Organizational culture shapes care in our communities. The concept of preferred view, which we looked at in February's column, p. 16, applies to the organization as a whole, as well as to the individuals both working and living in it. Having a clear sense of the organization's preferred view, often revealed in the mission and values of the community, can bring out the best in all its members and guide internal organizational alignment and culture change.
In “Using Strengths-Based Practice to Support Culture Change: An Australian Experience,”
1 in the book
Culture Change in Long-Term Care, Peta Slocombe recounts the story of Mary, a caregiver who had entered the field later in life after an experience reading to a vision-impaired elder. Mary was a patient, caring person and she found the pleasure that she took from this job so rewarding she decided to work in the field. However, Mary was experiencing difficulty at work because a woman with Alzheimer's was taking off her clothes after Mary helped her shower and dress, and the woman's daughter would visit and think that nobody was taking care of her mother. The daughter complained to management, and Mary's supervisor responded with more and more constraints on Mary and the frontline staff, requiring increased paperwork and regulation along with adapting a defensive stance. Slocombe recounts: “As the organization attempted to manage the [preferred view] gap and dealt with staff morale issues by increasing regulation and reviewing procedures, staff came to feel more and more despondent and unproductive. They felt that the imposition of these policy changes meant that management saw them as to blame for the complaints or at the very least deficient.” This widened the gap for Mary and many of her coworkers.
The solution here is to regroup and revisit the “positive intentions and resources of the organization” and work to bring them in line with “the staff's preferences to be caring, flexible, and client-centered.” Implementing top-down or punitive solutions rarely work as they take the focus off the individual's ability to bring their own strengths-based solutions to the table. The worker gets the message that she is seen as noncompliant, uninformed, rebellious, or uncaring. This widens the gap between how she sees herself (cooperative, caring, and responsive) and the way she is being seen and treated by management.
Professional development as well as problem-solving when a client, resident, or staff member is dissatisfied is most effective when the focus is on reaffirming the positive intentions and viewpoints of both the organization and staff, as opposed to workshops that point out or suggest deficiencies by implying a lack of skill or motivation.
Brainstorming and team-building sessions in which employees identify specific behaviors that express their commitment to the values of the organization are especially helpful. For example, if the organization has pledged to treat everybody with respect, what does this look like? People are generally very good at identifying these behaviors, especially when they are personalized in a golden-rule-type framework.
Christine Mour, Community Leader (formerly titled Administrator) of St. Elizabeth Rehabilitation and Nursing Center in Baltimore, who studied preferred view in the Master's degree program at the Erickson School, has spent the past five years using organizational preferred view techniques in order to change the model of care from institutional to person-centered at St. Elizabeth. She stresses the importance of honoring the good work people are doing, and have been doing, so that they do not feel criticized or implicated in the need for change. The preferred view of St. Elizabeth did not change, she says, as it has been and will always be a place with caring intentions. The story of the original St. Elizabeth, whose mission was to care for the needy, guides their work, but inspiration to change the way they carry out this vision came from becoming aware of wanting a more person-centered environment. “The worst thing you can do is tell people to change and then they feel like they have been doing it wrong for 30 years,” Mour says. “Acknowledge and celebrate the way you did it and bring people's gifts and talents to the table to get to the next level.”