Culture Change Now! is Action Pact's twice-yearly periodical for long term care professionals interested in Culture Change. It is filled with how-to information and articles of inspiration. All levels of staff and families will will enjoy the only publication solely dedicated to culture change!

There is no cookie-cutter model for culture change; every nursing home must choose for itself what works best in its own unique environment. But there is a replicable process of establishing a shared vision and moving forward as an organization to create a home for elders. The process includes six phases: the study circle, the design team, skills assessment and development, team development, implementation and evaluation.

Phase 1 - The Study Circle: Plan to spend up to a year assessing your organization's readiness for change and investigating the types of social models that exist in long-term care and other professions.

A successful culture change journey requires high involvement by many kinds of stakeholders, including all staff and as many residents, family and community members as you can engage. Begin by creating a study circle with a small group of leadership then gradually increase participation of board, staff and informal leaders among residents, families and the broader community.

Break the circle into smaller groups and assign each to study a particular issue or area of concern. What each group learns is reported at regular meetings with the entire, ever-expanding circle.

Tour other nursing homes that have gone through culture change to gather ideas and a vision for your own journey. As you look outside your organization for alternative models, also look inward at Quality Indicators to evaluate current practices, establish baseline data and consider new possibilities. Also, it is a good time to survey and interview staff, residents and family members about what "home" means to them.

Phase 2 - The Design Team: During this phase, you determine what changes are possible given your financial resources and unique organizational characteristics. Some organizations will want to consider new construction or renovation. Others will not have these options, but can make low-cost changes in the organization to empower staff and bring decision making closer to residents.

Two general principles should guide your team in determining what changes to make: small is better and community is vital. You may have a large nursing home, but you can divide the environment to feel smaller and bring people together.

Your design must retain regulatory compliance, so keep regulators apprised of your plans and seek their input.

Phase 2 tasks include:

1. Assembling the design team, making sure all stakeholders are represented and that staff, residents and family members are informed. Shape a purpose for the team reflecting its members' hopes for the project and their vision of the type of care environment they want for their parents and themselves as elders.
2. Reviewing or developing your mission and vision statements, ensuring they are compatible with your organization's new goals. This is another opportunity to get everyone involved.
3. Developing plans for any construction or renovation that may be part of your culture change journey. Work to sensitize architects and contractors to the special needs of elders.
4. Determining how best to structure your organization so it is as supportive of staff as of the residents. Proven methods include moving leadership as close as possible to the elders by creating self-directed work teams, cross-training workers, eliminating departmental barriers, flattening the organizational chart and permanently assigning staff to a particular resident "neighborhood" or "household". Additional options to consider are to place non-nursing personnel into coordinator positions within these neighborhoods or households, and to give workers more choices by creating flexible staffing schedules.

Phase 3 - Skills Assessment and Development: Ensure that everyone in your organization has the skills and attitudes to bring the culture change vision to fruition. The key is to create a learning climate where leaders are inspired to help others learn and grow.

Assess existing skills and interests and define those needed in the new world you are creating. Training for culture change happens in all formats‹in classrooms, small groups and one-on-one. Training materials may be acquired either from outside consultants or by developing them from resources you already have.

Phase 4 - Team Development: If your design incorporates a household, neighborhood or cluster model, begin as soon as possible to identify future team members so they may begin working together and with residents.

Phase 5 - Implementation: This phase begins when design decisions begin to be actualized in staff training and in new job descriptions, work assignments, reporting structures, policies and procedures.

It is when all of the innumerable questions not dealt with in the design phase come back to confront you: What terminology will you use to describe the new environment and the people who live and work there? What about job descriptions - will you use a universal worker model or blend roles? Will you expect or encourage all staff to become C.N.A. certified? How will nurses, non-nursing care services, ancillary staff and department directors be integrated into the new model? How, when, where and to whom will meals be served? Will diets be liberalized? Will there be household coordinators, and if so, who will fill those positions?

The implementation phase is the final dividing line between the old way and the new. When you cross that line, you want everyone in your organization stepping over together, hand-in-hand.

Phase 6 - Evaluation: This phase returns you to the beginning of your journey, the Study Circle, when you established baseline data for all Continuous Quality Improvement indicators. That data is now compared with new data tracked from clinical outcomes, infection control, customer satisfaction, human resources, regulatory compliance, safety/risk management and financial management indicators.

Make a priority commitment to correct and improve any deficiencies‹there is no compromise on quality inherent in this journey.

In the neighborhood model, everybody shares responsibility for all outcomes of living and working together. This charges all staff with additional accountability for outcomes, but also obliges the organization to ensure staff is adequately educated and supported in their new responsibilities.

Whether the evaluation is conducted with help from an external evaluator or internally within the parameters of your organization's Continuous Quality Management process, the results will bring focus to achieving positive outcomes in both quality of care and quality of life for residents and staff.