear Paths of Egress Isolate Dust & Noise with Barriers Investigate, Plan & Communicate for Temporary Loss of Services
Phasing Plan
Phasing Plan Overlay by Household Phase
Building Challenges Working in an Occupied Facility Working in someone s home! Being sensitive to work hours
Building Challenges Dealing with Existing Conditions Precon Recon!
Building Challenges With a Household complete, what s next?!
IMPLEMENTING THE HOUSEHOLD MODEL
Traditional Organization Charts Top Down Silo d Restrictive Promotes stay in your lane thinking
HEALTH SERVICES AT GLENAIRE CENTRAL HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers NORTH HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers The Glenaire Clinic SOUTH HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers COMMUNITY COUNCIL Nurse Mentors, Household Coordinators, Social Work Mentors, Staff Development Coordinator Dining Mentor, Life Enrichment Mentor, Environmental Services Mentor, Director of Nursing, and Administrator SERVICE TEAMS THERAPY SERVICES DINING SERVICE ENV L SERVICES SOCIAL WORK LIFE ENRICHMENT MAINTENANCE CENTRAL SUPPLY MEDICAL RECORDS ADMIN. SERVICES encompass WELLNESS EAST HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers ASSISTED LIVING Residents, Families Nurse Mentor Social Worker Life Enrichment Coordinator Household Nurses Lead Caregiver, Caregivers Dining and EVS staff The Glade Adult Day Program
3 Main Objectives Reframing the organization Increasing choice (renewing the spirit) Re-thinking systems
Reframing Leadership Roles Nurse mentors Household Coordinators Homemakers Job Descriptions Steering Committee Action Teams
Increased Choice Dietary Changes Medication Administration Changes Changes in "routine" schedules such as showers, sleep (am wake times and pm bedtimes), meal times Activities
Dietary Changes
Old Way Menus completed 7-14 Days In Advance Very little real choice No sights and smells of home Institutional
New way
New Way- Flexibility and Elements of Home Choice of entrée in real time Ability to cook to order- range, sandwich Cook a meal in the house Smells of home Particularly breakfast
Increased Choice Dietary Changes Medication Administration Changes Changes in "routine" schedules such as showers, sleep, meal times Activities
Activities One Household Coordinator is the activities mentor But everyone does activities Training Whiteboards- big calendar but also household specific activities
Activities Pics Training Whiteboards- big calemndar but also household specific expecations
Nursing "System" Changes Goal: Self-led teams and localized decisionmaking Household Budgets Household Scheduling MDS Completion Care Plan Process
Language Systems and Physical Plant changes are not the only important factors in Person Centered/Resident Directed care. Language enforces the "internal" change and dedication to creating/making the skilled facility a true home.
Life Happens Electronic Health records implementation New HRIS/Payroll/timekeeping system Staff changes
Questions