A friend of mine just recently helped her mother-in-law, whom I’ll call “Bea”, move into an assisted living memory care community. My friend was instructed that they were not “allowed” to visit Bea for at least two weeks because she needed to adjust to living there. They didn’t know anything about Bea – just that she was a person with dementia moving into a new environment, so they applied a general rule. While I think I understand why they are doing this, it seems that it is potentially not kind and it certainly isn’t person-centered. Hold that thought and I’ll come back to it.  

Debbie and I have been looking at a lot of things workforce-related lately. There’s a lot of discussion about current and future direct care workforce challenges. Turnover is very high and the ratio of workers to persons who need care is only going to continue to get more challenging. One strategy employers may use to help address workforce challenges is to better “engage” workers in their day-to-day jobs (see “In a Nutshell – Workforce Engagement”). Engaged workers are less likely to leave and more likely to contribute to the overall well-being of their clients and their employer. There’s no downside there. Creating an engaged workforce can involve significant culture change on the part of the company, but the investment may be worth the effort. In culture change efforts, it is important to be aware of “parallel process.”

There is a lot of very scientific literature on parallel process in psychology and social service work and that’s what many people think of when they hear the term. There is also organizational parallel process which is about the interplay between and among clients, staff, and the organization itself. Within this interplay, patterns of behavior and dynamics among and between staff are replicated in how staff behave and relate to clients. When two or more systems have significant relationships with each other, they begin to develop similar attitudes, thoughts and behaviors (paraphrasing Dr. Sandra Bloom).

In my very non-scientific take, parallel process is the organizational alignment of values and behavior across all systems in order to achieve maximum business outcomes. In health and human services those outcomes include clinical and quality of life as well as revenue and expenditure outcomes. Basically, you can’t ask or expect your direct care workforce to provide respectful, person-centered care if they aren’t having a respectful, person-centered work experience. This is what I mean when I use the term parallel process. Leaders and managers must model the same behaviors with their workforce that they expect the workforce to demonstrate to the clients. It does require an investment in the workforce that goes beyond wages and benefits.

Let’s go back to the facility I describe above. There was nothing “wrong” with the facility mentioned above and what they told my friend about visiting her mother-in-law – just like there’s nothing “wrong” with managers and supervisors who manage in “because I said so (even if I say it nicely)” fashion. Neither action breaks any rules. But quality is about more than compliance alone. 

What if there was engaged and empowered staff available, who were free to meet with my friend and Bea, who were able to ask questions, review records, and then work with the two of them on a visiting schedule that supported a positive transition? Is there any reason that the aide who was going to work with Bea the most couldn’t be part of that process and couldn’t be engaged with my friend and her husband to get Bea settled in? If it was determined that a no-visitation period was necessary, couldn’t those staff people be proactive in communicating with family members about how Bea was adjusting, instead of making my friend call each day and hear only that “she’s doing fine”.  

What would it take on the part of leadership and management in that building to have staff who want to take a person centered approach to care? Many people would say that it takes training and I would agree that training is part of the process because the skills may not come naturally. Does it need to be baked into performance expectations? Yes, it does – but howthat gets done is a key part of how successful an organization may be in engaging their workforce. 

Some organizations put a lot of words around their expectations and claim that this is what they do – including the assisted living facility described above. They have value statements and mission statements that say all the right things about putting people first and respect and service. These are just words if they don’t align to the experience of the staff. Richard Branson says, “Clients do not come first. Employees come first. If you take care of your employees, they will take care of the clients.” This investment can pay off financially with reduced expenditures associated with employee turnover and workers comp claims. It also can pay off with increased quality of life for clients and residents. That, despite all laws of geometry, is parallel process come full circle.