Barriers and Enablers to Changing Organizational Culture in Nursing Homes

Scalzi, Cynthia C.; Evans, Lois K.; Barstow, Alan; Hostvedt, Kathryn

doi:10.1097/00006216-200610000-00009

Cited by 89 publications

(49 citation statements)

References 2 publications

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“…Both high-caliber leaders and leadership support are known to be critical to successful implementation of NH innovation/culture change (Bradley et al, 2004; Deutschman, 2005; Scalzi, Evans, Barstow, & Hostvedt, 2006; Stone et al, 2002). As surmised by Deutschman (2005), innovative and assertive leadership is essential if the challenges inherent with the prevailing bureaucracy in U.S. NHs are to be overcome.…”

Section: Discussionmentioning

confidence: 99%

Nursing Home Organizational Change: The “Culture Change” Movement as Viewed by Long-Term Care Specialists

Miller

Jung

et al. 2010

Med Care Res Rev

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A decade-long grassroots movement aims to deinstitutionalize nursing home (NH) environments and individualize care. Coined “NH Culture Change” the movement is often described by its resident-centered/directed care focus. While empirical data of “culture change’s” costs and benefits are limited, it is broadly viewed as beneficial and widely promoted. Still, debate abounds regarding barriers to its adoption. We used data from a Web-based survey of 1,147 long-term care specialists (including NH and other providers, consumers/advocates, state and federal government officials, university/academic, researchers/consultants, and others) to better understand factors associated with perceived barriers. Long-term care specialists view the number-one barrier to adoption differently depending on their employment, familiarity with culture change, and their underlying policy views. To promote adoption, research and broad-based educational efforts are needed to influence views and perceptions. Fundamental changes in the regulatory process together with targeted regulatory changes and payment incentives may also be needed.

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Section: Discussionmentioning

confidence: 99%

Nursing Home Organizational Change: The “Culture Change” Movement as Viewed by Long-Term Care Specialists

Miller

Jung

et al. 2010

Med Care Res Rev

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“…Constraining system parameters depicted in Figure 1, and defined in Table 1, is a typical approach in NH management. For example, research suggests that NHs have common barriers to problem-solving such as not including Licensed Practical Nurses (LPNs) and Nurse Aides (NAs) in decision-making [7,17,18], poor communication between provider groups [19], and over-reliance on hierarchical management [9,11,20,21]. …”

Section: Introductionmentioning

confidence: 99%

Local interaction strategies and capacity for better care in nursing homes: a multiple case study

Anderson

Toles

Corazzini

et al. 2014

BMC Health Serv Res

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BackgroundTo describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff.MethodsWe conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases.ResultsParticipants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these ‘local interaction strategies’. We categorized these two sets of local interaction strategies as the ‘common pattern’ and the ‘positive pattern’ and summarize the results in two models of local interaction.ConclusionsThe findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.

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“…This federal directive spurred the “culture change” (CC) movement that organizations such as the Eden Alternative, began to undertake, loosely organized by The Pioneer Network (Guastello, 2011; Koren, 2010; Rabig, Thomas, Kane, Cutler, & McAlilly, 2006). Since the 1980s, multiple efforts have sought to reform care of NH residents though barriers to organizational change in NHs are complex and multiple (Scalzi, Evans, Barstow, & Hostvedt, 2006) (Wunderlich GS, 2001). …”

Section: Introductionmentioning

confidence: 99%

Why and How Do Nursing Homes Implement Culture Change Practices? Insights From Qualitative Interviews in a Mixed Methods Study

et al. 2013

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Objective To understand the process of instituting culture change (CC) practices in nursing homes (NHs). Methods NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail. Results The themes include: 1) Reasons for implementing CC practices vary; 2) NH approaches to implementing CC practices are diverse; 3) NHs consider resident mix in deciding to implement practices; 4) NHAs note benefits and few implementation costs of implementing CC practices; 5) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; 6) Education and communication efforts are vital ways to institute change; and 7) NHA and other staff leadership is key to implementing changes. Discussion Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations.

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Barriers and Enablers to Changing Organizational Culture in Nursing Homes

Cited by 89 publications

References 2 publications

Nursing Home Organizational Change: The “Culture Change” Movement as Viewed by Long-Term Care Specialists

Nursing Home Organizational Change: The “Culture Change” Movement as Viewed by Long-Term Care Specialists

Local interaction strategies and capacity for better care in nursing homes: a multiple case study

Why and How Do Nursing Homes Implement Culture Change Practices? Insights From Qualitative Interviews in a Mixed Methods Study

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