Organizations: What are your Pieces of the Puzzle?

Organizations: What are your Pieces of the Puzzle? post page

Debi Tyler Newsom

By Debi Tyler NewsomSeptember 15th, 2019

Organizations: What are your Pieces of the Puzzle?

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by Debi Tyler Newsom, OTR/L,
PAC Client Relationship Director


Many of us are quite familiar with the Six Pieces of the Puzzle, a wonderful tool that helps us to look at the person living with dementia in a new way. When using this tool, we realize:

  • there are factors that are historical or fixed
  • there are factors we can impact
  • we must be the ones to initiate and make changes as we become aware of the needs
  • small changes make a big difference
  • we will be more effective when we focus energy on the elements that we can change vs. those we cannot

Many of the organizations Positive Approach to Care (PAC) has relationships with want to proactively take their care to a new level by leveraging their strengths and identifying a growth focus in some area.   Positive Approach to Care offers a PAC Designated status, which acknowledges an organization’s efforts and progress to a more positive dementia culture.

Let’s think about those same six puzzle pieces from an organizational point of view:

  • Brain Changes:  
    • What types of dementia do we see in the population we serve? 
    • Are there other factors present such as delirium, depression, anxiety, or psychological conditions?
    • What is the range of GEMS States in our clients?
  • The Person:
    • What are the types of backgrounds, values, roles, and life stories of our clients, both collectively and individually?
  • Health Changes:
    • What are the health changes present in our population including acuity level, general health beliefs, patterns of nutrition, and medication use?
  • The Environment:
    • What are our spaces like where clients are served?  We talk about the Four Fs and the Four Ss to describe environmental aspects of the areas our clients occupy.  Are all those settings, including waiting areas, sleeping space, dining rooms, activity lounges, and even outdoor environments supporting the needs and enjoyment of the people who use them? Upscale and chic might look good for a marketing piece, but does not always equal functional, friendly, familiar, and forgiving for the client.
  • The Stakeholders - Everyone connected to this organization: 
    • What level of awareness and knowledge does the staff bring to the organization?  Where are the gaps in knowledge and how can those areas be addressed?
    • What strengths and competencies do the stakeholders add, both individually and collectively? How are abilities and skills maximized while growing additional competency?
    • What are the stakeholders’ values relating to relationships and agenda both with the clients they serve and with their co-workers and management?
    • Is there a match between management’s expectation of staff and what is truly realistic?
    • Does the leadership con model behaviors and values that staff are expected to practice?
  • Time:
    • What are schedules and workloads like?
    • How are staff empowered to feel productive and valued?
    • Do staff feel that the work they do makes a difference?
    • Do all staff have opportunities to restore and recharge?  How is the balance with work and leisure encouraged?
    • How much wait time is there for promised changes and what is the communication about delays?

As we think of the six pieces in terms of organizational health, the concepts apply very well.  There are things we can impact and factors that are fixed.  We can influence health and wellness by providing education; but this does not change a pre-existing diagnosis. Co-morbidities, levels of dementia, client’s past histories, roles, and beliefs are set when we open our doors for care.

How well-attuned are we to the other three factors—the ones we can impact?  We can commit to small changes that will make a big difference and focus our energy on these aspects of care instead of wishing and hoping that those fixed factors would be different.

What is the organization doing well and what are some areas of focus?  Do we have the resources (awareness, time, money, energy) to support the changes we identify?

Positive Approach to Care is available to help with this effort.  Working with PAC on an Organization Designation can provide tools to support growth in focused areas.

Read more information here and watch this video from Plymouth Harbor about their designated status.

Debi Tyler Newsom, OTR/L, brings to PAC years of experience working with older adults, dementia care experience, and a long history with Teepa Snow. She was educated at Tufts University in Boston, Massachusetts, with a degree in Occupational Therapy, and has provided decades of care and leadership for rehabilitation settings in Georgia, North Carolina, South Carolina, and Ohio. Early in her career, she recognized a passion for working in gerontology, and has been constantly enriched by the colorful stories and experiences of that population. As the Client Relationship Director for Positive Approach to Care (PAC), she helps to coordinate training and service offerings to clients with the goal of growing dementia awareness, skills, and competence. Debi is energized by family, her loyal, loving golden retriever, travel, and experimenting with new recipes, photography, and her latest creative project.


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