|By Steve Shields, CEO, Action Pact Development, LLC|
The long-term care industry offers a vivid example of the importance of promoting the spread of innovation—and of the difficulty of doing so within a care system that often is weighed down by inertia. Those of us who are pushing for innovation realize that our approach to systemic change will survive only if we develop effective ways to support its spread. After demonstrating the value of the “Household Model” of care that helps residents retain control over their own lives in a homelike environment, we began working to help other nursing homes achieve a similar transformation. We networked with our peers, published a detailed toolkit, and finally launched a consulting service. Our efforts during the past 12 years have helped build a growing consensus that our nation’s long-term care facilities must undergo a complete overhaul in order to provide care that respects the individuality and dignity of residents. Yet this profound shift in thinking has barely begun to transform our long-term care system. We have made real progress, but the pace of change remains far too slow. Above all, we’ve learned that the most difficult challenge is not to learn new ways to care for the elderly, but rather to let go of the old ways.
When my colleagues and I developed the Household Model in the late 1990s at the Meadowlark Hills Retirement Community in Manhattan, KS, our new approach was viewed as radical. The model required a comprehensive integration of driving principles with all aspects of the care system, including buildings, staffing, services, culture, and financing. In the early years, we were widely regarded as both innovators and troublemakers. The senior service sector was defensive about the need to change, and we found it difficult to get support and validation from our peers. Our initial efforts to spread the Household Model included working with the Pioneer Network, a not-for-profit organization founded in 1997 that advocates for new models of care for the elderly. Early adoption of the model generally involved retrofitting the physical design of existing facilities, but as we documented positive results, the business case for new construction became more compelling. We supported development of the model in a variety of settings, whether profit or nonprofit, and whether operated by nursing home chains or local companies. We chose not to trademark the Household Model, but we welcomed efforts to develop proprietary versions, such as the Green House® Project.
Our early efforts to promote adoption of the Household Model were successful, but we found that it sometimes took 3 to 4 years to help a single long-term care facility transform its culture, achieve desired results, and get the new business on a secure footing. It became clear that we needed to do more to accelerate the pace of change. In 2006, with support from the Commonwealth Fund, we published a guidebook and toolkit, “In Pursuit of the Sunbeam,” that outlines a step-by-step process for implementing the Household Model. And in 2008, increasingly aware that long-term care facilities needed more help with their efforts to change, I cofounded Action Pact Development, a consulting firm that grew out of an earlier educational company called Meadowlark Household Services. The company’s development work typically spans a period of 18 to 24 months, and includes a menu of bundled and unbundled services that address needs such as executive coaching, financial forecasting, building construction or renovation, and staff training. Action Pact Development has helped several hundred long-term care organizations learn about the Household Model, including about 25 that have fully implemented it.
Gradually, the principles we espoused have become mainstream thought, and our model has shifted from being an innovation to being a movement within the long-term care community. State and federal regulators, long seen as obstacles to change, are increasingly willing to adapt and support new models of care that are backed by solid evidence. In an effort to support companies that are interested in such change but are reluctant to go through the challenges of implementing a new business model, we recently rolled out a franchise option. This alternative will provide another pathway to innovation by allowing companies to purchase a total package that can be adapted to local architecture and business needs, while remaining true to the core principles of the Household Model. Finally, Action Pact Development is developing a team of talented young people who can continue and expand the company’s work for decades to come.
Nationally, however, the slow rate of change demands that we make a concerted effort to achieve large-scale innovation in the long-term care industry. Less than 5 percent of the provider community has adopted our approach, and only 1 or 2 percent of facilities have fully embraced the Household Model in a way that yields results and is sustainable in the marketplace. In general, providers recognize the need for culture change, and they want to improve the system in ways that will benefit residents and make it more rewarding to work in long-term care facilities. But providers are still struggling to develop leadership that is strong enough to overcome institutional inertia and occasional regulatory backlash. The mission of overcoming the old culture of long-term care is especially challenging within large companies, which tend to have bureaucracies that are resistant to change. It takes courage and commitment to innovate in the face of such obstacles.
The successful spread of innovation in long-term care depends on many factors, including a deep commitment to cultural transformation, strong leadership, a sound business plan, extensive staff training, and constructive engagement with regulatory agencies. Above all, it’s essential to develop a compelling vision that has the support of the entire organization. But the secret to success isn’t either a top-down or a bottom-up process, but rather a lateral process of promoting collaboration across organizations to create a new reality. Once you’ve reached the other side of the transformation process, you can finally see that the old way was actually much harder.
About Steve Shields
Steve Shields is CEO/Principal of Action Pact Development, LLC. Action Pact Development provides strategic planning, executive coaching, organizational transformation services, architectural design, financial modeling, and project development management services for the senior living sector. In the later 1990s, he pioneered the Household Model as president and chief executive officer of Meadowlark Hills Retirement Community, Manhattan, KS. He is coauthor of “In Pursuit of the Sunbeam,” a guidebook on transforming institutions into homes, and “The Household Model Business Case,” which documents the viability of this model in long-term care.
Disclosure Statement: Mr. Shields reported that he has received fees from a variety of organizations for his consulting services, speaking engagements, and other activities related to his work with Action Pact Development.