Successful Edenization through education: suggestions for encouraging LTC staff to embrace the change of the Eden Alternative

Nursing Homes, March, 2004 by Jack L. Steiner, Cean Eppelheimer, Marla Devries

In the December 2003 issue of Nursing Homes/Long Term Care Management, an article by Bethany G. Sampsell chronicled one LTC facility's experience with the Eden Alternative[TM]. The article, "The Promise, Practice, and Problems of the Eden Alternative," described the facility's struggle to achieve the fullest possible benefit from the process of Edenization.

In response to that article, we offer suggestions on how to introduce the Eden Alternative to a long-term care facility using an approach developed by BEAM (Bringing the Eden Alternative to Michigan), an organization which began as a coalition of senior advocacy groups, providers, people from government, and regulators who were frustrated with the lack of progress in care and services to our elders. The group also realized that punitive regulations did not contribute to improving quality outcomes.

The Eden Alternative came to Michigan in January 1998 when Dr. William Thomas trained 40 members of the coalition as Certified Eden Associates (CEAs). These people then began the difficult work of influencing state policy on creating incentives for nursing homes to design innovative projects to improve quality. Nearly three years later, in December of 2000, the coalition organized itself as a nonprofit, 501c3 organization, committed to transforming the culture of nursing homes in Michigan through training and education programs designed to recognize and support commitments to best practices and the 10 principles of the Eden Alternative.

Since June 2001, BEAM has been actively promoting the Eden Alternative in Michigan, touching more than 150 nursing homes, training 1,150 CEAs, and supporting 30 nursing homes and assisted living residences already on the Eden Registry.

Transforming the long-term care culture has been no easy task. The roots of nursing homes run deep, back to the medical/institutional model. The traditional nursing home operates through a very regimented and rigid hierarchical system. The Eden Alternative, on the other hand, seeks to create a human habitat where the focus is on relationships, and the locus of decision making is with the resident. So the question is: Can a traditional, institutional culture be transformed to a sustainable, growing, thriving, relationship-oriented culture? The Michigan experience may provide the answer.

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In the early days of BEAM, training was based on the personal transformation of individuals. Individuals from various long-term care settings would gather at CEA training sessions to learn the Eden philosophy and principles. Enlightened to Eden, each CEA then had the daunting task of returning to his or her respective nursing home and transforming its culture. As indicated in the Sampsell article, it is very difficult for one or two or even 10 persons, especially if they are not a part of a facility's formal leadership, to teach the Eden concepts, create a vision for the future, and ignite Eden in the hearts of the rest of the staff. BEAM had to ask itself, "Have we set people up for failure?"

BEAM has since learned that deep-rooted organizational change requires not only personal transformation, but also a change in organizational systems; hence the birth of the On-Site Training Model. This model incorporates individual, personal responsibility (ownership of the process) with an organizational systems overhaul (management style and structure).

On-Site Training Model

The On-Site Training Model focuses on the whole organization, looking back at its history, assessing its current reality, and envisioning a clear picture of the future it hopes to create. Additionally, mentoring (consulting) services provide support, infuse staff with new ideas, act as a catalyst to maintaining the momentum, and provide regular updates on benchmarking goals. These services are available through the 14 Eden Alternative Regional Coordinators (EARCs) who comprise the Eden Alternative organization.

The On-Site Training Model follows this seven-step process:

1. Conduct a brief organizational assessment of the existing culture and
   set the vision for the future with the formal leadership (i.e.,
   administrators, directors of nursing, department heads and, often,
   representatives of the board of directors) of the organization. The
   assessment is presented in a written report. This step requires a
   great deal of diplomacy.
2. Provide on-site CEA training for a minimum of 30 employees (or 15% of
   total staff--whichever is greater).
3. Provide "Eden immersion" training for 80% of remaining staff on the
   Eden Alternative concepts. This is a condensed (four-hour) version of
   CEA training that introduces the Eden Alternative's major concepts,
   jargon, and 10 principles.
4. Hold a Management Team (made up of the administrator, DON, and all
   department heads) planning session and present to the team a
   follow-up report of completed trainings. The purpose of this meeting
   is to develop a "next steps" action plan that all formal leadership
   will support.
5. Select a Core Team (selection is made by the Management Team and
   CEAs). The Core Team includes the administrator, the DON and other
   department heads, but mostly consists of direct caregivers, some who
   are CEAs and some who are not. Its purpose is to build strong
   relationships with coworkers and to assume responsibility for moving
   the education and communication process forward.
6. Provide individual management coaching (in Michigan, this is
   BEAM-facilitated).
7. Hold a vision-setting session with the Core Team, developing
   benchmarks and outcomes goals (again, in Michigan, this is
   BEAM-facilitated).