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Culture Change or Person Centered Care -- What is the Real Journey?

Joan Devine, Director of Education - Pioneer Network

A facility or a home.  A feeder or a person who needs assistance with eating.  A common room or a living room.  What we say and how we say it - it does matter. This is something that I believe passionately, I even wrote a book about it.  But some time ago, after hearing Steve Shields speak at an Illinois Pioneer Summit, I found myself doing some soul searching about the language I use.  Steve had shared with the group that he, like many of us, had always used the terms "culture change" and "person centered care" interchangeably, but had come to realize they aren't interchangeable.  The goal is culture change.

Wow...that really got me thinking, which brought me to have one of those "a-ha" moments that we all have along this journey. 
Like Steve and others, I too have used those terms interchangeably.  Sometimes I would say "culture change journey" and other times "person centered care journey."  So what IS the difference?  Well, here is what I have come to realize. Person centered care is the WHAT, while culture change is the HOW and WHY.  Person centered care is about practicesthat support and respect the individual, practices that are driven by the elders.  Culture Change is about the how we do what we do.  The design of our processes, the relationships, and the values that we share that tell us the why.
Let me demonstrate.  In the institutional model, residents were woken up based on a "get up" list while a person centered care practice is to support residents to get up based on natural awakening and resident choice.  I think we would all agree that in the institutional model, we did it because the DON told us to.  Now, if in the person centered practice we are also doing it "because the DON told us to", we may have achieved a person centered practice, but I would argue, this is not culture change.   Only when the reason we support a resident's choice is based on our universal understanding of how choice is the individual's right, and that we truly respect the choice and ability of every elder to control their own life, are we looking at culture change.  Only then is the "practice" likely to sustain for the long term.
In the traditional model of care for elders, we set our goal at quality of care, and even with practices that today we would question, for the most part, we did achieve quality of care.  The residents who we restrained in chairs in order to achieve the quality of care goal of not falling did not fall - quality of care was achieved, but at what cost?  Today we know the loss was to their quality of life.  Now we realize that quality of life should be the goal.  We have come to recognize that we can achieve quality of care without quality of life, but I would argue that if we set our goal as quality of life, you cannot NOT achieve quality of care.  You need quality care to achieve quality of life, but the reverse is not necessarily true.  We had set our goal too low.
And so, going back to my college days and logics class, I have a new logic argument to help explain the difference between person centered care and culture change. 
Quality of Care is to Quality of Life as 
Person Centered Care is to Culture Change.
I can practice person centered care without seeking true culture change, but I would argue that if what I seek is true culture change, I can't help but build my practices on a foundation of person centered care!  

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