Heidi Gil, NHA
Conversations with Leaders in the Field of Patient-Centered Care” is a regular feature that highlights these contributions. This Conversation is with Heidi Gil, one of the authors of the Long-Term Care Improvement Guide, published in October 2010 by Picker Institute and Planetree.
Heidi Gil is the director of Continuing Care at Planetree.
What was the genesis of the Long-Term Care Improvement Guide?
The origins of the LTC Guide really date back to the earliest stages of development of the Patient-Centered Care Improvement Guide. As much as the approaches in the PCC Guide are portable across the continuum of care, it was clear from the onset of that project that a companion guide dedicated to the unique experience of living and working in long-term care settings would be a valuable addition to resources already available in this field.
Once we experienced the overwhelming success of the Patient-Centered Care Improvement Guide—it has been viewed 175,629 times and downloaded 60,855 times since it was released in October 2008!—our conviction about the need for a long-term guide was further strengthened.
We were compelled not only by the high-profile challenges facing long-term care communities today, but even more so by our first-hand knowledge of nursing homes, assisted living communities and short-term rehab settings that have overcome those hurdles and transformed themselves into incredible places of life, possibility and lifelong learning and growth. The LTC Guide provided a venue to really shine a light on what is possible in long-term care, and to provide practical guidance on how to implement those transformative practices.
What are some of the issues the LTC guide address, and why?
We know that the movement to improve the quality of long-term care— often called culture change, though there are those who do not like the term and would prefer that it be called quality improvement—is the right thing to do. All the sites we visited as part of the development of the Long-Term Care Improvement Guide are living proof that culture change is not merely something to aspire to, though, but something that really can be made a reality—despite any number of state and federal regulations, financial pressures and staffing challenges. Where we tend to get tangled up is in our efforts to bring culture change to scale, in other words, making resident-directed, relationship-centered communities the expectation rather than the rule. In this guide, we take on the most pervasive myths and misconceptions that have for too long stymied more widespread adoption of culture change principles. We dispel the myths that culture change costs too much, that it is nice but not really necessary, that it conflicts with the regulations and many, many more. By breaking these myths down one by one, we hope to propel more organizations to recognize that the profound reasons to adopt culture change principles overwhelmingly trump the reasons that may be holding them back.
The guide seems to bring together many different kinds of stakeholders. How did you assemble such a robust group?
Well, of course we invited the involvement of those whose passion for this mission has made them outstanding leaders in the field: Bonnie Kantor of Pioneer Network, Dr. Bill Thomas of so many things, and many others. The participation of those who go to work every day in a nursing home or other long-term care setting was instrumental in ensuring that the guide retained an operational focus. The three Picker/Planetree Fellows, the senior executives we interviewed and the staff members we met with during our site visits all helped us to craft a well-rounded guide that captures a variety of perspectives.
But our most important partners were the hundreds and hundreds of long- and short-term residents and their families who shared so much with us—their experiences, their hopes, their disappointments, their courage, their strength. Their contributions informed every step in our journey, and their voices are heard on every page of the guide.
What do you see as the greatest strength of the guide?
Its practicality. The guide suggests about 250 specific changes a long-term care community—and in a minute I’d like to say a little something about the idea of “building community”—can make in order to create a more person-centered, resident-directed, relationship-driven approach, and every one of them has a track record. They aren’t fanciful or impractical or untested or wishful thinking. Every one of them has been a success someplace and a factor in improving the quality of long-term care.
But we’re not offering them as a recipe for producing culture-change success. We hope people will take the time to look at them, think about them, explore their possibilities and then choose the ones that are best suited to their own situation or that they think would make a good starting-point. Some of them are really fundamental; some of them are more closely designed for certain circumstances. And we do believe that there is something for everyone somewhere in the guide. We were very deliberate about making it applicable to independent, assisted living, short-term rehab and nursing home environments, as well inclusive of all models of culture change.
What did you want to say about building community?
Building community is really the essence of what the Long-Term Care Improvement Guide is all about. It is the crucial distinction between making changes for residents and staff, and making changes with residents and staff. That is a big paradigm shift, and it really pushes us to re-define leadership and re-consider planning and decision-making processes. That’s the crux of culture change, and fittingly, it is a core theme of the LTC Guide. An inventory of resident-centered practices will only get you so far if they are implemented in the framework of the traditional paradigm. However, when the process for making those changes is truly a community-wide endeavor, that is when the real shift occurs.