Nursing Home Quality Improvement NHQI Collaborative

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Nursing Home Quality Improvement (NHQI)
Collaborative
Transforming Nursing Home Culture Through
Person-Directed Care (PDC)
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Culture Change in
Long-Term Care is

• an ongoing transformation based on
  person-directed values that restores control to
  elders and those who work closest with them.
• Pioneer Network

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Pioneer Network Values

• Know each person
• Relationship is the fundamental building block of
  a transformed culture
• Put person before task
• All people are entitled to self-determination
  wherever they live
• Recognize that culture change and transformation
  are not destinations, but a journey, always a
  work in progress

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PDC Model
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PDC Model
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PDC ModelDomain
of Care Practices
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Current Process Institutional-driven systems
(person adapts to institution) Person-Directed
Process Individual-driven systems (institution
adapts to person) Principle Create systems that
honor and defend individual preference
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Areas to consider for changes

• Waking and sleeping
• Meals
• Food preference
• Daily routine
• Bathing frequency, time and method
• Activities

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Current Process Perception of nursing homes as a
place to die or the last stop Person-Directed
Process Rituals and celebrations that acknowledge
life Principle Establish an environment where
all are given the opportunity and provided the
resources to thrive, flourish, and grow
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Key Change Examples

• Activities that support life and growth
• Celebrate the lives of those who live and work
  there
• Residents have the opportunity to give, teach,
  offer, and share
• Death and dying rituals

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Current Process Medical model focus Person-Direct
ed Process Focus on integrated, holistic
model Principle Support and integrate quality of
life with quality of care by focusing on the
holistic model
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Key Change Examples

• Consideration of the whole person spiritual,
  mental, and physical well-being in all decisions
• Seek innovative and creative strategies and
  opportunities for improving care that consider
  quality of life

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PDC Model Domain of Workplace Practices
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Current Process Exclusive, impersonal work
practice Person-Directed Process Inclusive,
relationship-based practice (employee, resident,
family) Principle Create an environment where
relationships are placed at the forefront of all
practice
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Key Change Examples

• Make meaningful and lasting relationships the
  priority
• Allow consistent staff assignments
• Make sure administration is visible and knows
  staff, residents and their family
• Invest in staff through education
• Focus on soft skills communication and mediation

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Current Process Segregated departments Person-Dir
ected Process Integrated work teams that
influence care Principle Formulate integrated
teams that guide the organization into the best
possible care, work, and environmental practice
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Key Change Examples

• Use creative processes to develop new
  ideas for care
• Integrated Care Teams Nursing Assistants
  generate the basis of the care plan and function
  as equals on the care plan team
• Inclusive decision-making process

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Current Process Authoritarian change
process Person-Directed Process Empowered,
informed, integrated change process Principle Cre
ate opportunities for individuals to offer their
thoughts and ideas, participate in process
development and decision-making
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Key Change Examples

• Establish self-directed work teams
• Create team driven processes
• Promote a setting that empowers individuals to
  lead, make decisions, and take responsibility
• Support an environment where the opportunity to
  improve the facility and individuals lives is
  held in high regard

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PDC Model Domain of Environmental Practices
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Current Process Hospital environment (fosters
isolation and loneliness) Person-Directed
Process Home (fosters a sense of community and
belonging) Principle Commit to
de-institutionalize, providing a sense of peace,
safety and community at home
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Key Change Examples

• Encourage residents to decorate personal space
  with items that reflect their individuality and
  autonomy
• Provide for nature and natural settings as much
  as possible
• Decrease random alarms, alerts and pages
• De-institutionalize common rooms such as
  bathrooms, day rooms, and shower rooms
• Shift toward neighborhoods, communities

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PDC Model
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Online Resources

• www.nmmra.org
• www.culturechangenow.com
• www.pioneernetwork.com
• www.edenalt.com/welcome.htm
• www.wellspringis.org
• www.live-oak.net
• www.ksu.edu/peak
• www.dementiasolutions.com

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Contact Us
Lorri Eberlein, RN, LNHA, nursing home quality
improvement manager leberlein_at_nmqio.sdps.org
(505)
314-9015 Elayne Villa, nursing home quality
improvement coordinator evilla_at_nmqio.sdps.org
[phone]
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Questions?
This material was prepared by the New Mexico
Medical Review Association (NMMRA), the Medicare
Quality Improvement Organization for New Mexico,
under contract with the Centers for Medicare
Medicaid Services (CMS), an agency of the U.S.
Department of Health and Human Services. The
contents presented do not necessarily reflect CMS
policy. 8SOW-NM-NH-07-23