Person-centered care: The bottom line

In 2003, a study of best practices for meal service in long-term care found that residents and staff alike believed service at mealtimes had a significant influence on resident satisfaction. The residents saw three things as important: server courtesy and attitude during service, the social skills of their servers and the service techniques they used. On their side, staff described the pressure they felt to complete the service tasks with little or no regard for attitude or courtesy; in fact, most did not realize that residents anticipate being served.

In many LTC communities, the basic need for excellent service has been overshadowed by a single-minded adherence to numerous state and federal regulations, medical regimens and cost pressures, even though service and an environment conducive to healthy living were stated objectives of the organizations. Somehow, companies have not been paying attention to their own core values.

Beyond the moral objective of restoring dignity, honor, and respect to elders at mealtime (which we know enhances their health and well-being), we also know that increases in resident and staff satisfaction lead directly to improved community reputation, marketability and profitability. Satisfaction is all too frequently tied to the dining experience, which can have a great influence on how strongly a community is recommended to potential new customers. Industry expert Vivian Tellis-Nayak, PhD, who has conducted extensive customer and staff research, says it best: “Higher satisfaction with the dining experience wins over residents and family members.They in turn are more likely to recommend a community.”

INVESTING IN EMPLOYEES

Making an investment in employees is critical in advancing the culture within an organization. As business consultant Joanne Smikle wrote in the January issue of Long-Term Living, “Culture change requires all staff to have a deep awareness and keen understanding of what (person-centered care) really means… realigning resources so that they are consistent with the organization’s mission and vision…encompass(ing) the entire organization—from senior managers to the frontline employee.” She goes on to note that the focus of this investment must be learning: “This is more than creating snappy propaganda about culture change. Every employee must have the competencies required to create sustainable change throughout the enterprise.”

Smikle’s missive—that person-centered organizations need to become learning organizations—is echoed by two business professors who published an article titled “Creating Sustainable Performance” in the Jan-Feb edition of the Harvard Business Review. Spreitzer and Porath identify learning (“the growth that comes from gaining new knowledge and skills”) and vitality (“the sense of being alive, passionate and excited”) as the two necessary components that allow employees to thrive. “We think of a thriving workforce as one in which employees are not just satisfied and productive but also engaged in creating the future—the company’s and their own. Thriving employees have a bit of an edge—they are highly energized—but they know how to avoid burnout,” the authors wrote. Learning is key here because not only can it bestow a technical advantage and expert status (both supporting self-esteem), but “learning can also set in motion a virtuous cycle: People who are developing their abilities are likely to believe in their potential for further growth,” the authors wrote.

As for vitality, Spreitzer and Porath note that, “Companies generate vitality by giving people the sense that what they do on a daily basis makes a difference.” Smikle offers practical insight into this statement, “As we consider what person-centered care really means, those who deliver care must become more important in the equation…Dissatisfied caregivers have little chance of fulfilling the mandates of a mission that revolves around higher levels of care and concern for residents.”  Here is where the provider’s task lies: to create an internal culture that supports collaboration, professional development and innovation. In other words, to create a culture where employees are empowered to act like leaders.

Moving toward a person-centered organizational culture, Smikle recommends measuring the needs of each type of employee, then creating individual development plans for them. As a provider, imagining this type of professional development may seem overwhelming, complicated, or abstract. It doesn’t have to be. Start in the dining room, where everyone naturally comes together in community.

LEARNING AND EMPOWERMENT

In my last training, there was a stunning example of how a little learning and a little empowerment can go a long way. On Monday, the first day of the training, a seasoned nurse was adamant that, “There was no way [she] could see how [she] and her staff would be able to help serve at the evening meal.” On Tuesday, we actually had some fun for a few hours: We talked through the serving steps, practiced them together and discussed how socializing around the meal often moves people to get along better.

On Wednesday, as we talked through the value of individual initiative, the nurse volunteered her own story. At the evening meal the night before, she chose to pour coffee and water for the residents. The serving staff was so genuinely appreciative; the nurse was overwhelmed by their graciousness and continued gratitude for her help. She was amazed by their reaction, as well as the residents’ acknowledgement. She committed to continue helping in the dining room.

A nurse pours coffee in the dining room. A simple act, but this is where changing the culture really happens. That nurse made a conscious choice to try something new. She took an emotional risk, stepped outside her comfort zone and was rewarded with acknowledgment from coworkers and residents. This is learning, this is growth … and this is a tangible step beyond person-centered care. A win-win for all stakeholders: the nurse, her coworkers, the residents and ultimately the provider/company. Perhaps most significant is that this act breaks through the perceived barrier of “my job is more important than yours.” Principles of community learned in the dining setting may naturally extend to other areas of the organization as well.

It is a pleasure to witness staff, like the nurse mentioned above, who internalize and connect to the difference their attitudes and actions make. When staff appreciate their role as servers, they can quickly see the improvements in their residents’ quality of life. As the LTC profession moves increasingly toward person-centered hospitality, the time is right for providers to take the lead and advocate for best practices in serving meals that enhance the experience of residents and servers alike.

Cindy Heilman heads Higher Standards, LLC, an Oregon-based training and consulting company. She created the Kind Dining® training curriculum.