December 28, 2020
In his recent book, “No Rules Rules,” Reed Hastings, CEO of Netflix, wrote about changing the culture of his company from a focus of error avoidance to one of freedom with responsibility. Hastings reflected on his ideas of the creative workforce, noting that for the last 300 years, the factory has been the principal paradigm under which people worked in a repetitive fashion that required little input or thought. Instead, Hastings argues that in today’s culture, employees should be stimulated rather than supervised.
Perhaps this management philosophy works for Netflix and other businesses that produce a creative product. Do long-term care facilities produce a health service or a creative product? Could the nursing home actually provide health care that is creative in that front-line employees are encouraged to have the freedom to perform their job functions while ensuring they are responsible for complying with the regulations and our policies? The freedom to perform an individual’s essential job functions requires that they be responsible for maximizing the safety as well as the contentment of the residents under their care.
How would this work? Certified Nursing Assistants would have input on how the assignments for resident care are made and are supported and educated in understanding the unique needs, diagnoses and preferences of the residents under their care. They would be encouraged go beyond the tasks of bathing, dressing and toileting residents by being given the freedom to talk with residents and their families about the individual’s past. They would be provided with education by the licensed nursing staff about how the resident’s diagnoses impact their abilities and they would be supported by administration to be an integral member of committees and care conference to share their perspectives about the structure and function of the facility.
In an environment that is driven by regulations, rules, and inspections, can we find ways to enhance the workplace that increases the individuality of the resident by improving the autonomy of the staff? Can we encourage our staff to understand what makes residents uncomfortable so that they can intervene in toileting, repositioning, providing nourishment and alleviating fear or anxiety rather than relying on bed and chair alarms? Can we ever provide care that individualized and resident-centered if we don’t provide a workplace that addresses the individual employee’s need to have some degree of autonomy over their work product—the care of nursing home residents?
Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, is an assistant professor in the Department of Geriatrics and Palliative Medicine at the Philadelphia College of Osteopathic Medicine. Dr Warner-Maron is also the executive director of the Eastern Pennsylvania Geriatric Society.