Do you have change agents on your staff? If not, you should seek out and encourage them - even if it's politically incorrect - feature article

Nursing Homes, August, 2003 by Jaime Todd

Entire industries can collapse under sustained external pressure. One industry that is currently under extreme pressure is long-term care. Constant congressional scrutiny of nursing home care, frequent legislative mandates for more punitive regulations, out-of-control lawsuits and liability costs, critical-skills labor shortages, and media that thrive on amplifying isolated incidents all add to the external pressures that threaten the preservation of long-term care. Without question, no industry can survive under this much pressure without acceding to change.

"Improve nursing home care" quickly is becoming the battle cry of opportunistic politicians and soon will be the announced target of district attorneys across the nation. As the LTC environment becomes more politicized, more negative attention toward the industry will become evident. The quandary for long-term care, within the context of a politicized environment, will be a heightened public perception that all nursing homes are substandard.

The old quick fix of writing eloquent mission statements or mounting warm-and-fuzzy public relations campaigns has become a futile strategic response to current conditions. Effective organizational management strategies to reverse negative public sentiment toward nursing homes can only be achieved by cultivating industry-wide change.

Enter, the Change Agent

What is a change agent? Change agents are the most genuine of healthcare executives--those who are progressive and innovative, intolerant of complacency, and constantly striving to invent better organizations. Change agents possess a commitment level that drives them to enhance core competencies and organizational capability to ensure that residents have the highest quality of life possible. Change agents make all employees, both below and above their authority, feel a sense of urgency to perform better. Most importantly, change agents are the "good consciences" of the industry; their management decisions protect frail elderly people.

What Change Agents Do

Change agents never cultivate superficial or artificial work environments; in fact, they challenge superiors who are mediocre or fail to provide the organization with progressive thinking and innovation. Change agents are the people sitting around the oval table who question ineffective ideas when everyone else is afraid to say a word. Unfortunately, many executives at all levels of management prefer subordinate employees who admire, praise, and agree with them unqualifiedly, regardless of how insignificant or bad their ideas may be.

Change agents fight for optimizing management environments by challenging everyone below and above them. True change agents will foster a communication system where uncomfortable questions are asked and explored, because they know candid exchanges of ideas are how management decisions are refined and shaped into efficient processes.

Change agents raise expectations by seeking to hire people more capable than they are in various capacities--the antecedent to enhancing organizational capability. Change agents never compromise their high standards or "hire down." Since time immemorial, great leaders have encouraged hiring the best in order to be the best. Unfortunately, many of the best executives in long-term care have left the industry, moving on to a career/life offering less professional grief. They've been replaced by a procession of lesser executives, who are welcomed by those with lower expectations and standards.

Unfortunately, hiring down is a common practice involving:

* Misfits. These are executives who are placed in key positions but just don't belong there. They are inept and clueless regarding residents' essential needs. Their hiring decisions are based on personal feelings, not what's best for residents.

* Burnouts. These are executives who smolder in long-term care year after year, collecting a paycheck and never contributing to industry capability. These executives have no desire to exert the effort needed to be progressive or innovative; they hire subordinates who lack progressive ideas or any desire to innovate so they won't be challenged by them (a growing crisis that has eroded successive layers of industry capability).

* Defenders of vested interests. These are executives whose only real interest is self-promotion--they consequently avoid hiring people with obvious talent and capability. Their main vested interest is hiding their own incapability. These individuals thwart change, rather than foster it.

* Posers. These are executives whose only real skills are schmoozing and convincing others that they care about residents, even though they don't. Posers lack capability and are generally hired by those whose egos need stroking.

The most alarming reason for hiring down is the acceptance of lower standards because the facility profit margin has fallen below the bottom line. Providers with this mind-set purposely seek candidates with low expectations and shun well-qualified candidates to ensure an environment where employees never question substandard practices. While this group is in the minority, they present a major threat to the frail elderly and to the industry as a whole.