In their special design issue last month, Long Term Living featured an article titled “Everyone has a Voice in Environmental Upgrades” about the culture change efforts of Isabella Geriatric Center in New York City, a 705-bed skilled nursing facility located in two high-rise buildings in northern Manhattan.
PHI has played a significant role in the organization’s change initiative, beginning three years ago with supporting the Executive Leadership Team in defining their vision for person centered care at Isabella.
In 2008, the organization received a $50,000 grant from The Hulda B. and Maurice L. Rothschild Foundation, to address aspects of its physical environment that need to be changed to support a person centered culture.
Sara Joffe
Co-authored by Jennifer Bush of the IDEAS Institute, PHI National Director of Training and Organizational Development Sara Joffe, and representatives from Isabella, the March article highlights the engagement of a wide range of Isabella staff, divided into Performance Improvement Workgroups, in identifying and addressing potential environmental changes such as minimizing both human and mechanical noise, and improving the dining ambience.
Isabella’s size and urban environment present particular challenges to its becoming more person-centered. Three times the size of the average nursing home, Isabella takes up an entire city block.
“Undertaking a change initiative in such a large organization with so many layers and so many people affected by everything can seem overwhelming,” says Joffe. “People always talk about communication as an issue in any long-term care environment. The progress made at Isabella demonstrates how much can happen when you really pay attention to where and how people communicate, and provide them with tools to do this more effectively and collaboratively.”
PHI began consulting with Isabella in the early visioning stage, and since then has been training small groups in communication and collaborative problem-solving skills to support subsequent change initiatives, including the shift from centralized to neighborhood-based dining.
To guide the change process, PHI worked with Isabella to create a cross-functional team with a representative group that included direct-care staff, dining, housekeeping, mid level supervisors, and executives. They worked on developing a structure and process so that the voices, interests, and concerns of multiple stakeholders could be heard.
“It’s enormously encouraging,” says Joffe. “There was one time early on when the notion of anything moving forward in such a big environment seemed very daunting. Once the team was established and they were figuring out ways to use communication skills they had learned and how to reach out to other people, then things really started to happen. It’s not that’s everything is working out perfectly. It isn’t. . . . But a process is in place so that when issues come up they can more effectively be addressed, which is very exciting, especially in a big place like that.”
For the most recent Rothschild-funded initiative, PHI provided four days of training for a group of twelve staff — 6 Community Directors and 6 frontline staff — so that they would be prepared to facilitate workgroups addressing issues in the physical environment. A future article will discuss specific environmental changes made by Isabella Geriatric Center as a result of the Environmental Workgroups.
