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Westminster-Thurber Community

Challenges and Lessons Learned

Executive Director, Steve LeMoine, with elders at a drumming circle.

  • Clinical leadership is a crucial component of success. Westminster has spent many months searching for a Director of Nursing that "gets" culture change to provide leadership on person-directed care to the clinical team. Without this component, it has been difficult to more fully implement culture change in the Health Center environment.
  • Change doesn't happen overnight and leadership must stay the course.  Many aspects of culture change and a high involvement environment take time for leaders to learn and incorporate. It is often tempting to return to old management styles to fight the day-to-day fires of operations.
    • "On our leadership team, we have people who are much further along in their own journeys than others. We work in an environment that has been very top down for a long time. It's a struggle even for me, because it seems quicker to make decisions in a room with 3 people. That buy-in and high involvement has been the biggest lesson. When I do it right, it goes well and it's obviously the right thing to do. It saves you time in the long run." - Member of Leadership Team.
    • "There are days when we wonder, are we making a difference? The answer has always been yes, but you have to work through any discouragement." - Member of Leadership Team.
  • Your organization may have changed, but the rest of the world hasn't. Part of the process is taking additional time to educate partners, surveyors, family members and existing employees rooted in institutional practice.
    • "We encourage family members to also work directly with Care Partners, so those closest to the residents are part of the solution. But, that's not always what families want to hear. They want someone in charge to make directives." - Member of Leadership Team.
    • "There have been employees that just don't get it. We spend so much time coaching, counseling and educating, but you can't let those people linger if they don't fit with the changes." - Member of Leadership Team.
    • "What would I do differently? We started the Pathway Home without getting enough people onboard first. It was such a big undertaking. Staff from other parts of the community didn't always understand and families were occasionally confused. We've had to go back and address that [educate stakeholders not involved from the beginning] and it takes time." - Member of Leadership Team.
  • Jobs change when an organization transforms to a resident-directed focus. This means that the underlying systems and certain logistics of the organization must change to support the implementation process. This also requires sensitivity to staff while also empowering staff to embrace critical-thinking and problem-solving.
    • In the Pathway Home, certain concepts have taken months or nearly a year to fully incorporate. For example, care partners had concerns with replacing everyday scrubs with "regular" street clothes. Reasons are financial (purchasing new clothes can be difficult financially for care partners), logistical (the pockets in scrub tops provided extra space for care items), and operational (direct care staff in the Health Center still wear uniforms). Ultimately, scrub pants were accepted into the dress code, "aprons" solved the problem of extra pockets for storage, and Neighborhood Coordinators are using changes in the Pathway Home to educate Health Center staff about future implementation efforts in their areas.
    • Self-directed teams are a new concept for all involved and require additional guidance and support to function. This is especially true of communication regarding the division of work between day and evening workers. Who will mop the floors? Who will fold the laundry? Weekly team meetings help to raise the level of communication for these issues.
  • Implementation is an investment and, although relationships and engagement are tangible and observable outcomes for staff and residents, return on investment is difficult to measure in early- to mid-implementation stages.  While the Pathway Home is one of the soundest operational areas in terms of finance and budget, it did take many months for it to become profitable. Organizations should be aware of investment and forecast predicted returns for a 2-5 year timeframe. [Note: For guidance on potential outcomes in implementation, visit Quality of Life Impact, Quality of Care Impact, and Staffing Impact.] 
    • "The budget process is still very corporate driven, and the bottom line is, if we don't manage our budget, none of us have jobs. No money, no mission." - Member of Leadership Team.
    • "We struggle with: how do we make the best payroll labor budget, and live within our means, and still have all of this awesome programming and all of these great educational opportunities?"  - Member of Leadership Team.
    • "It's hard to measure how many times people were friendly to you today. You have to be aware of other expectations to measure going in." - Westminster staff member.

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