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Building a Solid Foundation for Culture Change in LTC:Working Together to Put LIVING First
Culture Change Exchange | May 11-12, 2016Josie d’Avernas, Susan Brown, Hilary Dunn, Christy Parsons
Workshop objectives
1. Introduce the culture change concept
2. Explore your organization’s readiness for culture change
3. Assess your organization’s current environment
4. Hear about one organization’s successful culture change journey
5. Learn about resources available to support you in your own individualized culture change journey
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Culture change requires
• personal transformation
• operational transformation
• environmental transformation
• societal transformation
Ownership and empowerment
OLD CULTURE NEW CULTURE
“I need to get buy-in of my staff”
“We all need to take ownership, we all
have a role to play”
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BHAG …it all started with a Big Hairy Audacious Goal…
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Take time to build a solid foundation
• Start with a small group of learning partners
• Learn about culture change from others
– Pioneer Network
– Eden Alternative
– Other LTC organizations engaged in culture change
• “Warm the soil” with enablers
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Learning partners…
…have an agreement to share:• Thoughts• Experiences• Changes that will inevitably
happen
…have a relationship that is founded on:• Intellectual rigor• Courage to share intimately• Mutual support and
encouragement
EXERCISE: Your learning partners
• Who will you invite as your initial learning partner(s)?
• What strengths does each individual bring to the partnership?
Reflection questionsGuidebook (page 13)
Take a few moments to consider the following reflection questions and record your answers on
the handout provided.
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Clarify organizational
values and strengths
Collaborative leadership
Command and control leaders
Consensus leaders
Collaborative leaders
LEVEL OF MEMBER ENGAGEMENT
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EXERCISE: The importance of collaboration
“When leaders in long-term care implement change without true collaboration, there is no culture change.”
Worksheet: The role of collaboration and authentic participation in culture changeAppendix 4 (page 15)
Discuss the following statement with people sitting near to you. We will then ask for some
ideas to be shared with the larger group.
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Awareness-Raising Event
Culture change is not about implementing a single vision of a new culture, but co-creating a new culture together.
In 2009, an awareness-raising event engaged 140 leaders and direct support team members to:
• learn about the culture change movement;
• learn strategies for meaningful group discussion and collaboration;
• discuss strengths and identify challenges/opportunities for improvement; and
• collaboratively decide whether or not to embark on a culture change journey.
Institutional vs. Social
INSTITUTIONAL MODEL OF CARE SOCIAL MODEL OF LIVING
Focus on care Focus on living (and care)
Scheduled routines Flexible routines
Team members rotate Team members assist same residents
Decisions for residents Decisions with residents
Environment = workplace Environment = home
Structured activities Planned, flexible, and spontaneous activities
Hierarchical departments Collaborative teams
Team members care for residents Mutual relationships
Us and them Community
(Adapted from Fagan, 2003)
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EXERCISE: Collaborative organizational assessment
Handout: Collaborative Organizational Assessment handoutAppendix 5 (page 23)
Take a few minutes to complete the collaborative organizational assessment on the handout provided. When you have finished the
assessment, discuss the following questions with someone sitting near you.
“In what domain did you score lowest or highest and why?”
“What is your organization’s area of greatest strength and area of greatest need for improvement?”
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Will we embark on this journey together?
YES!
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Traditional vs. Appreciative approach
vs.
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Appreciative Inquiry
Traditional problem solving Appreciative inquiry
Focus on “what’s wrong” Focus on “what works”
Identification of problemsAppreciating and valuing the best
of “what is”
Search for root causes of failure/decay
Search for root causes of success
Fix the past Create the future
Obstacles treated as barriersObstacles treated as ramps into
new territory
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The positive core is made up of those qualities, attributes,
strengths, and assets that already exist within the organization,
all of which will take us into the future, provide continuity, and
act as a source of pride and confidence for each village member.
DiscoveryPrimary Aim:
To discover an organization’s positive core
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Our Positive Core
Strengths & Contributions
Our Ideal Future
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The Dream cycle…
… occurs when the best of “what is” has been identified
… asks people to create life-giving images of their future
… is grounded in the organization’s history and strengths.
DreamPrimary Aim:
To expand or extend people’s sense of what is possible
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EXERCISE: Your ideal future
Based on Guided Imagery exerciseStep 6, Action 6.2 (page 66)
Take a few moments to write down the key ideas that came up during your imagining of an
ideal future.
1. What is happening? What do you see, feel, sense, or hear?2. What do you think would need to happen in order for this change to come about?”3. What is one thing that we can do today to support this vision?
To view a shorter version of the Dream video played during this workshop, visit:
https://www.youtube.com/watch?v=39IbGommlJU&list=PLHjCxNW-AgfFGkcvoX6lwf90W1qFRB6Z_&index=13
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Team members identified common themes that emerged from these performances and actionable ideas that would accelerate our journey toward a more ideal future.
Opportunity areas
Flexible dining Flexible living
Meaningful activities Cross-functional teams
Diversity Research and innovation
Resident empowerment Authentic relationships
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Aspiration statements articulate the desired organizational
qualities, processes, and systems to help guide the organization to
its higher purpose by challenging common assumptions or
routines, and suggesting desired possibilities for the organization
and its people.
DesignPrimary Aim:
To develop operational goals and actions to guide us in working
toward “what could be”
Aspiration Statements: Characteristics
Aspiration statements should be:
1. Provocative: Does it stretch, challenge, or interrupt the status
quo?
2. Grounded: Are examples available that illustrate the ideal as a
real possibility? Is it grounded in the organization’s collective history?
3. Desired: Do you want it as a preferred future?
4. Affirmative: Is it stated in bold and positive terms?
5. Participative: Does it engage and include people in decision-
making about the destiny of their own lives?
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Aspiration Statements: Flexible Dining
Key points for Schlegel Villages’ “Flexible Dining” Aspiration Statement:
• Industry leaders
• Honour resident choice of mealtime, food and company
• Always room for family, friends and team members
• Dining is an important ritual
• Homemade dishes and fresh-baked goods
• Comfortable environment
• Individual preferences
• Dignity and respect
Our villages are celebrated as industry leaders for our flexible dining program.
Our flexible dining honours the residents’ abilities to make choices regarding all aspects of dining including mealtimes and food choices.
Our flexible dining invites the broader community to the table, ensuring plenty of room for families, friends, visitors, and team members to share in the ritual of eating together.
Our homemade and fresh baked meals are tailored to honour individual preferences, and our dining services are offered with care and dignity, ensuring a comfortable and enjoyable experience for each person.
Aspiration Statements: Flexible Dining
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Village teams were encouraged to think about some possible goals
and actions that could help them achieve their newly realized
aspirations as well as to consider how to include village members
in the actual process of developing goals and actions.
DestinyPrimary Aim:
To engage participants in planning how to enact and
sustain the aspirations.
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Broaden engagement, keep momentum going
• Advisory Teams
• Culture change Roadshow
• Conversation Cafes
• Reflection interviews and retreat
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2009 2011 2013 2015
4.7 6.7 7.4 7.7
So How Have We Fared on Our Journey?
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Questions?
To order additional guidebooks or to inquire about coaching support, please contact:
Kate Ducak
Culture Change Project Officer
519.904.0660 ext. 4107
For more information about this workshop, please contact:
Josie d’Avernas
Vice President
Schlegel-UW Research Institute for Aging
[email protected] X 4103
Susan Brown
Research Coordinator
Schlegel-UW Research Institute for Aging
[email protected] X 4105
