DON/DOR/ED: “The Transformational Triad”

Submitted by Jennifer Raymond, Therapy Resource, Northern CA

trans·for·ma·tion·al/tri·ad/ “able to produce a big change or improvement in a situation; “a group of three connected people or things

The objective of a triad is to create a peer-to-peer-to-peer relationship to accomplish a mutual purpose. “Triads are based on core values and mutual self-interest.”

A triad is not just three people meeting together. It is a relationship where each person is responsible for the quality of the relationship between the other. It is where each person has the other’s back. It’s “I’ve got your back and you’ve got mine” or “All for one and one for all.”

We have traditionally had one-on-one ED/DON relationships in the facilities as the leadership core. By adding that third person, the DOR, the power of the group is enhanced, the exchange of ideas and perception increased, it ensures faster and more accurate communication with the rest of the leadership/facility, it provides support and even friendship to the three members, it allows this core team to grow in their trust of one another, and it provides a place to be honest and safe when dealing with issues big and small.

Transformational Triad Opportunities to Achieve Amazing Things Together:


Achieving BHAG Nursing/Rehab team strengthening
CAPLICO/Culture training and events Long term care programming
Census development Managing managed care
Customer satisfaction Program development
Employee satisfaction and retention PDPM updates and planning
Decreasing readmission rates Productivity enhancement for therapy
Facility-wide dementia training QAPI
Facility staffing/Local recruiting Quality measures/QASP-*****
Identification of barriers to facility goal achievement Reasons to celebrate
Fiscal health and growth Relationship building within the community
Holding each other accountable Section GG and other MDS processes
Ensuring we meet Flag criteria Survey prep/follow-up
IDT leadership growth Support and friendship
Improving relationships with our hospital and managed partners “What If” intelligent risk taking brainstorming
Joint educational opportunities for Nsg/Rehab Worker’s comp management


“Three is the minimum number of legs required to make a stable structure.”