Changing culture at work takes time, cooperation

Innovation is only the beginning.
Lots of people have great ideas, Dr. Mary R. Cooper told her audience at Quality Partners of Rhode Island’s first annual Quality Improvement Fair on March 10. The compact fluorescent light bulb, for example, was conceived by a General Electric employee in 1973.
Yes, 1973. There was even an energy crisis going on – what would seem like good timing. But the cost was deemed prohibitive, and the idea was shelved. It’s only now, more than three decades later, that the energy-saving bulbs are widely available to consumers.
What makes the difference, said Cooper, who is chief quality officer for Lifespan and an assistant professor at Brown University’s Warren Alpert Medical School, is the diffusion of innovation – gaining widespread acceptance, making it the new standard.
In health care, she noted, inertia rules; even medical techniques proven by evidence can take seven to 15 years to reach the mainstream. And the environment is ever more challenging, with sicker and sicker patients, tight regulatory scrutiny and great economic uncertainty.
So don’t think a couple of workshops will change your organization, Cooper warned. You need champions, too, people who are held in high esteem by their colleagues. You need mentoring, simulations and incentives, economic or otherwise.
“If you rely on education and training [alone], you will fail,” she warned.
Cooper’s audience, at Rhodes on the Pawtuxet, was a mix of health care experts and providers from hospitals, home health care agencies, assisted living centers, nursing homes and other facilities. They discussed a wide range of topics, from fighting pressure ulcers, to managing pain, to “culture change” and other innovations in elder care.
Leaders from three homes were invited to speak about their efforts to implement “culture change” in specific ways, and the challenges they faced.
Elizabeth Sarro, administrator of Riverview Healthcare Community, a 190-bed nursing home in Coventry, said that after a state inspector pointed out how loud the place was, administrators bought a decibel meter and tried to figure out what the main problems were.
All agreed that reducing noise would be good, she said, to create a more calm, peaceful, home-like environment, and reduce stress and anxiety among staff and residents alike. The goal was to reduce decibel levels by 25 percent, said Karen Morin, director of nursing services, and to eliminate one major noise problem, overhead pages.
It took work and new investments: a new phone system and service contract, portable phones on the medicine carts, walkie-talkies, and a document-shredding service so the staff wouldn’t have to run shredders at night. Riverview also got headphones for residents’ TVs.
Overall, noise was dropped by 26 percent, Morin said. But overhead pages could only be reduced, not eliminated, from 25 to 30 per day, to about nine.
Tammie Parkhurst, of Greenville Health Care & Rehabilitation Center, in Smithfield, a 131-bed facility, talked about a pilot project to assign consistent caregivers to the seniors.
Before, in all units, the certified nursing assistants had rotating assignments, so they’d help a group of seniors for a week or two, then move on to another. In one 25-bed unit, Greenville set out to assign CNAs permanently to specific people, just for the 7 a.m. to 3 p.m. shift.
“When we started, we said, ‘No, there’s no way we’re going to do it. What if we have a difficult resident?’ ” said Sainabo Touray, a veteran CNA. But the team worked it out, and months later, Parkhurst said, both staff and seniors are “much happier.”
Yet progress is slow. Greenville is only gradually switching to consistent assignments in other units and on other shifts. The CNAs, however, are increasingly eager to try it, Parkhurst said.
Brenda Toll, of the Tockwotton Home, spoke about changing her facility’s culture to allow residents to sleep and wake up when they want, a key tenet of individualized care.
There was “a great deal of apprehension,” especially among nurses, Toll said, but the results have been positive. Some residents are noticeably more alert. Still, there are challenges and doubts, so patience, support from the administration and involvement from the whole team are crucial, she said.
Another session offered good news to those willing to try culture-change despite the tough work involved. Brian McKaig, work force development officer for CareLink Inc., presented the results of a survey of long-term care staff involved in culture-change for three years.
Employees, the survey found, became far more invested in their organizations, more open to coaching and more open to creative solutions. Most noticeably, they came to like and respect one another a lot more: Asked whether their co-workers “give their best effort,” 97.5 percent said yes, up from 77.5 percent at the start of the project.
“Working together to push an organization forward helps people to bond together,” McKaig said. But he also warned that support, recognition and consistency are crucial, because the staff will notice and be demotivated if they are lacking.
“We worked with 20 organizations doing culture-change and found that those that were successful bought culture-change hook, line and sinker,” he said. “The worst thing you can do is tell someone that things are going to change and then not do anything to effect that change.” •