Interventions to nurture excellence in the nursing home culture

There is no one formula for culcure change. A joint steering committee of staff members can develop plans that will build trust, address each other as equals, and drive out fear as they move the process of change. Training and sharing information help staff recognize this is a process, not an event. New well-screened team members need training to integrate them into the culture. It is important to identify the knowledge and expertise of team members to maximize their energies and talents. Recruitment and retention of those who share the values of this culture are of paramount importance. It is worth the time and effort to secure commitment to these values. One example of this effort is a facility in Pennsylvania that, at its worst, had two thirds of its staff turnover in a year. The national average was 82% in 1995, an increase from 71.5% the year before. They were able to reduce their turnover rate to 27% by examining the hiring records and finding that workers with certain personality traits and attitudes were less likely to leave. They looked for compassion and communication skills, perceptions of older adults, ability to cope with death and dying, and ability to handle the unpleasant tasks of residene hygiene and bathroom visits. Current staff members determined and voted on best fit of candidates (Montague, 1997). Although training and evaluation are an important component of retention and commitment to values in any organization, training and evaluation of nursing home employees may be quite different from other employment. A nurse in a nursing home needs to be evaluated not only on clinical skills, but on communication skills, attitude, and leadership (Meyer, 1995). Then training and employee development programs can be targeted to specific areas for corrective action. What is taught in training and what occurs on the job should correspond, or role conflict occurs increasing the likelihood of turnover (Steffen, Nystrom, O'Connor, 1996). Although occasional exit of poor performers and fresh ideas of new recruits can be beneficial, inability to retain experienced personnel can result in replacement costs as high as $7,000 per employee (Proenca & Shewchuk, 1997). Furthermore, fostering employee commitment also has a mediating effect on family members' satisfaction with service quality (Steffen, Nystrom, & O'Connor, 1996). Each organization must be sensitized to its own problems. Attitudes cannot be changed by rules. Staff members need to be involved with listing all the strengths and weaknesses and how to change the negatives to positives in their own facilities. This requires a continuous learning process. The learning organization usually needs to restructure to improve its operation to reduce the hierarchy. If all employees understand the reasons for change and have participated in the change process, they are more likely to have learned organizational values such as trust, commitment, honesty, and integrity by inculcating these values and teaching them to others. Every employee is a partner in building a good reputation for the organization. One person can make a difference in creating, protecting, and building an organization's good name (Young, 1996). Staff members need to have a collaborative relationship with those who survey them, those who use their services, and those who compete with them. That does not mean "cronyism" (a dishonest, close relationship), but an honest, sharing relationship that fosters problem-solving and sharing of best practices. Leaders of the future must be more flexible with a broader variety of experiences. Their ceremonial responsibilities as the head of the organization become a critical and necessary function (Steere, 1996). Ceremonies, rites, and rituals bind the members to the organization. The values and culture work well because leaders exhibit these values in their interactive communication behaviors. The trend toward increasingly empowered organizations addresses the need to move decision-making to lower levels, leaving the leadership role to one of clearly articulating and demonstrating a sense of purpose and direction dedicated to excellence and quality.