The Rutgers collaborative used two structured full-day workshops to share information and prepare staff to implement communication and/or work practice changes.

Using a participatory, learner-centered approach, teams of frontline staff, supervisors, and managers were encouraged to think critically about the relevance of applying organization ideas and practices to their own work environment.

The goal: to break down hierarchical and disciplinary barriers and create an environment in which staff at all levels are able to listen to each others’ perspectives and work together.
At the first workshop, teams developed a plan for administering the work environment survey to their peers.

At the second workshop, teams applied basic quality improvement steps to develop an action plan to address the problem or opportunity they identified. During the following months, team members worked together with peers at their own facilities to implement and evaluate the project or new system. At the third and final workshop, teams came back together to share their projects.

Four facility teams focused explicitly on improving communication between shifts to ensure that incoming staff were fully updated about the status and needs of residents. Projects at other facilities included the following:

■ A peer mentoring program for nurse assistants to ensure that they not only knew what to do but why it is important.
■ Policies and training to encourage managers to treat direct care staff with greater respect.
■ Job shadowing (nurses shadowing certified nurse assistants and CNAs shadowing nurses) to strengthen relationships and communication between them.
■ With strong and consistent support from managers, CNAs and/or licensed practical nurses at four facilities led project design and implementation.