1. Strategic Mapping & Program Alignment Aligning Experiences – Expectations – Resources – Outcomes

2. March 8, 2005 IAHSA - Spring Conference 2 Session Objectives 1.Introduce Choice as a service culture 2.Review application of Choice in dining service 3.Present process for mapping from a strategic objective to a tactical initiative 4.Conduct the Mapping Exercise for a Current Project Initiative 5.Review Process, Q & A

3. March 8, 2005 IAHSA - Spring Conference 3 The Customer Value Of Positive Experience A Memorable Feeling Created By You As A Result Of Us Relative Customer Value EXPERIENCE SERVICE GOOD RAW MATERIAL Source Of Customer Loyalty Created Within The Customer Created By A Provider

4. March 8, 2005 IAHSA - Spring Conference 4 Operational Culture Rhythms of Daily Living is an operational culture that aligns resources and expectations of service experiences. RDL works in collaboration with initiatives of environmental culture change advocated by other organizations. The core service model for liberating residents and staff from an institutional paradigm is dining service. Dining is a catalyst and enabler to initiate change across coordinated services.

5. March 8, 2005 IAHSA - Spring Conference 5 Rhythms of Daily Living The core of RDL is the opportunity to exercise choice residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination. RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency.

6. March 8, 2005 IAHSA - Spring Conference 6 Alignment The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture

7. March 8, 2005 IAHSA - Spring Conference 7 When Landing A Plane, What Is The Main Thing? 1 1. Concepts and Diagrams From The Power of Alignment - How Great Companies Stay Centered and Accomplish Extraordinary Things By G. Labovitz/V. Rosansky Left Of Runway Altitude Too High Aligned Air Speed Cross Winds Altitude Wind Speed Pitch

8. March 8, 2005 IAHSA - Spring Conference 8 The Main Thing For Horizon House Choice

9. March 8, 2005 IAHSA - Spring Conference 9 PLAN & DEVELOP Organize Alter Codify Train Improve Choice Dining Alignment Process Overview Plan Evaluate Define Assess Implement

10. March 8, 2005 IAHSA - Spring Conference 10 Plan Transition Process and Commit Resources Write Program Transition Budget and Operating Narrative Organize Codify Organize For Culture Change Establish “Experience” Alignment Teams To Define/Implement Transition Codify Policies/Procedures and Training By Function Write & Task Procedures/Training Using RDL© Base Choice Dining Alignment Plan and Develop Plan Evaluate “Readiness” With Leadership, Managers & Residents/Families Define Outcomes Baseline and Expectations Evaluate Define Define Service Functions and Outcomes For Each Experience Identify Beneficiaries/Benefits and Diagram Service Functions

11. March 8, 2005 IAHSA - Spring Conference 11 STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT MAPPING As dining options and program enhancements are discussed, specific initiatives are defined and envisioned by department management and staff. These new “dining experiences" require a specific definition process from concept to strategic alignment to tactical implementation. Executive and Board leadership must clearly identify specific strategic organizational considerations. Leadership must clearly define their expectation and measurement of a successful contribution to the community strategic vision. This must take place prior to the initiation of Map 1.

12. March 8, 2005 IAHSA - Spring Conference 12 STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT MAPPING The following are the task requirements for this process: 1.Identify Service Initiatives 2.Define Their Contribution To Strategic Objectives 3.Define Appropriate Measurements Of Successful Experience Outcomes 4.Identification Of Resource And Operational Intersects 5.Identification Of Intersects And Roles Of Other Contributing Departments 6.Structure Of The Process For Resource Allocation To Develop The Defined Initiative 7.Sequencing Of The Tasks 8.Implementation of the Initiative.

13. March 8, 2005 IAHSA - Spring Conference 13 Map Process #1, 2,3 Strategic Objectives Community of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness Map#1 Strategic Objective Benefit Map #2 Benefit Measure Measurement Tool Map #3AdministrationRegulatoryOperationsPersonnelPP&ECommunity Operational Resource Requirements Budget Impact $/FTE’s

14. March 8, 2005 IAHSA - Spring Conference 14 Map Process #4, 5 Map #4 Collaborating Departments NursingResident Services TherapiesPastoralHousekeepingMaintenanceActivities Task Map #5 Task Implementation NursingResident Services TherapiesPastoralHousekeepingMaintenanceActivities Procedure Policy Resource Requirement Inform/Train Measure

15. March 8, 2005 IAHSA - Spring Conference 15 Project Management

16. March 8, 2005 IAHSA - Spring Conference 16 Alter Alter Procedures, Training, Tasking, Resources Confirm and Eliminate Practice Conflicts Train Improve Choice Dining Alignment Implement Learn Improved Procedures Demonstrate Understanding Measure Satisfaction and Efficiency Results Evaluate/Report Result Scores Assess Identify Opportunities For Improvement Assess Practices To Find Procedures Not Practiced

17. March 8, 2005 IAHSA - Spring Conference 17 Choice Dining Continuous Alignment Effective Practices AssessAlterTrain Improve

18. March 8, 2005 IAHSA - Spring Conference 18 Culture of Caring vs. Culture of Curing There is a significant difference between these two cultures. A culture of curing, the medical model, requires workmanship of certainty – specific, objective, regimented procedures to achieve a specific outcome. A culture of caring, the LTC model, requires workmanship of risk – the collaborative relationship to create a quality of living experience that is subjective and defined by the resident and care provider at the moment of service.

19. March 8, 2005 IAHSA - Spring Conference 19 Workmanship of Risk vs. Workmanship of Certainty The distinction between workmanship of risk and workmanship of certainty turns on the question "Is the result predetermined and unalterable once production begins?"

20. March 8, 2005 IAHSA - Spring Conference 20 Workmanship of Risk Leadership Attributes  Workmanship of certainty requires a traditional hierarchical leadership style.  Expectations are defined by the leadership  Outcomes are measured against static benchmarks  The process is predetermined and always replicated

21. March 8, 2005 IAHSA - Spring Conference 21 Workmanship of Certainty Leadership Attributes  Workmanship of risk is best developed with a servant leadership model of direction.  Leadership defines, through collaborative development, the expectations.  The role of servant leadership is to then provide the community direction and then assure that staff have the necessary resources and environment for achieving the experiential outcomes.

22. March 8, 2005 IAHSA - Spring Conference 22 Comparison of Culture Pioneer Network Institution-Directed Culture 1.Staff provide standard “treatments” based on clinical 2.Institutional defined schedule and routines – resident comply 3.Work is task oriented and staff rotates assignments – interchangeable residents 4.Centralized decision making 5.Hospital environment 6.Structured activities 7.There is a sense of isolation and loneliness Choice – Directed Culture 1. Staff enters into a care giving relationship based upon individualized care & resident desire 2. Residents and staff design the schedules 3. Care is relationship-centered, consistent assignments 4. Frontline decision making 5. Environment reflects the comforts of home 6. Spontaneous activities 7. Sense of community and belonging

23. March 8, 2005 IAHSA - Spring Conference 23 Servant Leadership Servant-Leadership is a practical philosophy which supports people who choose to serve first, and then lead as a way of expanding service to individuals and institutions. Servant-leaders may or may not hold formal leadership positions. Servant-leadership encourages collaboration, trust, foresight, listening, and the ethical use of power and empowerment.

24. March 8, 2005 IAHSA - Spring Conference 24 “Some facilities studied, usually the lower turn-over ones, were in the process of thinking about how to increase individualized care. For example, the researcher asked, what are you doing if anything about resident choice. ‘We are looking at it. Ideally, we want them to eat when they want. We encourage them to tell us what care they want, a shower or bath, or to get up when they want.” Page 5-49 Appropriate of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report prepared by Abt Associates for the Centers for Medicare and Medicaid Services, December 2001.

25. March 8, 2005 IAHSA - Spring Conference 25 Quality of Living Considerations A large proportion of nursing home residents are malnourished and up to half are substandard in body weight, leading to serious consequences including infections, hip fractures, and even death. The environment in which residents eat and the degree to which residents may choose when and what to eat can affect residents’ health (malnutrition and dehydration) and quality of life (perceived safety, enjoyment, social relationships, individuality, autonomy, choice). [i],[ii],[iii] [i][ii][iii] 1.[i] Burger, S.G., Kayser-Jones, J., and Bell, J. P. “Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment.” National Coalition for Nursing Home Reform. June 2000.[i] 2.[ii] Chou, S., Boldy, D., and Lee, A. “Resident Satisfaction and Its Components in Residential Aged Care.” The Gerontologist 42:188-198, 2002.[ii] 3.[iii] Kane, R. “Long-Term Care and a Good Quality of Life” The Gerontologist 41:293-304, 2001.[iii]

26. March 8, 2005 IAHSA - Spring Conference 26 Session Objectives 1.Introduce Choice as a service culture 2.Review application of Choice in dining service 3.Present process for mapping from a strategic objective to a tactical initiative 4.Conduct the Mapping Exercise for a Current Project Initiative 5.Review Process, Q & A

27. March 8, 2005 IAHSA - Spring Conference 27 Contact 1.Dan Look – 770-565-4006 2.Dining Management Resources, Inc. 3605 Sandy plains Road Suite 240-269 Marietta, GA 30066 1.dcl@dm-resources.com