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It's All About Culture:
How Culture Change Can Propel a Positive Image Among the Community

Clint Maun, CSP

While the digital age has allowed the world to stay connected at all times, much of the long term care community remains disconnected with its customers and the community. This is especially true when it comes to marketing. For example, many healthcare organizations market their success on hard data such as statistical reports, survey results, high reimbursement rates, etc. However, consumers often determine what makes a good facility based on different benchmarks, such as personal references and word of mouth advertising. Furthermore, the public's stance toward long term care facilities is filled with feelings and emotions, which has been hard for "insiders" in the business to tap into. All in all, this reality makes marketing your facility to the general public difficult.

Plain and simple, to be successful, healthcare facilities must create and maintain a positive image among the general public. To do this, a facility must focus on two key objectives: 1) creating a working environment in which the values and belief systems (i.e., culture) are customer-oriented, and 2) the individuals responsible for the facility's success buy into those systems. In other words, the culture needs to be resident-centered and staff-empowered.

The remainder of this article will discuss what you can do to attain and sustain this kind of culture, and thus create a positive image among the surrounding community.

Give the residents a say. Residents and patients are perhaps your best marketing tools. No matter how effective a brochure, advertisement, etc, a happy customer who shares his/her experience(s) with others can have a much more powerful impact.

Your patients and residents are going to be more likely to sing your praises if you give them a say in what goes on in their life. While employees certainly have schedules and tasks to adhere to, giving residents more of a choice doesn't have to be difficult or time consuming. It can be as simple as asking a resident, "Would you like mash potatoes or fries with your lunch today?" More importantly, this kind of autonomy is good for residents' mental and emotional well being, as they get the opportunity to decide some things for themselves instead of someone else deciding for them.

Focus on value.
Many facilities attempt to entice customers with a marketing strategy based primarily on price. While price is important to customers, it is not necessarily as important as value. Quite simply, when it comes to one's health and well being, value is what attracts the customer. And a healthcare facility that cannot create value in the minds of its customers will not succeed in a competitive environment-no matter how low its prices.

So how can your organization create and enhance value? In service industries such as healthcare, it is only through staff (and staff culture) that one can improve quality and thus, create value.

With the nursing shortage and high turnover rates, it's all too easy to make quick decisions in the name of filling a vacant spot. However, in the long run, this can have a negative impact on your organization's ability to produce value. That being said, it's critical that you undergo a thorough evaluation of your current staff and make careful assessments for all potential employees. These assessments can include determining what belief systems propel your staff when they care for residents. For example, is their primary focus on patients' needs, requirements, desires, etc? Or do they operate "by the book," looking at patients as just one more of their many duties?

When recruiting new hires, keep a primary focus on attitude and intention. A candidate who has a good attitude, but not as many qualifications as you'd like is still probably a better choice than hiring someone who has more qualifications, but a poor attitude. After all, you can teach and train for specific competencies, but you can't necessarily do the same with attitude.

Also, seek employees who have a background that includes volunteer work in a senior center, elective course work in gerontology, etc. People with a genuine love for the elderly are more likely to become good long-term employees than those who see them as a group of needy, demanding customers. Remember, a staff that possesses a sincere interest in working with the elderly will create a culture of respect and value.

Remember that as management does unto staff, so staff will do unto patients. When there's hostility between management and staff, the negative actions are often played out against the customer/patient. Additionally, when management ignores staff's concerns and suggestions for improving resident satisfaction, it produces a bad effect on staff attitude (culture) and the residents are ultimately the ones who suffer the consequences. Take the dining experience as an example. Your residents are not satisfied with their dining experience and you need to know why. Is it how the food is prepared? How it's presented? When it's served? Waitstaff are in a better position to answer those questions than management. So, seek their input and put it to good use.

You should also consider creating volunteer teams run by front-line workers instead of administrators to help address various issues: measuring quality, raising money, public relations, caring for plants and animals, welcoming children, etc.

Make it more like home. Another key principle of culture change is to make your facility more attractive and homelike, rather than institutional. This includes adding plants and animals and, if possible, making dining rooms smaller and creating more comfortable community spaces. Many facilities have implemented a more homelike atmosphere and have experienced positive results among patients and the community (refer to the right hand column for more information concerning these facilities.)

Parting Thoughts
Culture change ultimately requires nurturing from management in an era of high turnover among administrators as well as staff. Effectively changing how employees approach both their work and residents is not easy, to be sure. But, you can rest assured that culture change will not go unrewarded-money saved on reduced staff turnover and avoiding empty beds through the reputation in the community are just a few possible side effects!

Leading the Culture Change
Culture change proponents point to the depressing atmosphere and high staff turnover in many of today's long term healthcare facilities as evidence of need for change. While the culture change trend has reached relatively few homes, some institutions have implemented changes with great success. Below are some of the nation's leaders in long term care culture change.

Beverly Healthcare
A subsidiary of Beverly Enterprises, Beverly Healthcare runs 452 nursing homes and 29 assisted living centers in 26 states and the District of Columbia. Their philosophy is based on a team-centered approach to caregiving to design the resident's own treatment plan.

Eden Alternative
The Eden Alternative is a not-for-profit organization whose mission is to improve the well-being of elders and those who care for them by transforming the communities in which they live and work. The Eden Alternative, adopted by 300 nursing homes over the past decade, is built on relieving facilities of "the three plagues": loneliness, helplessness and boredom.

Pioneer Network
The Pioneer Network consists of elders, family members, administrators, nurses, certified nursing assistants, resident assistants, physicians, social workers, educators, researchers, ombudsmen, advocates, regulators and architects who advocate and facilitate deep system change and transformation in the culture of aging.

Meadowlark Hills
Meadowlark Hills seeks to change the architecture, staffing, and systems and also aims to add resident-directed care and services.