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Step One: Foundational Organizational Practices

Introduction


This section provides how-to information on four foundational practices essential for high quality individualized care. These practices include:

1. Consistent Assignment

2. Huddles


3. Involving CNAs in Assessment and Care Planning


4. QI Huddles Closest to the Residents




Two basic premises of quality improvement are that:
  • Quality, the result, is a function of the quality of the process; and organizations cannot continuously improve interdependent systems and processes until they progressively improve interdependent, interpersonal relationships
  • The "end user" and the people closest to the "end user" have essential contributions to make to quality improvement. In nursing homes, the end users are residents and the people closest to the residents are their consistent caregivers.
The theory of relational coordination, as developed by Jodi Gittell, applies these quality improvement principles to nursing homes and finds that relationships are the foundation for individualized care and for quality improvement. She found that staff's relationships with the resident are shaped by the staff's relationships with each other. It is the community of staff relationships that shapes the resident experience. Gittell found that when organizations have systems that facilitate frequent, timely, accurate, problem-solving communication among staff, they then have shared goals, shared knowledge, and mutual respect as they work together for shared solutions to meet residents' needs. Gittell's research confirmed that the relationships closest to the resident matter most and that when homes secure these relationships and align resources so that these staff closest to the resident can meet residents' needs, nursing homes have better outcomes for residents, staff, and the organization.
 
The systems in this section (consistent assignment, huddles, involving CNAs in care planning, and QI closest to the resident) build the staff's relationships with each other and with residents by ensuring that they have the time and place for talking through aspects of care that need to be shared and thought through together. This way of being in it together with shared goals and knowledge is the bedrock of solid communication and the means for quality improvement.

The fifty-two incubator homes started with these four foundational practices. Many of the homes already had some aspects of these practices in place but few had all of them fully functioning. Their experiences are incorporated into this starter toolkit, to help you put these foundational practices in place.

Consistent Assignment

Consistent Assignment Tip Sheet

Consistent Assignment Starter Exercise

Consistent Assignment Video Clip - Hear from the team at incubator home Cornerstone Care Options in Portland, OR, how they went from consistent assignment in theory to dedicated assignments in practice.

Huddles

Huddles Tip Sheet

Huddles Starter Exercise

Huddles Video Clip - Hearfrom the team at Glenridge Living Communities in Augusta, ME, how theyuse huddles for teamwork and problem solving to provide high qualityindividualized care.


Involving CNAs in Care Planning

Involving CNAs in Care Planning Tip Sheet

Involving CNAs in Care Planning Starter Exercise

Involving CNAs in Care Planning Video Clip - Hear from the team at incubator home Rose Villa inPortland, OR, how they involved CNAs in care planning and the benefitsof doing so.


QI Huddles Closest to the Resident


QI Huddles Closest to the Resident Tip Sheet


QI Huddles Closest to the Resident Starter Exercise

QIHuddles Closest to the Resident Video Clip - Hear from two incubator home teams from Lutheran Senior Services in St. Louis, MO, how they use QI huddles involving staff closest to the resident to improve quality of care andquality of life outcomes for residents.



Download Step One: Foundational Organizational Practices Introduction (PDF)

Starter Toolkit Home          Step One          Step Two          Step Three          Self-Assessment

Prepared by B&F Consulting for PioneerNetwork's National Learning Collaborative on Using the MDS as the Engine for High Quality Individualized Care. Funded by The Retirement Research Foundation.