Nursing Home Culture Change - Research Paper Example

 Nursing Home Culture Change Introduction In the United States, nursing homes play vital role in delivering long term care (LTC) to people in an effective manner. However, the needs and requirements of LTC are quickly changing, and hence nursing home chains need to change their operational style so as to better meet the emerging needs of the patient care. The last few decades witnessed the emergence of a number of patient care models which intended to transform the organizational culture of nursing home care across the United States. The culture change is usually taken place through radical innovation over several years. The major culture change models developed over the years include Wellspring, Service House, Eden Alternative, and Regenerative Community. In the words of Grant (2008), these culture change models share the common goal of focusing more on ‘person-centered’ or ‘resident-directed’ care and developing new operational practices that would transform nursing home environments from an institution to home. This paper will discuss the business case for implementing nursing home culture change with particular focus given to for-profit organizations. An Overview of the Nursing Home Culture Change The culture change movement emerged in some isolated sectors of the nursing home industry during the late 1980s. At the initial stages, this movement was promoted by a variety of independent organizations. This initiative gained formal status in 2000 with the formation of the Pioneer Network and since then, the culture change movement has gradually grown in the US. The state culture change coalitions taken place in US in the recent years have greatly contributed to this movement. According to the authors like Grant (2003) that the level of feasibility of a culture change (CC) in the nursing home industry depends on some contextual factors such as leadership or organizational resources. In the view of the author, one of the major challenges associated with the culture change is that there is no common definition to describe the CC process and therefore there is limited consensus regarding the implementation of CC. Grant (2003) continues that the CC process takes place through four distinct phases of organizational change and development, including institutional model, transformational model, neighborhood model, and household model. Institutional model is a conventional medical model characterized with the absence of permanent staff assignment. Under this model, the organizational structure is hierarchical and hence neither residents nor staff is focused. The transformational model is the initial phase of culture change execution and it begins when the CC knowledge and awareness spreads among the leadership team and the direct care workers. During this stage, most of the organizations tend to employ permanent staff and to add minimalist changes to the physical environment so as to make it less institutional. The neighborhood model entirely restructures the traditional nursing style and introduces a resident-centered dining. In addition, the ‘neighborhood coordinator’ role is created during this stage. According to Grant (2003), the household model represents “self-contained living areas with 25 or fewer residents who have their own full kitchen, living room and dining room”. Here, staff duties are allocated to cross functional or self-led work teams. In addition, the traditional departments are eliminated to flatten the hierarchical organizational structure. Real life case As described by Grant (2008), the CC initiative launched by the Beverly Healthcare -one of the leading nursing home chains in the US – was the first time that a huge national level for-profit nursing home chain executed the culture change. The framed culture change is known as resident-centered care. Since this CC was implemented by a national for-profit corporation, this CC was particularly notable in the nursing home industry because all of the previous culture changes had been implemented by nonprofit organizations in limited number of nursing home facilities. The CC involved introduction of new organizational practices, resident life quality improvement, and creation of better worksite environment for staff. The organization could not achieve significant short term financial gains. However, the basic objectives of any culture change in the nursing home industry are based on long term goals. Referring to this, health care experts opine that the resident-centered care is successful today. Given the fact that the nation’s majority of nursing homes are owned or operated by for-profit organizations, the CC implemented by the Beverly Healthcare is very inspirational for the culture change movement. According to the author, this CC gave specific focus to five major areas including “permanent staff assignment, culture change awareness, informal leadership behavior, resident-directed behavior, and leadership team behavior” (Grant, 2008). It is found that the implemented CC had profound positive impacts on residents’ quality of life because this policy enhanced residents’ choice and autonomy. Better staff satisfaction and improved financial performance are some other potential benefits identified from this culture change initiative. For instance, Grant (2008) points out that RCC (resident-centered care) facilities experienced smaller increases in operating expenses than non-RCC facilities over the period 2003 -2005. Reports indicate that the governmental authorities are interested to lend funds for financing culture changes in the nursing home industry because this practice is likely to reduce the overall spending in the healthcare. As per the details, $1 million Federal package was granted to nursing home industry in Connecticut. CC Implementation in for-profit Nursing Homes Like the case of any other for-profit organization, increase in profitability or wealth maximization is the utmost objective of a for-profit nursing home facility. Hence, a for-profit nursing home is likely to create and implement a program that would improve the organization’s net profitability. Evidences suggest that a CC in the nursing home facility would contribute to the firm’s operational efficiency and market stature and thereby to profitability improvement. Today, clients’ expectations in the nursing home industry are growing and this trend necessitates the development of a holistic socio-residential model. Hence, many of the modern for-profit nursing home facilities tend to implement a culture change in order to meet the growing needs of their clients. This CC program gives specific focus to the modernization of the firm’s architectural designs. To illustrate, design of small private rooms, elimination of corridors, establishment of neighborhood living arrangements, and elimination of nursing stations are the major infrastructural features of a CC plan (Chapter 8). In a culture change environment, cluster design and nested single room design are the two primary architectural designs. Under the cluster design, small residential units are built in a large facility whereas nested single room design is a special setting where small private rooms are nested to conserve space and construction costs (Chapter 8). In addition, the CC initiative pays particular attention to the aesthetic aspects of the nursing home setting as health care professional believe that aesthetics can affect sleep, physical and mental health, and social behaviors. Other aspects like lighting, colors, and furnishings are also emphasized while planning a CC in a nursing home facility (chapter 8). Undoubtedly, change awareness spreading is vital process that has to be particularly emphasized while dealing with a CC implementation. Effective awareness spreading would assist the nursing home to manage the staff resistance to change efficiently and thereby ensure staff satisfaction and success of the change execution. Authors like Grant argue that CC process should focus not only on physical or infrastructure modifications but also on system changes. It is not possible to describe specific job requirements of an individual in a culture change organization because people’s roles are getting less differentiated under this system. In addition, a hierarchical structure cannot be suitable for a culture change facility as command is initiated by frontline workers and gone to the top management under this CC setting. For a for-profit nursing home, it is easy to improve profitability by changing the traditional care delivery practices. For this purpose, the organization has to adopt the elements of person-centered care and enriched environments. This CC implementation also involves a transformation in the management philosophy with intent to empower the associates concerned. This strategy would enable the nursing associates to design schedules in a way that residents’ needs and requirements would be adequately met. One of the most potential challenges associated with culture change implementation is that this change would not benefit a nursing home industry to experience immediate financial gains. It is clear that large for-profit organizations make investments with the objective of achieving financial gains based on quarterly performance. However, the CC process will definitely assist the for-profit nursing home facilities to attain competitive advantages in the long run. Another challenge is that most of the nursing home managements are interested to practice the hierarchical management style in order to enjoy more powers. Conclusion From the above discussion, it is clear that CC is a potential strategy for modern nursing home organizations to improve their efficiency and thereby profitability in the long run. In addition to emphasizing the needs of physical changes, experts point out that system changes are also essential to make the CC program successful. In order to implement this change effectively, organizations have to deviate from its conventional hierarchical management style and focus more on frontline workers. Furthermore, the nursing home must spread culture change awareness among its workforce because active employee cooperation is vital to manage this program effectively. References chapter 8. Effective management of Long term care facilities. Lecture notes. Department of social services. (n. d.). Governor Malloy: $1 Million Federal Grant to Improve Patient Care in Medicaid, Medicare. Retrieved from http://www.ct.gov/dss/cwp/view.asp?Q=476862&A=2345 Grant, L. A. (2008). Culture Change in a For-Profit-Nursing Home Chain: An Evaluation. The Commonwealth Fund, 85. Retrieved from http://www.commonwealthfund.org/Publications/Fund-Reports/2008/Feb/Culture-Change-in-a-For-Profit-Nursing-Home-Chain--An-Evaluation.aspx Grant, L. A. (2003). A stage model of culture change in nursing facilities. Retrieved from http://actionpact.com/assets/cache/stage-model.pdf Read More