A Culture of Empowerment

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Yang

In my last post, I listed the structural elements that enable the Green House Project’s core value of empowered staff to become a reality. In this post, I will begin to tackle the less easily defined dynamics of empowerment.

Whenever we talk about staff empowerment, we need to keep in mind the reason behind it. While the title “shahbaz” denotes respect for the caregiver, it is actually the elders that are being empowered. The Green House model simply recognizes that in order for elders to be empowered, those closest to them and know them best must have the means to facilitate that empowerment.

Obviously, caregivers in traditional institutional settings play a critical role in how a resident experiences life in in long-term care. Both the nature of the work and the manner in which caregivers engage residents guarantee that central role. For many long-term care residents, the quality of their relationships with their caregivers determines the quality of their lives.

However, when it comes to actual power – the ability to make day to day decisions that most directly impact residents and the accountability for those decisions – the traditional model provides the caregiver with a distorted version of power, created more by default than by design. While caregivers report to a unit supervisor, much of their daily routine is conducted without the direct involvement of that supervisor. The nature of the long-term care business demands that a manager’s time and attention be occupied by matters not directly related to the details of daily care. Simply put, a supervisor has limited awareness of what goes on down the halls and in the rooms.

In this vacuum, individual caregivers are compelled to make decisions regarding the use of limited resources – time, especially. How they prioritize these choices is often influenced by an informal, but powerful subculture in which the caregivers with the strongest personalities sent the standards. Sometimes, this actually works well and supervisors even learn to rely on these caregivers to help manage the unit. But all too often, it leads to mistrust and petty bickering among caregivers. The relationship between caregivers and managers is commonly characterized by conflict over authority, self-promotion, stonewalling and manipulation. Good work is not rewarded and poor work is left uncorrected. This is not the kind of “power” that contributes to a meaningful life for residents on a consistent basis.

By providing the Shahbazim with real decision making power, the Green House Model formalizes and expands the caregiver subculture. In doing so, it changes the dynamics of the relationship both among caregivers themselves and between caregivers and the individual charged with holding them accountable, the Guide. Leaders will still emerge within the group, but everyone is expected to grow into leadership roles. Along with the guide and clinical staff, the strongest and most experienced shahbazim are charged with coaching newer staff members into those roles.

Furthermore, the Shahbazim are held accountable in a way that caregivers in a traditional setting are not. While caregivers are always responsible for their individual actions, the ultimate responsibility for what happens on an institutional unit falls on the licensed supervisor. In the Green House Model, the caregivers assume that responsibility. The team is self-managed and while there can be a degree of flexibility in some matters, they have a vested interest in following their own rules and developing a cooperative work environment.

While the Guide expects and encourages the Shahbazim to make decisions, he or she is much more aware and involved with the day to day details of the home than a traditional manager. Not only does this allow the Guide to be effective in the coaching and support roles, it leaves less room for the kind of finger pointing and lack of transparency so prevalent in traditional settings. Issues are more likely to be dealt with directly and in the open. Again, this is aided by the small size of the home compared to large institutional nursing units.

In my next post, I would like to talk about how an empowered staff’s approach to problem solving differs from the approach taken in a traditional institutional setting.

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