Staff Asked to Brush Each Other’s Teeth, Guess What Happens

The following is a guest post written by Sue Ellen Clark, a culture change leader with PHI client Westminster Canterbury in Lynchburg, Virginia. Searching for tools and assistance in empowering their frontline staff to deliver more person-centered care, Westminster Canterbury came to PHI. They have trained their staff in the PHI Coaching Approach to Supervision and the Coaching Approach to Communication, and are now rolling out training in Person-Directed Living. Sue Ellen will be joining PHI Organizational Change consultants Anna Ortigara and Cean Eppelheimer in introducing Person-Directed Living in a half-day intensive at the 2016 Pioneer Network Conference.

Brushing your teeth is second nature. You barely think about it unless, well unless, someone else is brushing your teeth. Westminster Canterbury has been engaged in teaching the PHI curriculum Creating a Culture of Person-Directed Living over the course of the last few months. As one of the class instructors, several interesting things have come up related to the tooth brushing exercise presented in the material.

The participants in the class are simply asked to brush each other’s teeth. This humbling exercise is to convey a point about losing control from the residents’ vantage point. My co-instructor and I have witnessed looks of bewilderment and unbelief as we unfold this activity as if we just asked them to do the impossible.

Staff Reactions

One nurse was so incensed, she went into a tirade in front of the entire group. Seething, she said, “How in the world do you expect us to do this? I find this very humiliating and embarrassing to brush each other’s teeth in front of the class and no less in this meeting room!”

These words came from the same nurse that oversees other nurses that pass meds and do treatments in common areas and dining rooms in full view of other residents and staff. Other participants have made up fictitious diseases in order to be excused from the activity. Some participants could not complete the activity and had to leave the room because of some conjured predicaments. No joke. This has been quite an experience.

It was amazing the number of CNAs and nurses that could not complete the task despite this activity being a part of their daily job responsibilities. Watching these reactions, my co-instructor and I proposed the following theory: When the CNAs and nurses have been assigned to brush the residents’ teeth and maintain control and power over that process, the act of tooth brushing is much easier for them. If those same CNAs and nurses do not have control and power over their own tooth brushing experience, it is something they are not interested in doing. Period.

An Unexpected Outcome

The biggest revelation of this exercise was that the toothpaste tasted absolutely awful. The participants were drinking extra water as fast as they could and chewing whatever food particles they could grab to get rid of the rancid taste. Many acted like they had been poisoned with the stuff. It was that bad. The participants were greatly dissatisfied with the cheap, hard toothbrushes as well. Hard would be best described in this situation as in like a rock and unyielding to pressure.

Well, my co-instructor and I could not have prearranged these experiences this way even if we tried. And now here is the drum roll moment. The toothpaste and toothbrushes provided for the activity are the same toothpaste and toothbrushes provided for the residents. Once the participants found that out, they expressed an urgent concern for the residents who deserve to have name brand toothpaste and a soft, quality-made toothbrush. My co-instructor and I did not know the toothpaste was terrible or the toothbrushes were unbending. We had never tried it and neither had any other staff member.

Our purchasing department is now actively looking to replace the toothpaste and toothbrushes with the help of recommendations by the residents. What an unexpected outcome and a glimpse into the life of the residents! What else do we unintentionally subject the residents to that is considerably less than what we expect ourselves? The slogan for Colgate for many years has been, “Number 1 recommended by dentists.” Here’s our version, “Person-directed living. Number 1 recommended by residents.” We are learning much on this journey including resident perspectives and toothpaste preferences.