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Successful Edenization Through Education

March 1, 2004
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A Michigan staff-training model expedites this popular approach to culture change by Jack L. Steiner, Cean Eppelheimer, and Marla DeVries

  • Provide individual management coaching (in Michigan, this is BEAM-facilitated).
  • Hold a vision-setting session with the Core Team, developing benchmarks and outcomes goals (again, in Michigan, this is BEAM-facilitated).
  • These seven steps are implemented within the Eden Alternative organization. In Michigan, BEAM provides additional motivation and support; in other states, these are provided by the EARCs. Effective January 1, 2004, BEAM has been assigned six more states in which to replicate this organizational training process: Indiana, Illinois, Wisconsin, Minnesota, Kansas, and Missouri.

    The aim of the On-Site Training Model is not only to educate individuals on the Eden concepts, but also to better position the facility for a future of continued growth and success. The benefits of conducting the Eden Associate Training with at least 30 members from one organization include the development of relationships (the cornerstone of the Edenizing process) among staff, greater teamwork, and the ability to focus on concrete, rather than merely hypothetical, issues affecting the organization.

    One of the principles the Eden Alternative teaches is that Edenization is a process, a journey that never ends. Celebrating successes along the way is an important ingredient in the process of change. Homes are therefore encouraged to record their Eden journey in a facility journal and to share their story with the community, family members, and residents.

    Why the On-Site Training Model Works
    It is helpful, when the day-to-day demands of the nursing home environment threaten to overshadow Edenization efforts, for staff to realize they are not alone. Using this model, an ample number of an organization's staff members have been "Eden educated" and can help keep the home focused on its Eden journey. In our state, BEAM provides continued support and encouragement to the organization, as well as being a conduit of best-practices ideas gathered from organizations around the state.

    Indicators of Success
    As with many developing systems, the Eden Alternative and BEAM have not yet developed sophisticated data collection processes. However, data gleaned from existing datacollection methods-such as the MDS, Medicare Compare, Quality Indicators, and internal human resources records-can be used to measure progress.

    A reduction in staff turnover has emerged as a major benefit of Edenization. Administrators successfully implementing the Eden Alternative report staff stability approximately 6 to 10 months into the cultural transformation process. One Michigan facility reported an annual turnover reduction from 106% to 24% over a three-year period. (The statewide average of turnover for nursing home employees is about 69%.) Seven of the 30 Eden Registered Homes in Michigan have reported an average turnover reduction from 72% to as low as 9%, the average being 15% (visit for more details). Some Michigan nursing homes are saving in excess of $100,000 per year in reduced staff turnover costs.

    As anyone in long-term care knows, a stable staff correlates with improved quality of care, which translates into greater customer (resident and family) satisfaction, as well as a reduction in recruitment costs. Additionally, a stable staff creates opportunities for staff members to develop ongoing relationships with residents.

    Relationships, particularly those between hands-on caregivers and residents, are at the core of the Eden philosophy. As these relationships develop, decision making for residents is put into their own hands (or into the hands of those closest to them, their caregivers) instead of upper management's. This important Eden Alternative principle often presents the greatest challenge to directors of nursing, nurse managers, and administrators where Edenization is taking place, because it requires that they change the top-down way they've been operating. However, the problems many nursing homes face-decline in census, financial instability, and concerns about their reputation-tend to strengthen their leadership's resolve to "become different" from others and commit to improving residents' quality of life. They are further motivated by the expected benefits of stabilizing staff turnover, as mentioned previously.

    Other benefits of successful Edenization include reduced medication use (e.g., sleeping pills, antianxiolitics, and antidepressants) and fewer complaints from residents, families, and staff. The concept that "friends do not hurt friends" prevails because of the strengthened interpersonal relationships between residents, staff, families, and administration. This correlates with the Eden belief that everyone is important, equal, respected, valued, and honored for his or her daily contribution to a warm and caring place to live and work. Because the Eden Alternative is as much a personal transformation as it is an organizational one, every person in the organization is valued and respected, irrespective of job role or title. The objective is building "community" in the purest form, where trust and honor are not just words but actions.

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