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Westminster-Thurber Community

Executive Summary



EXECUTIVE SUMMARY

Motivation for Change: Gradual education of the leadership team, Eden certification, and a new Executive Director with prior success in person-directed implementation.

Goal of Change: Transform the environment from a medical, task driven model to a person-directed, social model.

Assessment Steps: Started with the leadership team and training; Expected each member of the leadership team to become coaches and mentors in shedding traditional roles; Developed an orientation curriculum that reinforces the desired culture for all employees; Incorporated learning circles with employees and elders; Surveyed employees to determine grasp and acceptance of culture change principles.

Implementation Progress: Westminster-Thurber is currently in an implementation phase of culture change. Leadership and staff are fully educated in culture change principles via organizational communication, a culture change orientation curriculum and training (to be discussed in subsequent sections of the case study). However, operational areas of this CCRC are at varying stages of incorporating environmental, systems and process transformations.


 PRE-TRANSFORMATION

POST-TRANSFORMATION 

 AREAS OF ORGANIZATIONAL DIFFUSION

Staff unaware of culture change or person-directed principles. Orientation curriculum for all staff. 100% implementation.
Staff-resident interaction not a priority. Consistent assignment of residents with care assistants. 100% implementation.
Leadership style is "command and control."         Leadership style is "serve and support." Implemented in most areas. Westminster is searching for a DON to provide clinical leadership to support this style.
Residents and direct care workers are not involved in developing care plans. The care planning process involves residents, their families and care partners. 100% implementation.
Lack of autonomy for residents in activities and schedule. Staff were task driven and organized work around delivery of care and staff preferences. Activities are meaningful. Residents maintain personal schedules based on preferences. - 100% implementation in the Pathway Home.

- Activities and choice in schedule for rising time are implemented in most areas.

- The Health Center is still in early implementation for full scheduling based on personal preference.
Centralized departments and scheduling by management. Staff are cross-trained and able to help residents with multiple requests and utilize self-directed scheduling. - 100% implementation in the Pathway Home.

- Some use of cross-training and self-directed scheduling in other areas.
Environments are institutional and separate residents and staff. Staff and resident workspaces are no longer segregated. All spaces in community are designed to promote resident independence. Westminster is at varying stages of environmental transformation. Visit "Physical Environment Transformations" for more detail.


Examples of "AH HA" Moments: 1) Clinical leadership is a crucial component of success; 2) Change doesn't happen overnight and leadership must stay the course; 3) Underlying systems and certain logistics of the organization must change to support the implementation process; 4) It is essential to integrate resident-directed philosophy and expectations into the recruitment and interview process of new staff; 5) The development of an orientation curriculum assures that employees have consistent information and expectations.   

Impact on Quality: Consistently high Resident Satisfaction Assessments; In the Pathway Home, staff observe combative or depressed behaviors of residents to be decreasing and engagement to be increasing; In the Pathway Home, staffing ratios far exceed Ohio's staffing regulations; The percent of long-stay residents who were physically restrained while in skilled care declined from 4% in 2008 to 1% in 2009 (4% below the national average).

Impact on Business: Nearly full census; Rehab studios admissions increased by 62% from 2005 to 2008; Use of agency staff decreased by 50% a year in 2007 & 2008; Annualized staff turnover decreased by 9.4% from fiscal years 2007 to 2008. One year post-implementation, the Pathway Home is Westminster-Thurber's most profitable operational area generating positive operating margins and occupancy waitlists.

Visit Quality of Life Impact, Quality of Care Impact, Staffing Impact, and Additional Case Study Findings to learn more about outcomes and early- to mid-implementation signs of impact.

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