Impact of Investment

The "impact" phase of investment typically occurs during implementation but carries on into the sustainability phase of culture change. This is a time when leadership, staff and elders are aware of changes related to person-directed practice. Understanding this impact is a critical step to measuring the return on investment of culture change; yet, impact variables are difficult to measure. "Something is different here" is a common expression among new staff or elders entering a community that embraces a person-directed philosophy, but how does this impact become a measurable, observable change for a community? One method is to evaluate impact with a critical eye on resulting quality and organizational outcomes.  For example, increasing levels of engagement between staff and elders is a likely element of impact. While it may be possible to begin to measure this engagement with satisfaction surveys, true return on investment impact could be measured by lower staff turnover costs or increased revenue from a full census. The examples below highlight impact and outcomes.

Staffing

Consistent staffing is a critical element of culture change implementation that impacts employee engagement and satisfaction. For example, in nursing home environments, culture change neighborhoods give staff the opportunity to develop relationships with elders and fellow co-workers. Relationships increase the likelihood that staff will stay with an organization and knowledge of elder preferences leads to better quality of life and care. This, combined with a flattened organizational structure, improves efficacy of problem-solving and creates opportunities for innovation. In one example, a resident of a Mount neighborhood was losing weight and staff were concerned. This elder, an English woman, loved to drink tea. In this instance, the staff's understanding of the resident's likes and preferences was extremely powerful. Working with dieticians and clinical care, staff utilized traditional English "tea times" to fortify her tea. The result was an elimination of weight loss for the resident and proud, empowered staff. Examples of Impact Variables: Average length of tenure for a CNA at The Mount is 7.6 years. Annual employee turnover at The Mount fell from 50 percent prior to the implementation of the "neighborhood" model to 15-18 percent voluntary turnover in 2006-2007. The Mount scores consistently high on staffing surveys.

Elder 

Elders in all areas of the long-term care continuum are likely to notice impact of person-directed care as well as autonomy and choice in schedule and activities. It is interesting that interviews of residents from varying parts of The Mount community (independent, assisted living, skilled, sub-acute) all result in similar choices of word and sentiment in response to the question, "What does living at The Mount mean to you?" In all instances, "home" and "family" were word choices used to describe The Mount experience. Examples of Impact Variables: The Mount scores consistently high on resident satisfaction surveys. Quality of care (as measured by quality indicators) remains above the national average in several areas including no use of restraints, fewer pressure sores, and fewer instances of weight loss.

Organization

Staff and elder impact is also reflected at the organizational level. As Charlene Boyd of The Mount says, "We strive to be the employer and the provider of choice." Perhaps this statement is best exemplified when former Mount employees choose to come back to the community after retirement and make it their home. One of these former employees, now a current resident, sees the person-directed philosophy as similar for staff and residents in the community. As a staff member and a resident, she states, "It is the same loving, supportive care for whatever you need physical, emotional, spiritual (no matter your background)." Examples of Impact Variables: Quality care, committed staff and exemplary leadership often lead to a community reputation which improves occupancy and market competitiveness. Both The Mount and Westminster Thurber receive local and national recognition for innovation in the workplace. This level of support leads to high impact and return for culture change investment.
 
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