Collaboration Can Redefine Long-Term Care

Abstract

DIANE L. DIXON is managing principal of D. Dixon & Associates LLC, specializing in health care leadership and organizational development. She also has taught leadership and organizational behavior for the business of medicine program at Johns Hopkins University and holds a doctorate in human resource development from George Washington University, Washington. Robert R. Meiss is the president and CEO of Beechwood Continuing Care in Getzville, N.Y., and the leader of the Western New York Alliance for Person-Centered Care. I met him last year during his presentation at the Pioneer Network Conference and interviewed him recently about how the transformation of Beechwood led to a community-wide effort to redefine long-term care (LTC) in this region. He told me that once, during a routine walk through his nursing home, he saw residents sitting around the nursing station looking disengaged. This was a typical day, but something was different this time. Mr. Weiss had recently participated in a culture change seminar, the spark for innovation was ignited, and he made a commitment to explore better ways to care for elders. He shared his concerns with staff and learned that they were frustrated too. So they began identifying changes that would make a difference in the lives of elders and created a new vision. To make this vision a reality, they needed support from their board of trustees. They got it, as well as the board's instruction to share all lessons learned. Four key objectives were established for this process—remaining cost neutral, measuring outcomes, sharing everything, and going slow enough to embed learning. Beechwood reached out to the University of Buffalo's schools of nursing and social work for their expertise. Mr. Meiss contacted the John R. Oishei Foundation for support with training, construction of an education center, and research. The foundation challenged Beechwood to lead a community-wide process to introduce person-centered care so that all long-term care providers would benefit. The meeting to introduce person-centered care to the Buffalo-Niagara region was held on April 11, 2008. Mr. Meiss and other leaders knew that collaboration would be essential, so they invited the 79 nursing homes, 60 assisted living community administrators, and other LTC stakeholders in western New York state. Attendance included administrators, chief executives, owners, physicians, senior administrators, regulators, educators, and private foundation representatives. Participants learned about person-centered care from national and local perspectives. They heard the Beechwood Continuing Care story, and with the help of facilitators Anne M. Moretti, president of Moretti Consulting LLC, and Arvela R. Heider, PhD, president of Holark Systems, the group created a community-wide vision for change. This groundbreaking experience marked the first time that so many providers in the region worked with other LTC stakeholders to develop a framework for person-centered culture change. As a result of this meeting, the purpose of the Western New York (WNY) Person-Centered Care Initiative was clarified to encompass the following: ▸ Learn more about person-centered culture change principles. ▸ Evaluate the current practices in the region. ▸ Initiate the development of a collaborative framework that would support providers and build a learning community that helps the group meet challenges through shared problem solving, implementing solutions, and measuring outcomes. A steering committee included a representative group of participants, who agreed to survey providers in order to evaluate current and future culture change activities, develop a plan for community presentation, and establish work groups for development of a more specific action plan. The group created a “framework for change,” and the circle of involvement continues to widen. More than 600 people now receive regular communications about the initiative because of their expressed interest in this process. Key to success is taking action on plans developed as a result of the provider survey and discussions during the group's initial meeting. To that end, work groups produced recommendations in four key areas: collaboration, education, research, and resources. Here are some examples of recommendations within each area that are currently in various stages of implementation: ▸ Collaboration. Establish learning collaboratives that include peer mentoring. Create centers of excellence. ▸ Education. Develop a core curriculum focused on person-centered care principles for staff at all levels. Make available a wide range of educational programs to enhance leadership innovations, sustainable systemic change, and cross-sector collaboration. ▸ Research. LTC communities will partner with academic institutions to foster research that measures the effect of culture change. ▸ Resources. Act as western New York state's central resource for information on person-centered care. Initiative Becomes an Alliance What started as a loose network of participants is now formalized as the WNY Alliance for Person-Centered Care, the first community-wide alliance in the country organized to focus on person-centered care in LTC. This alliance has continued to define and expand the framework for change to include: networking and learning, advocating for policy changes, building relationships, promoting culture change, and providing access to resources. An important additional goal is to continue to find innovative methods for collaboration among all people interested in improving quality of care and quality of life for residents of LTC communities. The alliance is working hard to become a resource for training, coaching, and mentoring. Resources on all aspects of transformational change in LTC will be available. A good example of these efforts was the alliance's first symposium, held in Buffalo, N.Y., on Sept. 19, 2008, which was a major effort to broaden the circle of those interested in the need for change and the move toward the person-centered care model. The alliance continues to grow and strengthen its commitment to elders. When asked what advice he would give others in the field, Mr. Meiss said he did not know many people who are happy with the current LTC model, so here's an opportunity to do something about it. “If we don't take the initiative, we will not get the model that we know is best. This is in everyone's best interest.” Mr. Meiss also has learned that it is important to reach out to willing partners in the community and not to rule out the regulators or others who may not be considered typical collaborators. Another lesson is that there are actions that don't cost a lot of money but can move an LTC community toward change. For example: ▸ Change the mind-set to focus on the person rather than the institution. ▸ Develop a welcoming living environment, such as by redesigning resident rooms for privacy, personalizing care to individual needs, and implementing environmental changes without having to move walls. ▸ Involve direct-care staff in care planning and conferences. ▸ Make staffing consistent and permit self-scheduling. ▸ Create a community that empowers by building teamwork, enhancing communication, and developing good leadership. ▸ Build an organizational culture that embeds continuous learning and explores ways to make life better for elders. Mr. Meiss says that “leadership matters.” He believes that it takes the CEOs, owners, administrators, and other facility leaders with a passion for change to engage others in the community. One of the biggest lessons learned is that collaboration is essential for developing an alliance. Gathering a group of diverse stakeholders who are not accustomed to working together is not as hard as you might think when the shared purpose is focusing on the common good. Consider contacting Mr. Meiss at 716–504–1999, [email protected] , to learn more about the WNY Alliance for Person-Centered Care. A good resource: “A Framework for Change: Redefining Long-Term Care in Western New York (2008, prepared by Beechwood Continuing Care, Holark Systems, and Moretti Consulting, LLC. Funded by the John R. Oishei Foundation). In addition, here are several tips for getting started: ▸ Involve all LTC leaders and other interested stakeholders in the community. ▸ Agree on leadership practices for guiding and coordinating efforts. ▸ Determine opportunities for change. ▸ Develop a common purpose. ▸ Create a shared vision for change. ▸ Build an effective organizational structure. ▸ Develop concrete goals, along with accountability for implementation. ▸ Engage in group-development processes that enhance collaboration, trust, and decision making. ▸ Develop resources to support change-management efforts. ▸ Embed continuous learning for sustainability and growth. LTC alliances have the potential to implement significant changes in communities. Collaborations have the power to far exceed what individual organizations can achieve alone. In these challenging economic times, working together is the most effective way to achieve common goals.