The Common Denominator of Government and Nursing Homes

This commentary is in response to Dr. Reid Wodicka’s “Hey, Government Can Be Innovative, but We Have to be Intentional About It.” To view the original article, visit https://view.publitas.com/county-of-bedford-virginia/bedford-county-review-for-march-23-2018/page/1. Government has a long history for being an unbending infrastructure wrapped in red tape and doing anything outside the status quo seems like an almost impossibility. Bureaucracy and innovation are oxymoronic ideologies. There is almost a shocking lack of understanding about what the true issues are with its Citizens at the ground level. 

When I think of other obdurate make-ups, I think of nursing homes. Innovation is not necessarily a word that comes to the mind either. Rigid schedules and a deficit-based model of care emphasize the tasks and routines above the resident itself. That structure has been in place for almost 80 years and is fashioned on an efficient factory, hospital based models. The day is centered on the work to be done, and the person claimed to be served is lost in the hubbub of traditional old culture systems.

What do government and nursing home organizations have in common? You guessed it, innovation has little room to grow or opportunity to succeed. With the very best of intentions, government and nursing homes are limited by the confines of traditional systems and can quickly reflect disempowering practices. Just to clarify, there are many good people working in government and nursing home organizations. After all, we work in these places for a reason usually around the mission and values of the organization. It is just a broken system. 

Creating a culture of innovation in government and nursing homes is easy right? The obvious answer is no. It fact, it is really complicated. What gets in the way of ensuring each Citizen and Resident has control and power over the things most important to them? The biggest barrier is the traditional organizational chart in place in most organizations. 

Government and long-term care settings have usually had top down power structures with most of the decisions made at or near the top of the organization. This type of structure has not always supported collaboration and definitely not innovation. For problems to be solved, they generally need to go up one silo of the chain of command for a decision to be made. 

This thwarts collaboration and innovation and prevents fully informed decision-making and negatively impact buy in for solutions to problems due to lack of participation in the process. Boards, administrators, department heads delegate authority and make decisions downward through a hierarchical chain of command. Citizens and Residents are not part of the hierarchy and often lose control, choice and a voice. Work can get done with some efficiencies but decision-making and power is far away from the actual people served. 

I propose a reimagined organizational design that returns some control and puts Citizens and Residents in the center of these organizations where supports and services are designed around their needs. That is innovation in it of itself to the highest level possible. These people would be in a position to contribute to and make decisions. If an organization’s complete focus was on the people, decisions and outcomes would be different. Innovation would start to burgeon and become a norm. 

Decisions and innovation that need to be made must come from those nearest to the situation. Think of CNAs who closely work with the residents if they had the ability to make day to day decisions with and in conjunction for the residents. The same goes for Citizens. If Citizens worked on groups or committee across and with Government functions, genuine innovative results would happen. 

It does not take the smart people to have innovation either. It just takes people. Sharing ideas and collaboration can generate innovation. I have seen groups of CNAs, dining workers, housekeepers, and other industry professionals with no formal education solve some pretty tough things. It did not need to go up the chain of command for approval, and up the chain of command would never have thought of that idea in the first place. If anything, up the chain of command may have stalemated the process. 

What could innovation around a redesigned org structure look like at the government level? I am glad you asked. 

-teams working across departments and groups 

-additional board members consisting of a greater cross section of people served

-well-being and healthy lifestyle emphases

-efficiencies through privatization

-grow you own; internships; mentorships

-limited government scope through partnerships and shared power

-smart recycling and waste management

-participatory budgeting

-being an employer of choice

I have seen innovation around vending machines, wood by products, trash, parking, community education, dining, and food waste. In one organization I worked, employees were tasked to come up with creative ways to save money in various areas. People took ownership of the process and found some practical ways to cut expenses that resulted in thousands of dollars. Innovation can come in various big and little forms and without necessarily spending a lot of money if any at all.

When I think of innovation in a nursing home, my mind quickly jumps to over 30 years ago, when people in the field of eldercare began to challenge the traditional institutional culture. People wanted more than to be labeled by their disease. A person needed to live in a meaningful life, pursue joy and goals and have control over their daily lives while receiving the support they need to live that life. This movement is called person directed living. Solutions at the Bedford County Nursing Home are future at this point. We are starting to have discussions about what this may all look like at the end of the day. Westminster Canterbury Lynchburg and Richfield of Roanoke are two local communities moving their nursing homes in this very direction. 

To learn more about some innovative nursing home concepts visit the following.

-Green House Model www.thegreenhouseproject.org

-Eden Alternative www.edenalt.org

-The Pioneer Network www.pioneernetwork.net

Innovation must be deliberate as Dr. Wodicka denoted. It must be a discipline, calculated focus, and purposeful way of strategically doing things if the unbending structures are to become malleable for change. It takes one conversation at a time to shift the paradigm. Each organization must be willing to learn and change with appreciation for the system being left behind. Power must be shared with the Citizens and Residents in clear focus. Bedford County has the ability and opportunity to make this happen now. It takes somebody to do something different like incite innovation. It takes somebody to go against the grain of tradition. Somebody like you and me.