Keeping the customer merely satisfied doesn't quite cut it for the staff at Leelanau Memorial Health Care Center in Northport,
MI. Here, workers in the Center's nursing home are taking quality of care to the next level. "We want to go past the satisfaction
piece.. our mission is to delight our residents," says Jayne Bull, Center Head Coach/Administrator, "and improve the health of the
community.. that's what the staff says we are about."
The mission is indicative of the culture change that has transformed Leelanau's top-down management structure to one that is
team-based, and its workers into an empowered, cohesive work unit over the last four years.
The change has brought dramatic outcomes for both elders and staff. Resident weight loss and skin breakdown have essentially
been eliminated. Depression is suffered by so few elders, says Bull, that "A Joint Commission surveyor was concerned about our low
usage rate of anti-depressants for long term care.. she had trouble believing we don't have more depression." Residents in the
last stages of dementia seldom end their days bed-bound. "Most are walking up until the end and eating on their own," she adds.
Turnover for employees has dropped from 78% to under 20%, and wages have gone from substandard to well above average since Bull
left retirement to become Administrator in November, 1996. Ever since, Leelanau has been a trailblazer in culture change, becoming
the first nursing home in Michigan to implement the Baldrige Criteria for Performance Excellence and the Eden Alternative, and
likely the first in the nation to become registered as an International Standards Organization (ISO) 9001. All these disciplines
have played an important role in Leelanau's evolution.
It was Bull's desire to experiment with the Baldrige Criteria that pulled her from retirement. Named for Malcolm Baldrige, U.S.
Secretary of Commerce from 1981 to 1987, the Criteria are designed to help organizations enhance their competitiveness by focusing
on ever-improved quality for customers and overall organizational performance.
Before she agreed to take the position, she asked the Leelanau Board of Directors if they were interested in making quality the
driving strategy. They were. Her first task as Administrator was to assess the Care Center using the Baldrige Criteria. Two
things were immediately apparent: staff turnover was "horrendous" and workers lacked empowerment in terms of feeling responsibility
or having the authority to make decisions. A common comment from employees was, "That's not my job."
"Over the next couple of years, we helped them realize that not only is [decision making] their job, but it is the expectation,"
says Bull. An immediate hurdle was the employees' lack of decision-making skills. Bull established four parameters to guide them:
if it delights the customer, has a neutral or positive impact on the bottom line, does not violate regulations and does not affect
other stakeholders, then the employee is responsible for making the decision and for its consequences.
Decision-making began gravitating to the employees with the restructuring that followed just weeks after Bull's arrival. The
management hierarchy was flattened, directors and managers became coaches and coordinators, and the staff was reorganized into
cross-functional teams. Her new role as Head Coach/Administrator, says Bull, is to facilitate and educate.
Today, residents are cared for by self-directed teams consisting not only of nursing staff, but also of workers from nearly
every department. Housekeepers, activity workers and other non-nursing or therapy staff are trained as nursing assistants,
allowing them to step out of the traditional boxes of their job titles to better serve the immediate needs of the residents.
A multidisciplinary team facilitated by Resident Care Coordinators design the individual resident care plans with input from the
residents, their families and representatives from all the various departments, as well as from physicians, pharmacist and mental
health providers outside of the nursing home. Team Coaches and Coordinators are key to helping empower employees in making
front-line decisions.
"It's not a matter of telling somebody 'no, this isn't a good idea'," Kathy Garthe says of her role as Coach of Inpatient
Services, "it's helping others see what the vision is, and then letting them assess whether their action supports the vision."
Implementing change at Leelanau is an ongoing process, a day-to-day conversation with employees to learn what's important to them,
then acting on what they say, says Bull.
Affinity diagrams are one of the practical means used to gather employee input. Employees are given stick pads and asked to write
down the most important things they believe make Leelanau a good place to work and what is needed for improvement. The Coaches
group and categorize the slips of paper, and the ideas that emerge become part of the human resources plan.
Leelanau's mission and vision statements are instrumental in defining the way the home's culture is evolving, and both are the
result of ideas gleaned from the workers, says Bull. Implementing The Eden Alternative was helpful in writing the vision
statement, which is simply to create a place where everyone can grow and thrive. Concise and all-encompassing, the vision gives
permission to do things with people we never could before, she says, like implementing English as a Second Language or a wellness
program for workers. She credits The Eden Alternative with enabling a more rapid culture change at Leelanau because it comes
already packaged.
To ensure quality control in their new care-giving model, Leelanau turned to the ISO 9001, a series of international standards
for establishing and maintaining consistency in a company's quality management system. ISO guidelines were useful in establishing
the nursing home's policies and procedures and internal auditing process. The former is derived from a system of controlled record
keeping, ensuring that employees have only the most up-to-date procedures that are geared to the residents' individual needs.
Rather than sitting on a shelf collecting dust, says Bull, the policies and procedures are living, breathing documents created by
the workers and easily understood "so that you can pull out the book, follow the process and be confident you are doing the right
thing."
Fourteen employees are trained as auditors through the ISO program and continually monitor the Care Center to ensure that
procedures are followed. ISO 9001, the Baldrige Criteria and The Eden Alternative all have been important steps toward meaningful
culture change at Leelanau. Without culture change, nursing homes will never reach the next level in quality care, says Bull. She
believes three components are necessary for successful change.
"My formula," she says, "is dissatisfaction with the current state times vision for the future times knowledge of the first steps
to take. The product of that has to be greater than your resistance to change. That little formula has stood up very well over
the last four years."
