Transcript Rhythms of Daily Living

Rhythms of Daily Living
Dining & Choice
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STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION
Aligning Experiences – Expectations – Resources – Outcomes
Why Do 65% Of NH Residents Eat
Less Than 75% Of Most Meals* ?
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Primary Factors That Contribute To Malnutrition
In Nursing Homes
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3.
An Inappropriate Dining Experience For The
Resident.
Meal Delivery Methodology and Systems Not
Conducive To Eating.
Good Nutrition is of no value if it is not consumed
*Excerpted From Ch 14 Of Report To Congress “Appropriateness of Minimum Staffing Ratios In Nursing Homes”
Authored By J. F. Schnelle et al, Borun Center For Gerontological Research
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Must Rising Acuity Levels Mean Lower
Dining Quality ?
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Independent Living
Nutrition Quality
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Assisted Living
Memory Enhanced
Food Quality
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Service Quality
Skilled Nursing
Life Quality
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The Simple Answer Is No!
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What Are Factors of Rhythms Of Daily Living For Dining?
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service
choice of where you eat
Defined and met expectation
Reputation – consistency
Timeliness
Presentation of meal
Taste
Do not rush me
NeighborsAtmosphere, aroma
cleanliness
choice
Residents eat when hungry
friendliness
Generational expectations
Personal eating habits
Choose to dine at a time of the resident’s choice
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Skilled Care Dining Today
Restricted Service Times, Too Short For Quality & Assistance
Loading Time
Transport Time
Waiting Time
< 20 Minutes
For Dining
Service Time
The Quality Gap
Dining Time
Extra Assistance
Food Quality Zone
Temp. Integrity
0
10
20
30
40
50
60
Minutes
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Bridging The Quality Gap
Serve The Resident, Not The System
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The System – Individual Preparation, Bulk Service
 Prepare Individual Menu Items For Storage
 Place On A Tray For Transport To Feeding Area
 Transport and Leave In Cart
 Distribute and Unwrap At Scheduled Meal Time
The Alternative – Bulk Preparation, Individual Service
 Prepare Menu Items In Bulk
 Transport To Dining Room Servery
 Plate Individually and Serve Upon Request
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Balancing the Natural Rhythms of Resident
Living and Care Work
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A “More Normal” Pattern of Living and Work
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Residents Eat What And When They Want Over A Longer Meal Service
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Pre-Meal Medications, Bathing and Other Activities Are Less Pressured
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Staff Provides Assistance As Required
 24 Minutes Is Average Optimal Feeding Assistance Time With A Range
From 5 To 70 Minutes Depending On ADL Status*
 48% Of Nursing Home Population Require Some Degree of Assistance*
A Dining Experience, Not A Feeding Period
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Shift Dining Service Focus From Trays To Residents and Quality
 Collaborative Service Support
 Aroma Therapy
 Course Presentation
 Minimal Distraction Environment
*Excerpts From Ch 14 Of Report To Congress “Appropriateness of Minimum Staffing Ratios In Nursing Homes” Authored By J. F. Schnelle et al, Borun
Center For Gerontological Research
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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.
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RDL Is Real
Reported Results From Ten Communities That Have
Implemented RDL
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40% of Residents Gain Weight In The First Few Program
Months
50% Reduction In The Number Of Residents Losing Weight.
Consistent Improvement In Resident Satisfaction
$0.18 – $0.21 Reduction In Food Cost Per Meal From Less
waste.
85% Decrease In Use of Supplements
Higher Job Satisfaction
Improved Hydration
Outcomes Exceed Regulatory Requirements
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Assessment Points for RDL
Implementation
Stages are defined against the requirements of:
 Administration: fiscal, management and leadership
considerations
 Regulatory: compliance criteria (grouped by clinical and
operational considerations)
 Systems: software programs, forms, policy & procedures,
protocols
 Personnel: staffing requirements, training, HR. The impact
on each care disciplines is identified by department
 PP&E: Property, Plant & Equipment necessary to perform
the tasks and functions
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STAGES of RDL
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Readiness GAP Analysis
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Culinary Capacity
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Establish the opportunity for residents who are self-sufficient and independent to dine at a time of their
choosing, within established service times.
Schedule Choice II
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Establish the opportunity for the resident to choose alternate items from a menu during meal service.
Schedule Choice I[1]
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Establish a service program without the tray system. Meals are plated in the servery when the resident is in the
dining room. Choice is based on pre-ordered menu items, however time of service is not flexible.
Point of Service Menu Choice
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Establish a servery on the resident floor where all meals can be finished, plated and served.
Individualized Service
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Establish clear understanding among all constituents (residents, staff and administration) as to the program
impact on 6 principle areas.
Establish the opportunity for residents who require assistance with dining but are able to determine when they
would like to dine to do so within established service times.
7. Venue Choice (If Appropriate)
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Establish the opportunity for residents to choose alternate places to dine.
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[1] Schedule choice is the last and most difficult stage to implement because it affects the scheduling of all resident activities from bathing to medication and activities.
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How Do You Individualize Care?
1.
2.
What Are Strategic Objectives?
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Current Strengths
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Opportunities Identified For Improvement
What Is The Vision for Community Dining Experience?
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Choice
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3.
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Menu, Time and Venue?
What Is History of “Transformation” Projects?
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What Were Expectations
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How Defined and Structured
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How was it trained & accepted?
What Are The Most Important Experiences?
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Resident Experiences
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Staff Experience
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Family & Other Stakeholders?
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The Customer Value Of Positive Experience
A Memorable Feeling Created By You As A Result Of Us
Relative Customer Value
Created Within
The Customer
EXPERIENCE
Source Of
Customer Loyalty
SERVICE
Created By
A Provider
GOOD
RAW MATERIAL
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Strategy Mapping
As dining options and service evolution and enhancements are
discussed, specific initiatives are defined and envisioned by
community leadership, community constituencies, department
management and staff. As these new “dining experiences" and
expectations are defined, mapping aligns resources from vision
to strategic objective to tactical implementation assuring
effective implementation and benefits.
Drs. R. Kaplan and D. Norton present this process in Strategy
Maps. The mapping process allows communities to:
 Clarify strategies and communicate them to all constituents
 Identify key internal services that drive strategic success
 Align resources to a common objective
 Expose operational gaps and initiate appropriate corrective
response
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Mapping Process Tasks
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Identify Service Initiatives
Define Their Contribution to Strategic Objectives
Define Appropriate Measurements of Successful
Experience Outcomes
Identification of Resource and Operational Intersects
Identification of Intersects and Roles of Collaborating
Departments
Structure of the Process for Resource Allocation to
Develop the Defined Initiative
Sequencing of The Tasks
Implementation of the Initiative.
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Program Intersects Grid
PROJECT
COMMUNITY OF
DISTINCTION
FINANCIAL
ENHANCEMENT
QUALITY OF LIVING
OPERATIONAL
EFFECITVENESS
QUALITY OF WORK
HEALTH CARE CENTER
3 & 4 Modification
RDL
RDL Dining
MDR Service Modifications
MOW Capacity Increase
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Creates a signature service for
the Memory Support
neighborhood
Creates a signature model of
resident service for the HCC
Reduce costs with the
implementation of RDL
Compliment service model of
RDL, grille options and service
venues
Increased accessibility to dining
program increasing revenue
options
Increase presentation of
McLean Brand into the
community
Increased revenues and
improved efficiencies of the
existing resources
Reduce costs with the
implementation of RDL
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Improved resident QoL and
improved staff working
environment
Improved resident QoL and
improved staff working
environment
Increased selection and choice
improving QoL
Improve QoL for MOW clients
Operational benefits of RDL
Operational benefits of RDL
Increased productivity while
increasing services reducing
neighborhood service
requirements.
Increased operational
effectiveness for facilities
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Choice Alignment
Process Overview
PLAN & DEVELOP
Evaluate
Organize
Define
Plan
Codify
Implement
Assess
Alter
Train
Improve
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Continually Test For Outcome And Process Alignment
Make Sure That Procedures Are Practiced, Understood and
Working
Assess
Current
Practices
Assess
Develop
Improved
Procedures,
Revise Tools
and Protocols
Procedures
Assure
Expected
Outcomes
Assure
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Train
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Train Improved
Procedures
(Test Understanding
Of What and Why)
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