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Common System and Environment Themes Prior to Implementation

Common Themes in Westminster-Thurber's Processes and Systems Prior to Implementation

 Medical, institutional model of care;

 Lack of autonomy for residents;

 Decision-making at the leadership or organizational level;

 Language supported a culture of dependence (e.g. "patient," "ward," "floor" and "unit");

 Residents identified by medical conditions or level of care;

 Staff-resident interaction was not a priority;

 Staff were task driven and organized work around delivery of care and staff preferences.

Note: Common themes in the physical environment are elucidated by describing the space transformed into "The Pathway Home" (Westminster's most expansive environmental culture change transformation to date).

Common Themes in the Pathway Home's Physical Environment Prior to Implementation

A 10 bed "unit" organized around staff spaces;

Aside from resident rooms, many spaces "belonged" to the institution;

Mostly semi-private shared rooms with shared toilet rooms;

Kitchen off limits to residents;

Portion controlled meals were delivered on trays;

Outdoor spaces were often challenging for residents to access and not relaxing environments.

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