Pioneering change in Kansas: the PEAK project: Kansas offers its nursing homes the tools needed to embrace culture change

Nursing Homes, April, 2004 by Gayle Appel Doll

Sharon didn't know where to turn. She desperately wanted to make a new life for herself. For the past four years she has worked as an aide at Windsor Place, a nursing home in Coffeyville, Kansas. Her attendance record is exemplary and she works hard to give residents the quality of life she feels they deserve. While her work life grows more rewarding, past decisions interfere with improving her home life. She was living in a rented apartment but had found a nice little "fixer-upper" house she dreamed of buying. Unfortunately, everywhere she turned, Sharon's credit history blocked her way.

One day, after yet another loan refusal, Sharon was expressing her frustration to the human resources director at the home. Because Windsor Place had helped staff members in the past with personal challenges, including loans and advances, Sharon decided to ask for assistance. To her amazement, she was told that because of her commitment to the nursing home and its residents over the years, the organization would be happy to demonstrate its commitment to her. Leadership co-signed her loan. Two months and one very happy employee later, Sharon moved into her new home.

The philosophy at Windsor Place is: "As the staff is treated, so shall the residents be treated." When the administration shows that it values its employees as individuals, then these same employees--from aides and housekeepers to nurses and dietary staff--will pass this caring on to the residents. This is just one reason Windsor Place is a repeat winner of the PEAK (Promoting Excellent Alternatives in Kansas) nursing homes award.

The PEAK Project

In 2002, Kansas Department on Aging Secretary Connie Hubbell's interest in improving nursing home care converged with the national culture change movement to dramatically accelerate change in the Kansas long-term care environment. To encourage culture change, Hubbell's staff designed PEAK as a recognition and education program to advance new care practices in the state. Nursing homes applied for recognition of their efforts to implement the Pioneer Network's core objectives of returning the locus of control to the residents; enhancing frontline staff's capacity to be responsive; promoting home; and community involvement. Seven sites were visited and selected to receive statewide recognition. Monetary awards, raised through suppliers, were distributed and used to celebrate the progress that had been achieved with staff members.

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The PEAK recognition process continues to evolve as organizers learn more about the principles of culture change and the different ways change can be creatively implemented. In 2003, PEAK applicants faced more rigorous screening, but could compete in a category of their choosing rather than having to demonstrate change in all of the core objectives. Ten sites earned recognition, with Windsor Place qualifying in all four core objective areas and the only participant to repeat its achievement. As a result of Windsor Place's first award, empowered staff were in a position to proactively use their skills to seek input from residents and their families so that resident-focused care could continue to develop. Recognizing that winning in only one area might not necessarily change a nursing home's culture, the advisory group for the recognition process has stipulated that those competing for the award this year must be working in both resident control and staff empowerment, in addition to other areas of excellence.

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While examples of culture change are essential to disseminate new ideas, providing information about the process of change is also critical. The Galichia Center on Aging at Kansas State University (KSU) was awarded a contract to develop educational materials and resources on culture change targeted toward nursing home personnel.* The initial PEAK-ED project was Pioneering Change, a 112-page booklet that highlights culture-change principles, illustrated with examples from PEAK award winners and other exemplars of culture change in Kansas. The booklet was organized around Pioneer Network objectives and includes research to support changes, possible expected outcomes, and a wealth of resources. It was distributed to all nursing homes in Kansas and is also available online at www.ksu.edu/peak.> The second phase of the project was to provide in-depth educational materials focused on teaching culture change concepts. The first two modules developed focus on Culture Change Basics and Measuring Change. Each module lists suggested projects that might help fulfill a step toward culture change. The modules provide activities for personal reflection and for group practice. Most of the activities begin with a case study. For example, after learning about goal setting in the Culture Change module, a list of goals compiled at a real-life in-service was given. Two of the goals were to help others when needed and to have positive attitudes and improve communications with other shifts. Staff were asked to mark a target posted on a bulletin board whenever these goals were achieved. If a goal remained unmet, staff members were asked how the goals could be rewritten so they would know when they hit the target. The resulting group activity is to take each of the goals from the staff-meeting case study and state them as measurable objectives.