In this post I will address how the Green House Project’s core value of staff empowerment creates a work environment that better utilizes the ability and motivation of direct care staff to solve problems. Please bear with me as I take a bit of an indirect route…
One of my favorite games in elementary school was “Telephone.” In Telephone, one person whispers a message to another, which is passed through a line of people until the last player announces the message to the entire group. The original message is inevitably changed in some significant way, often absurdly. There were those of us who took advantage of the anonymity and helped the process along by purposely changing keys words. Thus “Miss Austin says that London Bridges will be falling down at 2 p.m. next Tuesday” became “Miss Austin says her big britches will be falling down with b.m. today” much to the delight of her entire 4th grade class. But the lesson remained the same.
The object of the lesson was to teach us the impact of gossip and rumors. You simply shouldn’t believe something just because someone says it (an idea that seems to have lost ground with the advent and popularity of social media). And perhaps it was also meant to teach us the value of clear and precise communication.
I remember actually playing a version of Telephone during an inservice training class. Again, the focus was on gossip and rumors, but also to demonstrate the importance of written communication and to help explain why health care in general seems obsessed with documentation. Of course, this part of the lesson didn’t say much about the fact that written communication can distort the truth as well, indeed more powerfully and often more by design than by misunderstanding. We were left to surmise that part of it ourselves.
There is something else that happens to both verbal and written communication as it is passed down the line. Not only can the literal meaning be altered, the significance of the message can change. In other words, the message is often most important to the person who initiated it and it can lose a measure of importance with every link in the communication chain it passes through.
I experienced this both as caregiver, and later as a storekeeper responsible for keeping a 730 bed facility and its 300 busy nurses supplied and happy. As a caregiver, I learned that it was often quicker and more efficient to bypass the official line of communication – that is, through my supervisor – and go straight to the person who could help me solve the problem. Plugged toilet in Room 237? I knew the extension of the maintenance person responsible for plumbing issues and I knew he would come up to the unit ASAP if I asked because we had a good working relationship and he knew I wouldn’t expect him to drop what he was doing unless it was really important. And it was really important, because Mr. Verlander absolutely refused to use any toilet except the one in his room and would rather risk defecating in his pants then sit on an unfamiliar commode. And the clock was ticking.
Normally, I would inform my supervisor of the problem who would then instruct the unit secretary to create a work order that would be sent to a maintenance supervisor who then delivered the work order to the plumber’s desk. While the literal meaning of the problem – a plugged toilet – doesn’t change, with each step the immediacy and significance of the problem fades and thus the motivation to address it promptly diminishes as well. While no one wished for Mr. Verlander to crap his pants and understood it as – in the parlance of moderately over-educated professionals – a “negative outcome,” it had the greatest meaning first to Mr. Verlander and then to me. My supervisor, the unit secretary and the maintenance supervisor may or may not have been present and able to respond quickly – they weren’t always where I wanted them to be. And besides, they all had their own problems that no doubt had higher priority to them.
As a storekeeper, I got to experience being at the other end of the service chain. Every day I would get requests for nursing supplies from caregivers who chose to contact me directly rather than go through their supervisors. While I completely understood their reason for doing so, it did create a few problems for me, like the phone constantly ringing and a bit of flak from the people in my own department who insisted that I was subverting the requisition process by responding to requests from “just caregivers.”
But I knew something about these workers. That is, the ones who pestered me the most were also the best caregivers. I knew this because I had worked on the nursing units with them, some for several years. I was well aware of the kind work they did, how they treated the residents and how important they were to their residents. They were willing to do whatever they needed to do to get the job done, even if it meant breaking some rules and going outside the facility’s official procedures. Bad caregivers tend to hide behind the rules and use them as an excuse not to act.
I should also note that while I knew these caregivers well and trusted their judgement, they also knew me well and thus felt comfortable coming directly to me. In a sense, this relationship empowered them, albeit unofficially.
Recently, I sat down with a small group of shahbazim from a local Green House Project home. When one of them used an example of dealing with a broken bed to illustrate how problem solving differs in a Green House verses a traditional institutional setting, I knew exactly what she was talking about. No one could understand better than her the particular difficulties the broken bed created for one of her elders and thus she was the one most motivated to get the problem resolved as quickly as possible. Not having to go through any chain of command or requisition process, she made the appropriate call herself and was able to state the urgency of the situation directly to the individual that could help her solve the problem. In one person, she represented the authority, the responsibility and the motivation to resolve the problem in a way that benefited the elder most. And make no mistake, such problems are routine in a long-term care setting.
Given the appropriate tools and support, no one is more capable of creating a “positive outcome” for a resident than a motivated caregiver.