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A new joint publication of PHI and the Pioneer Network details how Partners in Care (PIC), the country’s largest home health agency, changed its culture, increased staff morale, and lowered turnover.

The profile (pdf) explains how PIC’s decision to participate in the PHI Center for Coaching Supervision and Leadership (CCSL) affected the entire agency.

“Coaching Supervision has transformed the culture of this organization,” said PIC president Marki Flannery. “Relationships between office-based supervisors and home health aides are much more positive.”

Based in New York City, PIC employs more than 9,500 home health aides and serves more than 20,000 clients each year.

Coaching Training Gets Results

PIC’s culture-change journey began in 2006, when it agreed to participate in CCSL. Several managers were trained in the core skills of PHI Coaching Supervision^SM, which include active listening, collaborative problem solving, and nonjudgmental communication.

Later, those managers trained several hundred of PIC’s supervisors, instilling the lessons of coaching throughout the organization. Currently, PIC is trying to train all 9,500 of its home health aides in the communication skills involved in the PHI Coaching Approach^SM.

The infusion of PHI Coaching Supervision into the organization has produced clear benefits, detailed in the case study.

Supervisory staff turnover has dropped dramatically to around 14 percent, down from more than 32 percent in 2006, the year PIC began its involvement with CCSL.

Home health aides are also experiencing stronger relationships with their supervisors, according to both survey data and anecdotal evidence. “Supervisors now listen to you more,” said Pauline Smith, a home health aide who has been at PIC for 12 years. “You’ll have a complaint, and the supervisors are more attentive to you and what you have to say. That way, we get better results.”

Supervisors at PIC also say that aides have been able to deliver better care to clients, due to both their enhanced communication skills and the newfound sense that they are truly valued by PIC management. “If the aides feel more valued…their whole approach with their clients is going to be [changed], and the clients are probably having a better experience,” Flannery said.

– by Matthew Ozga

PHI is sponsoring a webinar on the newly adapted Eden Alternative version of the PHI Coaching Approach^SM series, which is designed to infuse fundamental communication skills throughout an organization.

Two PHI staff members — Sue Misiorski, national director of training and organizational development, and Cean Eppelheimer, Midwest training and organizational development specialist — will lead the webinar and focus on elements of the coaching process, how they support the Eden journey and why they are essential to sustainable transformation.

Date: November 9, 2011
Time: 3:00-4:00 p.m. EST

There is no fee to participate; registration is required.

– by Deane Beebe

Just as the Green House Project® announced the completion of the nation’s 100th Green House home in September, Seniors Home & Care Journal published an article concluding that the Green House model’s operations are “comparable in cost to traditional nursing homes as well as nursing homes that are implementing other culture change practices.”

The article, “Financial Implications of The Green House Model,” explains that several published studies have already shown that the Green House Model of licensed nursing homes “provides significant and sustained satisfaction and clinical improvements when compared to traditional nursing homes,” but that questions remain as to the model’s initial and long-term financial viability.

The authors review past studies on the financial performance of the Green House Model and report on two recent studies that look at the 1) costs of Green House administration and organizational staffing, and 2) environmental costs, overall financial performance, and benchmarks of Green House homes.

The first study found that the total estimated personnel costs of the Green House homes and traditional models are “essentially equal.”

While there is an increase in the number of full-time direct employees in the Green House homes compared with traditional facilities, this increase is offset by a reduction in the number of both administrative and support staff (housekeeping, laundry, and food service staff), the authors report.

Shahbazims’ Larger Role Reduces Other Costs

In the Greenhouse model, the certified nurse assistants known as Shahbazim are responsible for the tasks of these support staff in addition to their typical direct-care duties.

The authors attribute the reduction in administrative full-time employees to the increased role of both the nursing staff and the Shahbazim who coordinate care and maintain patient records in the Green House model rather than having unit secretaries or charge nurses do so.

The second study compares the overall costs — including food costs, plant operations, ancillary costs and administrative expenses — of Green House homes to traditional nursing homes. It also compares their capital costs, both per square foot and per unit.

In this study, the authors conclude that the capital costs of the Green House homes are equivalent or less than similar culture change models but higher than traditional facility designs. They note that the increased occupancy and more private-pay days that are associated with the Green House model may offset these capital costs.

Tripling the Number of Green House Homes

The Robert Wood Johnson Foundation, a partner of the Green House Project, announced the organizations’ mutual goal of tripling the number of Green House homes in the next three years.

PHI, also a partner with the Green House Project, has worked with the project to imbed its Coaching Approach^SM in the educational offerings for all Green House staff, including the formal leadership team, nurses, and the self-managed work team of Shahbazim.

– by Deane Beebe

A Centers for Medicare and Medicaid Services (CMS) memorandum (pdf) issued on September 30 lists the categories of approved uses of Civil Money Penalty (CMP) funds by state.

Topping the list of nine “categorically permitted uses” — which do not require prior approval from CMS — is the use of CMP funds to promote “culture change” in projects that involve multiple nursing homes.

“This announcement provides an important opportunity for state culture change coalitions to tap into CMP monies to support training and culture change initiatives in their states,” said Susan Misiorski, PHI national director of training and organizational development services.

“There are currently 36 states with culture change coalitions, fueled largely by volunteers,” Misiorski added.

CMS describes culture change in the memo as “the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values are choice, dignity, respect, self-determination and purposeful living.”

The memorandum lists examples of culture change initiatives in several states, including:

• a culture change project that focuses on achieving staff stability in nursing homes in Louisiana;
• projects that facilitated implementation of culture change in New York State nursing homes; and
• the development of web-based training modules on culture change principles and practices for ombudsman staff and volunteers in Georgia.

Training Initiatives Approved

Training for facility improvement initiatives that are open to multiple nursing homes is also on the CMS list of categorically permitted uses of CMP funds.

One example provided in the memorandum is the joint training of surveyors and facility staff from multiple nursing homes committed to implementing effective fall-prevention programs.

Under the Affordable Care Act, a portion of collected federal CMP funds may be used to support activities that promote quality care and the well-being of nursing home residents in certified nursing homes.

– by Deane Beebe

Susan Misiorski

PHI National Director of Training and Organizational Development Susan Misiorski will lead a seminar entitled “Change Management: Leading through Resistance” at the 2011 LeadingAge Annual Meeting & IAHSA Global Aging Conference in Washington, DC.

Misiorski’s seminar will take place on October 18 from 3:30 PM–5:00 PM.

“Change Management: Leading through Resistance” is a part of the “Leadership and Strategy” track; participants will:

• examine the three different levels of resistance commonly associated with organizational change.
• discuss how to successfully overcome resistance from board, staff, consumers, and family members.
• acquire coaching techniques that can be used to effectively lead teams through change initiatives.

Misiorski, the founding president of the Pioneer Network Board of Directors, manages PHI’s organizational development work with nursing homes and home care agencies across the country.

She has been instrumental in helping client organizations understand that there is no single “starting place” when it comes to culture change.

– by Deane Beebe

The National Fire Protection Association (NFPA) has revised its Life Safety Code handbook to include provisions in the health care occupancy rules that support making nursing homes more home-like environments.

Four proposals recommended by the Pioneer Network to “create home in the nursing home” have been included in the 2012 edition of the NFPA 101^® Life Safety Code^®, according to a statement by the national culture-change organization.

The proposals that have been adopted, with some restrictions and providing that certain criteria are met, are:

• Kitchens serving no more than 30 residents will be permitted to be open to the corridor and other spaces, and either residential or commercial stoves or cooktops may be used.
• Furniture may be provided in corridors.
• Combustible decorations will be permitted in resident rooms, corridors, on doors, and in common space.
• Gas or electric fireplaces will be allowed to be used in smoke compartments that contain sleeping rooms, but not within individual sleeping rooms.

The Pioneer Network plans to advocate for the federal Centers for Medicare and Medicaid Services (CMS) to also accept these revisions, followed by states.

New Dining Practice Standards

Additionally, the Pioneer Network has proposed new Dining Practice Standards (1.4 MB pdf) that “support individualized care and self-directed living” for people living in nursing homes.

The proposed food and dining standards, such as individualized nutrition approaches and a diabetic/calorie-controlled diet, “reflect evidence-based research available to-date as well as current thinking which is in some cases in advance of research,” a press statement from the group explains.

The Dining Practices Standards have already been agreed to by 12 national clinical standard setting organizations, including the American Association of Long Term Care Nursing and National Association of Directors of Nursing Administration in Long Term Care.

The Pioneer Network is planning to submit the Dining Practices Standards to CMS as well as to the U.S. Food and Drug Administration, Centers for Disease Control, and the long-term care community, and anticipates that CMS “will refer to these new agreed-upon standards of practice within [their] long-term care interpretive guidance where they fit.”

– by Deane Beebe