Here’s my latest article on McKnight’s Long-Term Care News:
Enhancing organizational communication improves outcomes, reduces adverse incidents
McKnight’s Long-Term Care News frequently notes stories about rogue employees engaging in illegal and disturbing behavior and then trying to cover it up after the fact.
There are regular reports about intra-organizational systems that fail, leading to wrongful death lawsuits and other problems, such as this one about a resident who died from scabies.
Occasionally there’s an article about a whistleblower alerting the authorities about a questionable practice, resulting in repercussions for the company.
It’s very likely that there were employees who noticed that things were going awry before these stories became stories.
I know I’m not the only one who has observed that in some facilities, staff reports of potential problems are met with appreciation for the alert before rectifying the situation, while in other nursing homes, information is so often ignored that it is no longer reported. These vast differences in the culture and communication style of organizations directly impact health outcomes.
In a New York Times article last week, “A More Egalitarian Hospital Culture Is Better for Everyone,” author Pauline W. Chen, M.D. detailed efforts to alter interactions between hospital staff members, moving from an authoritarian style to a more egalitarian approach.
In authoritarian hospital cultures — those with a “do as I say” management strategy — nurses feel powerless to affect change. Patients fare worse in authoritarian environments than in egalitarian hospitals where nurses are regularly asked for input and senior management staff meet consistently with clinicians.
The article describes a program called Leadership Saves Lives, which created significant cultural changes in a relatively short time frame and improved clinical outcomes. The effort involved “guiding coalitions,” with the more successful coalitions having more diverse membership, including participants across departments as well as frontline, mid-level and top leadership and administrative staff.
Effective groups were able to elicit authentic contributions from members, who felt that their perspective was welcomed and valuable, and they found ways to handle conflict, fatigue and motivation over time.
While this particular study focused on hospitals, long-term care — with its similar interdisciplinary team approach and fragile population — might take note. Authoritarian, top-down communication makes it less likely that workers will notify supervisors about practices that could negatively affect the health of residents and could potentially lead to litigation and unfavorable press.
Teachable moments
While there’s a temptation to blame rogue workers for their mishandling of an event (and to feel relief that the situation happened elsewhere), we’d be better off viewing these events as teachable moments for any organization.
For the entire article, visit:
Enhancing organizational communication improves outcomes, reduces adverse incidents
Horror stories now daily are media reported, describing all different levels of LT skilled care and operations but still, many believe, they neglect to label the culprit allowing potential for occurrences. Maybe this correctional approach seems too simple and maybe because it cuts into the profit pockets of controlling corporations… Nursing care is hands on involvement, availability of floor staffing determines its extent. The disabled and elderly are people, recall, with memories and regrets, habits and demands. They can be hostile and combative, fearful, often confused. Ideally they require patience and time. It takes skill to coordinate their needs into a 2 minute task. Costs for their facility care rises continually, families often want subsidies for that care, which can be slow to arrive, additionally straining skilled care operations. Labor, as the biggest overhead cost, is absurdly cut, resulting overwork wears down existing staff, contributing to turnover. Scabies and infestations are institutions vulnerabilities; their indications are always first spotted during floor care, news does not originate in administrative offices. Treating the entire facility can be costly, too often a compromised focus is on roommates or areas of proximity. Results are not always successful. One corporation is recently trying a plan of cutting down on staff per shift but giving existing staff a pay raise. Hopefully this will increase employees hustle as they simultaneously transfer a hip fracture resident from chair to toilet, prepare others for bed and stop a 100yr. woman from pushing her walker out an exit door into the path of a busy highway. Most residents harbor potentially libelous conditions, from diagnosing a persistent rash to monitoring married seniors intent on hitting each other. Nursing care needs to be staffed. Public Health should be willing and able to assign fines for insufficient staffing and a realistic staffing number should be determined. While eagerly tapping the market of surviving babyboomers, Corporations need to be willing to extend the profit margin toward a necessary staffing allowance.