Culture Change from the Inside Out

Yesterday I was talking with a colleague in a state office about staff training. Somehow we got onto the subject of culture change. It's a hot topic here in Oregon, as it is around the nation right now. It's a topic that's hot not just because it's an "in vogue" concept - it's hot because it's desperately needed. We're facing mammoth problems of staff turnover, lack of employee engagement, and a continued negative viewpoint within our society on senior care options - from retirement housing through nursing facility care.

We talked about how hard it is to change a culture of care, especially when business needs, not to mention regulatory compliance, seem sometimes to directly conflict with our goals of creating the ideal culture.

It's of increasing interest to me as the topic moves from the theoretical to the personal.

As a senior care professional with more years in the trenches than I care to count, it's an interesting experience convincing your own parents to move into senior care. My mom moved willingly after my dad passed away nearly 2 years ago. It's been the in-laws that have given the whole family fits.

My mother-in-law, dead-set against ever moving out of her home, has been growing increasingly forgetful, difficult to communicate with and depressed. My father-in-law, normally a socially outgoing person, has retreated so far into his home that it has begun to feel like a prison to him. Even his speech has become forced sounding, as he talks less and less throughout the day.

Shortening a long story into a brief summary, they're finally moving into a senior community next weekend. My mother-in-law called me the other day and said, "We've asked everyone we meet how they like it. Everyone has told us they love it there. I can't wait to be that happy again."

Meanwhile, she's exclaiming over and over about how many old people there are in this place. We began to gently point out that, at 90, she's right up there with them, when she stopped us and said, "I don't mean that they're old - I just mean that there are so many of them. I thought I was the only person my age still alive!"

Watching both parents smile more, talk more freely, and even walk with a little more spring in their steps is worth all the past years of convincing them to move.

What I find, in addition, is that this whole topic of culture change is now much more personal than it has ever been. It's me - my mom - my in-laws that need care. It's my family that is affected personally and directly.

And so the topic of how to truly effect culture change seems to come up more often, as I discuss it with colleagues and keep in on the board with my team all the time.

My colleague and I discussed how sometimes culture change happens best from the inside out - or from the bottom up, as it were.

Consider her example of teaching staff in nursing communities to use gait belts to assist heavy-care individuals in transferring and walking. Even though it had become "best practice," some communities didn't even have gait belts, let alone teach staff how to use them.

So she decided to add it to the new caregiver training curriculum mandated by the state. As new caregivers were trained to use gait belts during initial training, they began asking their supervisors to please provide them. Now, gait belts are common and available nearly everywhere in the state. It was definitely a more effective way to change that particular part of behavior than mandating that all staff shall use gait belts.

What if we teach principles of resident care and of working together in the same manner? As we turn out new staff, trained in new ways, we can change the culture from the inside out - from the bottom up.

It might just be the way culture change really has to happen.