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Providence Mount St. Vincent

Executive Summary


Motivation for Change: A series of behavioral studies and resident feedback helped to identify a "culture of dependence" that was ultimately misaligned with the organization's values and mission.

Goal of Change: A resident-directed community where residents maintained control and choice over their lives – "A Continuum of Community".

Assessment Steps: Visited other organizations implementing change; Evaluated steps to be the Provider of Choice and the Employer of Choice; Conducted meetings with staff, residents and employees to discuss transformations and engage these stakeholders in the change process; Members of the leadership team "worked on the floor" and took on the role of the resident; Analyzed processes and environment to determine change priorities.



Four floors of skilled nursing units with approximately 56 beds per unit. Nine 20 to 23 person skilled neighborhoods.
A small centrally located dining and activity space. Design of spaces physically separated residents and staff. Staff and resident workspaces are no longer segregated. All spaces in community are designed to promote residence independence.
Lack of autonomy for residents in activities and schedule. Staff were task driven and organized work around delivery of care and staff preferences.  Activities are meaningful. Residents maintain personal schedules based on preferences. Resident choice is documented in the care plan.
Staff-resident interaction not a priority. Centralized departments. Consistent assignment of residents with care assistants. Staff are cross-trained and able to help residents with multiple requests.

Examples of "AH HA" Moments: 1) The locus of control just had to be closer to operations for success; 2) Change is systemic and requires more than just one change; 3) Jobs change when an organization transforms to a resident-directed focus; 4) Even though physical transformations are complete, resident-directed care won't work without the underlying systems.

Impact on Quality: Consistently high Resident Satisfaction Assessments; Full census; Improvement of quality indicators from pre- to post-implementation; 95% of staff and 100% of residents interviewed utilized words that describe The Mount as a cohesive unit (e.g. family, team, home).

Impact on Business: Turnover decrease from 50 to 15%; Average length of tenure for a CNA at The Mount is 7.6 years; The Mount scores consistently high on staffing surveys; Very modest estimates put cost savings of lower turnover and increased retention at $270,000 per year.

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