Rejuvenation The long term care industry has changed. Have you and your organization?

by Fraser Wilson

Every organization faces challenges. The most common motivation to initiate change is when problems exist. Organizations are usually willing to initiate new steps when it is believed that the stress related to the existing problems is greater than the stress associated with the change process.

Industry leaders, on the other hand, view change as an opportunity for growth. They are driven to become the best at what they do and their hunger creates new opportunities that often propel the industry into new performance levels.

Then again, there are those who do not face serious problems or have never assumed the role of industry leader. They become too complacent and accept only the status quo. They are not pressured from within to take the risks to change and not pressured externally to make them re-organize.

As CEO and owner of OMNI Health Care Ltd., which operates 14 long-term care facilities in Ontario, we faced the dilemma that confronts most organizations. Void of any serious problems, we were not forced to change. We then had to decide – do we simply keep up with the industry or do we lead it? The decision was clear - it was time to turn our desire to be the Best, into a Passion for Excellence.

To achieve our goal, OMNI approached FCS International to help us become the best care providers in Canada. We were quickly confronted with the reality of the goal. To become the best and remain the best, we had to do what most avoided – look at ourselves to determine what we must change in order to evolve as a leader in the industry. It was time to rejuvenate our organization to achieve best practices in all areas of performance.

It became obvious that rejuvenation was a significant transitional shift. We needed to define what it meant to be the best, how we were going to get there and what was the expected outcome.

To be the best means to provide the best quality of life to every resident, every shift, every day, 365 days a year. Although simply said, attaining consistency with multiple staff, multiple managers, 24 hours a day, 7 days a week is not easily accomplished.
To become the best can only be done with our people. Together, our staff, managers and organization needed to elevate our level of knowledge and understanding of our residents and how to meet their needs in a proactive, not reactive, manner.
To be the best will result in an organization that is self-propelling. With enhanced skills, knowledge and understanding, our organization is empowered to evolve and take ownership and pride in our accomplishments in resident care.

The four principles driving the OMNI rejuvenation included: Education, Empowerment, Consistency and Communication.

Education

It is well known that the level of care in our sector is becoming heavier and more complex. The percentage of residents with Alzheimer’s and related dementia within most long term care facilities is between 65% to 70% and growing. To meet this need, OMNI has undertaken to educate 100% of all staff including frontline caregivers in Alzheimer’s and related dementia and leadership skills. In the past 18 months, 500 of our 1000+ employees have completed a series of intensive training sessions ranging from 3 to 7 full days in length.

Through this training we have increased the knowledge and skill set of our staff and managers, which has demonstrated a significant increase in the efficiency and effectiveness of the organization. The obvious outcome from educating all of our people is simple - a work environment where staff and managers implement best practices in care delivery and organizational performance allows them to more effectively concentrate their efforts on resident care. The more the organization is resident-centered the greater the quality of life experienced by the resident, further improving work satisfaction for staff and managers. A positive outcome cycle that becomes self-perpetuating.

Empowerment

An organization that believes it is only as good as its people must embrace empowerment. It became obvious to all OMNI facilities, that extending the opportunity for staff to offer their input, recommend solutions and participate in the implementation of their ideas, resulted in their feeling valued and respected. The ultimate outcome is a greater sense of ownership and pride in what they do and the successes they accomplish. However, OMNI learned that professing empowerment was easy. Implementing it was a greater challenge.

During our rejuvenation, the shift to empowerment required complete rethinking. Making it happen created significant stress and even at times confusion on how to proceed. We realized that true empowerment takes considerable time for the entire organization to make the transition.

However, we have discovered the benefits even at this stage of development. By empowering the organization, we have created an environment where staff and managers at all levels are more cohesive. There is a greater feeling of support for new ideas regardless of who generated them. More importantly there has developed a more consistent approach to the care of our residents by involving all levels of staff. Flipping the organization around where managers assume more of a facilitator role in order to encourage staff to become the problem solvers takes time, but is well worth the investment.

Consistency

Long term care is a 24 hour operation. We have multiple departments, a variety of staff and many managers.

We are constantly challenged with the objective of ensuring consistency. To understand the significance of this challenge in our setting, we have separated consistency into three categories: resident care, personnel management and communication.

Resident Care - A true measure of success is consistency in care. It is reasonable for our residents and their families to expect the same interventions, assistance or redirection from all staff. Our challenge is to create a care team that is aware of and understands the reason for our interventions, and apply them consistently. When staff have ownership, this outcome becomes easier to achieve. They then become selfmotivated to ensure that the desired individual resident outcome is met.
Personnel management - Registered personnel are taught clinical assessment skills for providing primary care. However, in long term care, registered personnel are nurse managers responsible for managing the staff people who directly influence resident care. The OMNI management team realized that investing in our nurse managers to develop their management skills and to become assertive in their ability to lead their staff would be the greatest step towards consistency in resident care and organizational efficiency. An intensive management training program for all registered staff was initiated, along with a strategic planning session. At the end of the training program, over 250 OMNI nurse managers, facility managers and head office personnel met over a two day period to plan the transition from registered staff to nurse managers. Collectively, we determined the supports needed to assist registered staff in fulfilling their responsibilities, with the emphasis on effective communication and consistency in performance. Empowerment again in action.
Communication – Effective communication can lead to predictability in resident care. Consistency can only be achieved if everyone knows the plan of action and the needs and preferences of our residents. OMNI continues to explore different vehicles for effective communication that cover changes in resident health, the sharing of effective interventions and planned activities in each department and facility. Pursuit of Excellence Committees, the OMNI newsletter, committee structure, e-mail initiatives and the like have kept our people informed. Informed staff and managers are more able to be consistent in fulfilling their roles.

To become the best will not happen overnight. Time is not the factor that determines effective rejuvenation. Ensuring an ongoing process of growth and advancement will keep an organization motivated forward.

What is important about this process is where the decision lies. Staff and managers cannot achieve best practices if the CEO, senior executives or Administrator do not commit to the decision to pursue that transition. We can only succeed with our people - together! We have experienced the pain of rejuvenation and reaped the benefits. Now that the process has been taken, we would never turn back or slow down. The energy and creativity that have been elicited from our staff and managers is unparalleled. The level of care to our residents is impressive.

Long term care is rapidly changing. As the complexity of care increases, it is ever more important to have effective communication systems that ensure consistency in the care for our residents. Education and empowerment are critical to keep pace with the rate of change. At OMNI, we will remain true to our Mission and Vision and we will continue to evolve, and to better ourselves and the care which we provide.

Rejuvenation

In order to truly rejuvenate, an organization must develop a Mission and Vision that is simple, yet powerful. OMNI established the Mission “In Pursuit of Excellence”. This implied progress and evolution and has challenged all OMNI staff and managers to always strive for something better.

Our Vision is “To be the Best Care Provider in Canada”. We realize that our Vision is a bold statement. We are cognizant of its undertakings and we know that we will be compared to incredible care providers throughout Canada. However, our mission and vision defines what we believe is needed for effective rejuvenation. To implement best practices one must target the highest goal. In that way full potential can be achieved.