The Providence Mount St. Vincent Experience

SUMMARY In 1991, a strategic planning team at a senior-living care facility in Seattle, Washington, began a process of organizational and cultural change. The process transformed both the philosophy and model of care, as well as the physical environment of Providence Mount St. Vincent. In 1998, a New York Timeswriter described the results she observed within and around the nearly 300,000-square-foot building constructed in 1924: The Mount, as those who live there call it, is widely regarded to be what many Americans consider an impossibility-a good nursing home. That is to say, in an industry freighted with the dread of old age, disability and loneliness, and periodically tainted by scandal and abuse, The Mount has found ways to be a home to people who can no longer care for themselves, to provide a sense of community in a place where no one wants to be, to be a community that is more about living than about dying. Prior to the change process, The Mount maintained a traditional, medical model of operations designed to achieve staff efficiencies and meet residents' medical needs within a mission of compassionate care. Studies to measure residents' daily levels of activity and engagement helped determine quality of life within a medical model setting. In a typical U.S. nursing home, residents spend 25–35 percent of their day engaged in some activity. Based on a series of behavioral studies at The Mount in the early 1990s conducted with approximately 1,400 observations of resident activity, a typical waking day in the life of a nursing home resident included engaging in any type of activity for 32 percent of the time. After The Mount's strategic planning team introduced a “neighborhood” concept for people receiving nursing care, the measure of engagement jumped from 32 to 42 percent and the death curve reversed and improved by 83 percent. For the past five years, The Mount has worked with and through a national group called the Pioneer Network to serve as a culture change resource and learning laboratory for other senior-living care providers around the country. This article describes the journey and outcomes of culture change in this facility.