1

Project Vision, Objectives, & Goals

This task will crystallize the vision of a resident directed model of care.  Objectives and Goals will be set to achieve that vision.  The vision will include a statement in story form of what we hope to achieve. This will provide a framework upon which the rest of the project will be built

·        A first person “story” written in present tense that describes the community experience in vivid detail.

·        A written description of the project with an outline of basic elements

·        A project charter that outlines the project Vision, Objectives and Goals.

·        A written description of the project

·        The written description of  project will be a tool to communicate the vision, objects and goals of resident directed approach to care

·        A compelling description of the environment drawn from testimony of residents and staff.

·        The environment evokes an emotion that is reminiscent of home.

·        The environment conveys a sense of warmth and charm that feels like home.

·        The approach to care story fosters choice, independence, and dignity for the individual.

·        Is a task force for change organized that has broad representing all the views within the community (Resident, Family, Staff, Governance, Community)

·        Is the vision drawn from the active involvement of residents and staff of the community?

·        Is the vision descriptive of the environment and approach to care that is desired?

·        Does the vision paint a picture of how the environment will look, sound, smell, and feel?

·        Do the Resident Community, Administration and Board of Directors agree on the written description of the project?

·        Does Administration and Board understand the plan?

·        Does plan agree with the philosophy of the Creating Home & Building Community Culture Change Initiative?

·        Is the written description clear and easy to understand?

2

Engagement of Residents, Staff & Community

In order for this concept change to be accepted and sustainable, it is important for residents and staff to understand and buy into the concept.  Beyond this staff must believe that this is will improve the lives of our residents and improve the working environment.   The community also must be included in this discussion as their understanding, assistance and support are necessary for long-term success. 

·        Formation of Resident & Staff Steering Committee.

·        Presentation made at a Resident Council meeting allowing input and discussion of the concept.

·        Presentation to the staff allowing input and discussion.  Emphasis to be put on the importance of their input and designing of systems through the Rapid Cycle process.

·        Presentations made to family members and the public outlining the plan and introducing the concept of resident directed care.

·        Make written plan available to all interested parties

·        Creation of a system for collecting comments, concerns, and ideas

·        Buy-in of Residents and collections comments, concerns and ideas.

·        Buy-in of Staff and collection of comments, concerns, and ideas.

·        Buy-in of Community and collection of comments, concerns and ideas.

·        Active involvement of Residents & Staff in the process.

·        Has a system been put in place to collect comments, concerns, and ideas?

·        Do residents understand and agree with the concept of resident directed care? (survey)

·        Do Staff understand and agree with the concept of resident directed care? (survey)

·        Does the Community participants  understand and agree with the concept of resident directed care

3

Baseline assessment/Select Metrics

Create a measuring tool and baseline to assist in fostering resident centered care principles.  This will include the creation of ongoing reports to assess reversal in functional decline among our residents, using national indicators.  We will also measure changes in resident quality of life, staff satisfaction, family satisfaction and costs of daily operation.

·        Identify metrics to measure

·        Decide on how metrics will be measured and/or tracked.

·        Determine baseline numbers.

·        Creation of a system for gathering data

·        Data Collection System is in place.

·        Forms are created to collect data.

·        Ongoing reports are designed.

·        Baseline numbers are recorded.

·        Do the metrics relate to the vision, objectives & goals listed in Task 1?

·        Are we using national indicators to assess reversal in functional decline?

·        Do the metrics measure Staff & Resident satisfaction in addition to other more standard measures?

·        Will the measures chosen allow us to measure improvement against a “self best” benchmark, with the goal of showing marked improvement against a baseline?

·        Are the metrics measurable?

·        Are the metrics actionable?

·        Is the data collection system manageable & sustainable?

·        Are the reports easy to understand?

·        Do the reports tell you what you need to know?

4

Site Visit – Commissioners

The Board of Commissioners will do a site visit to Providence Health System in Seattle, Washington.  Providence has successfully transformed itself from a traditional skilled nursing home with 215 beds to a resident directed approach with 10 neighborhoods of 20-24 residents.  They have implemented a decentralized management system with an emphasis on teamwork and job role flexibility. 

The purpose of this visit is to give commissioners a first hand view of what resident directed care looks like.  This will help to achieve greater buy-in and commitment to the process as well as generate ideas that can be implemented at Garfield.

·        Creation of a form to gather thoughts, ideas, and questions for use on Site Visit

·        Site visit will occur

·        Site visit form will be used to gather information, ideas and comments.

·        Board of Commissioners will have a greater appreciation and understanding of resident directed care

·        Board of Commissioners will have a greater engagement in the change process.

·        Board of Commissioners will generate ideas that can be implemented at Garfield.

·        Gathering of information on Site visit.

·        Create a “Diary” of choices and observations that discusses how we negotiate the change process and articulate the vision?

·        Are commissioners better able to articulate what resident directed care is?

·        Do commissioners understand the scope of changes that must take place to implement a resident directed model of care?

·        Were ideas and concerns gathered from commissioners regarding the resident directed model of care?

·        Is there a feed-back loop to the leadership of the organization from residents and staff?

·        Does the Organizations leadership believe in the vision for the project?

5

Site Visit – Staff & Residents

Staff in teams of 4-6 people will do site visit of Providence Health System in Seattle, Washington.   The management team and process leaders (from all functional areas within the organization) and resident representatives will be selected to attend site visits..

The purpose of these visits is to give staff and resident representatives a first hand view of what resident directed care looks like.  This will help to achieve greater buy-in and commitment to the process.  This will give residents & staff a chance to ask questions, address concerns, and generate ideas about implementing this change in their work environment. 

·        Site visits will occur over a 4-5 week time period.

·        Site visit form will be used to gather information, ideas and comments.

·        Residents & Staff will have a greater appreciation and understanding of resident directed care

·        Residents & Staff will have a greater ownership of the change process.

·        Residents & Staff will generate ideas that can be implemented at Garfield.

·        Gathering of information on Site visit.

·        Is staff better able to articulate what resident directed care is?

·        Does staff understand the scope of changes that must take place to implement a resident directed model of care?

·        Were ideas and concerns gathered from staff regarding the implementation of the resident directed model of care?

·        If a resident is unable to participate is a resident and/or family proxy provided?

6

Implement Rapid Cycle Staff Training

Intensive education and learning by doing.  All organization levels learn together.  Team implementation of rapid turning Plan-Do-Study-Act (PDSA) cycles.  Creation of a spirit of improvement throughout the organization.  Analysis, visioning and implementation during the process to achieve significant improvement across multiple indicators.  Team takes ownership of improvements.

·        Rapid Cycle training module is created.

·        Presentation to staff of Rapid Cycle reasoning and methodology.

·        Managers are able to answer staff questions regarding rapid cycle.

·        Rapid Cycle Training Module is available to train staff now and ongoing.

·        Staff understands and has a working knowledge of the Rapid Cycle process.

·        Is the Rapid Cycle Training Module an effective tool?

·        Does staff have a working knowledge of Rapid Cycle?

·        Does staff understand how and why Rapid Cycle will be used to implement the change to resident directed care model?

7

Select Theme – Living Environment

A theme for the environment will be drawn from the vision in Step 1.  This theme will support the “story” of our vision. Decorating is what makes a house a home.  By selecting and agreeing upon a decorating theme, the residents, staff , Board and community can have a starting point for how the “home” will look when all of the pieces to the resident centered care puzzle are put together. 

A theme will help to keep the architect and decorator on the same page as the administration, staff and residents.  By giving all parties a visual idea of what the physical plant will look like will greatly assist successfully creating the look and feel of “home”.

·        Steering committee will select and recommend theme to Board of Commissioners.

·        Recommended theme will be presented to Staff, Residents, and Community in the form of a discussion, asking for input, concerns, ideas and fit with community values/lifestyle

·        A final theme will be decided upon.

·        Selection of an architect and decorator and communicate the vision, objectives, goals, and outcomes of this project.

·        A final theme will be decided upon with input of residents, staff, and community.

·        Architect has been selected.

·        A decorator has been selected.

·        Architect and decorator are able to communicate

o        resident approach to care

o       project vision, objectives and goals

o       decoration theme

·        Has a theme been selected and agreed upon?  Are there any dissenters?

·        Is the theme workable within budget, building and vision constraints?

·        Is the Story presented in a visual and written fashion (Big Print posted on the wall)?

·        Can the story be articulated by all the participants with some measure of detail?

·        Are people “telling the story”, casting the vision?

·        Do the Architect and Decorator understand the project and overall goals?

·        Is the design realistic given operational, regulatory and budgetary guidelines?

8

Rapid Cycle – Work Environment

Using the Rapid Cycle approach to managing change within an organization the staff will look at the changes needed to implement a resident centered care approach.

The Staff will examine all aspects of the work environment including tasks, delegation of duties, impact on other departments, changes needed to the physical plant to implement these changes and any other issues that may surface during the process.

·        Team of staff members will be selected to work through the Rapid Cycle Process.

·        A written plan of action will be created outlining the changes needed to the work environment.

·        Changes needed to the physical plant will be forwarded to the team working on task 11, Design – Environment of Care.

·        Ideas generated regarding approach to care and environment of care will be forwarded to teams working in those areas.

·        A written plan of action will be created.

·        Creation of a system for evaluating ideas.

o       Encourage & reward creativity.

o       Review every idea.

o       Let the criteria be the judge.

·        Are the plans feasible?

·        Do the plans implement ideals of resident centered care?

·        Which of these ideas are based on proven practices of other service providers?

·        Which of these ideas are innovative?

·        Were there ideas generated that were not accepted as part of the final plan?  Please list for possible later inclusion.  Why were these not included?

·        Using a Plan, Do, Study, Act process are we implementing plans without delay where we can?

·        The organization is not caught in the “perpetual planning” trap.

·        The bias is toward immediate action.

9

Rapid Cycle – Approach to Care

Using the Rapid Cycle approach to managing change within an organization the staff will look at the changes needed to implement a resident centered care approach

The Staff will examine all aspects of their approach to care utilizing the basics of resident centered care,

·        Discovery process with residents to solicit wants and needs.

·        Teams of staff members will be encouraged to work through the Rapid Cycle Process.

·        A written plan of action will be created outlining the changes needed regarding the approach to care

·        Changes needed to the physical plant will be forwarded to the team working on task 11, Design – Environment of Care.

·        Ideas generated regarding environment of care will be forwarded to teams working in that area.

·        Draft vision of care

·        A written plan of action will be created.

·        Changes that can be implemented now will be implemented

·        Use multiple PDSA cycles to implement and evaluate change.

·        Are the plans feasible?

·        Do the plans implement ideals of resident centered care?

·        Which of these ideas are based on proven practices of other service providers?

·        Which of these ideas are innovative?

·        Were there ideas generated that were not accepted as part of the final plan?  Please list for possible later inclusion.  Why were these not included?

10

Rapid Cycle – Environment of Care

Using the Rapid Cycle approach to managing change within an organization the staff will look at the changes needed to implement a resident centered care approach

·        Discovery process with residents to solicit wants and needs.

·        Team of staff members will be encouraged to work through the Rapid Cycle Process.

·        A written plan of action will be created outlining the changes needed regarding the environment of care.

·        Changes needed to the physical plant will be forwarded to the team working on task 11, Design – Environment of Care.

·         

·        A written plan of action will be created.

·        Score and prioritize action points.

·        Changes that can be implemented now will be implemented

·        Are the plans feasible?

·        Do the plans implement ideals of resident centered care?

·        Which of these ideas are based on proven practices of other service providers?

·        Which of these ideas are innovative?

·        Were there ideas generated that were not accepted as part of the final plan?  Please list for possible later inclusion.  Why were these not included?

11

Design – Environment of Care

A team of residents and staff members will take the plans of the rapid cycle teams and integrate them into a design plan with the help of the architect and decorator.

All plans are measured against the vision in step 1.

·        Plans from tasks 8,9,10 will be gathered as well as their lists of changes needed to the physical plant.

·        A design plan will be created utilizing the rapid cycle plans.

·        The final design will be brought before all staff and residents involved in the rapid cycle planning process to discuss recommendations not included in the design and deal with any discrepancies that this may cause.

·        The final design plan will be presented to the board of commissioners & community.

·        A final design plan will be completed.

·        The final design plan will be approved by the Board of commissioners.

·        Is the plan feasible?

·        Is the plan within budget constraints, if not how will this be handled?

·        Are the ideals of resident centered care incorporated in the plan?

·        Are any rapid cycle recommendations which were incompatible or recommended items not included resolved to the satisfaction of the involved team?

·        Are there any negatives or downsides to the accepted plan?

·        Were there any plans or design elements considered but not implemented?

12

Develop “Caring Touch” Standards

A team of staff members will create our “Caring Touch” Standards. 

They will use the plans created by the Rapid Cycle teams, learning sessions and information evidenced by best practices in residential care and skilled environments to create the “Caring Touch” Standards.

The “Caring Touch” Standards will articulate our specific approaches to creating a resident centered approach and environment of care.  These standards will be posted within our facility, and used as a tool to communicate this approach to Residents, Staff, and the Community.

They will be a foundation upon which we build our staff training and run our organization.

·        A team will create an initial list of “Caring Touch Standards”

·        Residents, Staff, and Community will have a chance to make comments and revisions

·        Board will adopt final “Caring Touch Standards”

·        Board will adopt final “Caring Touch” Standards

·        A matrix will be developed to measure the extent to which the standards address OBRA and state regulatory issues.

·        Conflicting standards will be discussed with the enforcing agencies and resolution sought.

·        Are Standards in line with ideals of resident centered care?

·        Do the standards support the spirit, intent and letter of the regulations?

·        Were there any standards considered but not adopted? Why?

·        Are the Standards attainable? (reasonable)

·        Actionable

·        Sustainable

13

Facility Improvements

Facility improvements will be done as outlined in the Design - Environment of Care.

·        Renovation is complete

·        Decorating  is complete

·        The facility has the homey feel and functionality to meet:

o       Task 1 Project Vision, Objectives & Goals

o       Task 7 – Theme – Living Environment

o       Task 11 – Design – Environment of Care

·        Does the facility feel like a home rather than an institution?

·        Is the facility able to meet the needs of the resident centered care as outlined by the rapid cycle teams (Tasks 8,9,10)

·        Is there anything that you would do differently? Why?

·        Is there anything that you would add or change if you could?

·        Is there any changes you would like to make some time in the future?

·        Is there a plan to implement and sustain these future changes?

14

Full Implementation & Coaching

At this stage, the facility improvements are underway. 

Staff training systems will be in place enabling the team as soon as tools and systems are in place to get up and running quickly as soon as all of the faculty improvements are completed.

Leaders are trained to encourage and correct team members.  Results are measured and communicated to the team effectively.  Successes are celebrated on a daily basis.

Once the facility improvements are done/almost done the residents will be updated about what to expect and what will be changing.  Meetings will be held with each resident to find out the resident’s preferences and choices to make this transition be a positive experience.  Each resident will have the opportunity to ask questions and have concerns addressed.  This information will then be dispersed to the resident’s care giving staff.

·        Staff training sessions will be held to coach:

o       Principles of Resident Centered Care

o       “Caring Touch” Standards

o       work plans as developed by the Rapid Cycle Teams (Tasks 8,9, 10)

·        Resident & Staff issues and concerns will be addressed and modification of plans as needed.

·        Staff will be able to articulate the philosophy of Resident Centered Care.

·        Staff will know and understand the “Caring Touch” standards.

·        Staff will understand the plans outlined by the Rapid Cycle Teams (Task 8,9,10)

·        Residents will experience the warmth and charm of a home environment that fosters independence, choice, and quality of life.

·        Staff transition smoothly to the new approaches and the change in duties and responsibilities that accompany them.

·        Work is reported to be more satisfying.

·        Can each staff member articulate the philosophy of resident centered care?

·        Does each staff member understand and buy-in to the “Caring Touch” standards?

·        Does Staff understand the plans outlined by the Rapid Cycle Teams (Task 8,9,10)

·        What would you do differently to implement this part of the program?  Is there additional training needed?  What is the best way to provide that training?

·        Has this been a smooth transition for the resident? Why/Why not?

·        Has this been a smooth transition for staff?  Why/why not?

15

Sustainability & Maintenance Standards

Development of a plan to sustain changes.  Plans include scheduled maintenance and replacement of furnishings.  Plans include scheduled staff training and development, daily, weekly, monthly, quarterly and annual reviews.

• Documented standards and checklists.
• Assignment of duties and legacy systems in place.

• A document exists that outlines standards, schedules and assigned duties.
• A method exists to ensure program goals are measured and monitored consistently.

• Is the sustainability plan complete?
• Is the sustainability plan feasible?
• Is there enough input of the supporting stakeholders?
• Is the sustainability plan documented and incorporated into the legacy systems of the organization?

16

Marketing Planning

A plan to market the “New and Improved” Garfield to the community will be developed.

This will include phases to celebrate with the residents, communication families regarding changes, and communication with Community.

·        A written marketing/Celebration plan will be agreed upon by the staff and residents.

·        Input will be obtained from the board and staff

·        A complete marketing plan has been created.

·        The “Marketing Plan” recognizes that this is the home of the people who live here.

·        Is the marketing plan complete?

·        Is the marketing plan feasible?

·        Is there enough recognition of the supporting stakeholders?

·        Were there any marketing ideas dropped due to budget or time constraints?

·        Is there anything you would do differently next time?  If so, what?

17

Community Celebration & Marketing

The Marketing plan will be implemented.

·        A resident celebration will be held.

·        A community open house will be held.

·        The residents &family members agree that the changes are worthwhile, meaningful and improve the quality of life within the community.

·        The Community will understand the changes that have been made and why they have been made.

·        The staff will fee pride in the changes and the benefits of the new approaches.

·        Was the marketing plan fully implemented?

·        Did additional marketing activities take place?

·        What would you do differently?

·        What was effective?  What was ineffective?

18

Reassessment of Residents and Staff

The reassessment of residents will include a meeting with the Resident Council meeting to obtain feedback on how the process is going and to discuss any issues of concern to the residents.  We will also be meeting with each resident and their families to fine tune their care plans and assess how they are doing with the changes.

We will be reassessing the staff to see how they are doing with the changes.  We will be reviewing the plans with the staff and looking for ways to improve our systems and service to our residents.  This will become part of an ongoing evaluation/change  process to assure that we are meeting our “Caring Touch” Standards and the ideals of resident directed care

·        Meet with the Resident Council

·        Meet with each resident

·        Discuss at quarterly care conferences with family members

·        Managers to meet with staff to review action plans.

·        Care teams to meet on a regular basis.

·        Receive feedback from Residents and Staff regarding the change over.

·        Receive ideas on how to improve our system

·        Residents experience a better quality of life with greater self-sufficiency, autonomy, and dignity.

·        Staff will experience an increased quality of work environment and enjoyment in their work.

·        Be started on the path of continuous improvement of our systems and care for residents

·        Was this a smooth transition for each resident? Why/why not?

·        Is the quality of life enhanced for each resident?

·        Was this a smooth transition for staff? Why/why not?

·        Has the work environment improved for the staff?

·        What could we have done differently?

·        What do we need to do differently in the future?

·        What was the hardest part of the transition for both residents and staff?

·        What was the best part of the transition?

·        Was this change worth the effort? (resident and staff point of view)

·        Is there a marked improvement in functional decline of residents?

19

Project Assessment/Blueprint our Story

The administration will put together a final report summarizing what steps Garfield has taken and the outcomes of these steps.  The assessments taken along the way will be summarized and made available to interested parties. 

We will prepare a presentation to blueprint our story and the successes and challenges we have faced. 

We will make available copies of forms and systems that we have created to help others desiring to implement similar changes.

·        A written report will be made available to the Rothschild Foundation and other interested parties.

·        A presentation will be created and given to interested parties outlining the highlights of the change process.

·        Forms, checklists, data collection systems and other systems implemented will be made available to interested parties.

·        A blueprint will be available to interested parties seeking to create a replicable model of care delivery.

·         Forms, checklists, data collection systems and other systems implemented will be made available to interested parties.

·        Is a written report available to interested parties?  In what formats?

·        Is a presentation prepared to share the Garfield story?

·        How many presentations were made and to whom?

·        Are forms, checklists, data collection systems and other systems available to interested parties?  In what formats?

·        What are your plans to further disseminate this information and promote the ideals of resident directed care?

20

Spread

Seek opportunities to share

• Use of web site, printed materials and conferences to tell our story.
• Invite and encourage duplication

• Web site dedicated link with downloadable materials.
• Trade journal stories and press release
• Duplicate-able materials available and shared upon request.
• Team available to speak upon request.
• Community site visits

• Is the link to the web site clearly defined and the information easily accessible?
• Have press releases been released at mile stones in the project?
• Are materials simple, clearly written and proscriptive?
• Are our Leaders and Residents invited to share our story?
• Are people encouraged and invited to visit the community? How many visits do we have?