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Advocates Explore Culture Change through Eyes of a Surveyor

September 5, 2012

Last month’s Pioneer Network conference was, as always, an inspirational event conveying innovative information and best practices from the world of person-centered long term care. Also interesting was a pre-conference session, entitled “Culture Change through the Eyes of a Surveyor.” This full-day session featured presentations by well-known culture change advocates including Carmen Bowman and the recently retired Karen Schoeneman, as well as the valuable insights from innovative state regulators from Missouri and South Dakota.

Every presentation pushed us into thinking beyond the boundaries of traditional regulatory and provider practice into a person-centered realm — one that moves us closer to realizing the essence of the Omnibus Budget Reconciliation Act of 1987. As Schoeneman said in reference to resident choice and preference, “As regulators and providers, it’s our job to figure out how to say ‘Yes,’ even when it’s more convenient to say ‘No.'” This sentiment was echoed throughout the day as presenters consistently demonstrated a willingness to review and question regulatory practice, seeking a more person-centered approach and interpretation of the regulations.

Proof of the CMS commitment to person-centered care was demonstrated in a review of the many recent CMS/Pioneer-led initiatives. Schoeneman spoke of the environmental symposium that resulted in new interpretive guidelines and moved the industry towards creating environments that meet the needs of the residents rather than reflecting the institution. She also talked about the new Life Safety Code of 2012, citing its person-centered components and the collaborative and inclusive process that led to its creation. Bowman shared a summary of the dining symposium and resulting guidelines, which also demonstrated a collaborative approach and a move to recognize and respond to resident choice, preferences, and self-determination. Throughout the day, the CMS commitment to supporting person-centered practice was evident — and on-going, with yet another symposium scheduled to begin the conversation about risk and surplus safety.

Attendees were also treated to a panel discussion featuring the forward-thinking and innovative practices of the Missouri and South Dakota regulatory agencies. Both state survey agencies actively partner with the provider community to support quality improvement through person-centered practice. Missouri, in particular, has pushed the envelope by creating within the state survey agency a position charged with infusing person-centered thinking and practice into The Section for Long-Term Care Regulation‘s (SLCR) policy and practice and to support the dissemination of culture change and person-centered thinking to the state’s providers, state agencies, and consumers. As the Culture Change Coordinator for the Missouri survey team, Sam Plaster is specifically responsible for providing culture change training for Missouri surveyors and is working closely with them on culture change issues as they relate to the survey process. Plaster’s position is consistently supported by Matt Younger, Administrator of SLCR, who demonstrates an intentional and courageous approach to instilling person-centered practice into the Missouri regulatory system.

The “a-ha” moment of the day came for me as I reflected on the session and realized that the regulations and the specific issues that state agencies and providers wrestle with on a daily basis are the same everywhere in the country. We all struggle with coffee temperatures, elopement, what constitutes a reportable incident, alarms, and issues of safety vs. resident choice. But where the real difference lies from state to state — the difference that determines whether a regulatory environment is constructive and amicable or contentious — is in the nature of the relationship that exists between the state survey agency and the provider community. The willingness of regulators and providers alike to sit down at the same table, trust one another, listen to each other differently, and seek collaborative solutions forms the foundation of a system that supports innovation and person-centered care for our elders.

– by Cean C. Eppelheimer, PHI Organizational Change Consultant

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