Culture Change Management in Long-Term Care: A Shop-Floor View

Abstract

Advocates of culture-change management suggest that the right sort of managerial philosophy can transform nursing homes from impersonal institutions into safe, caring communities. However, participant observation carried out at Heartland Community, a nonprofit culture-change nursing home, suggests that culture change founders on the structural problem of inadequate staffing. Resource limitations imposed by Medicaid and Medicare reimbursement rates mean that even nonprofit facilities desiring to maximize staffing cannot afford to hire enough staff to live up to basic care standards. Thus, above-average staffing notwithstanding, Heartland's nursing aides could not complete their work on time without compromising the quality of care by breaking important care rules. Resource limitations also forced management to adopt a series of punitive personnel policies that actively undercut the rhetoric and aims of culture change, turning culture change into a rhetorical device for shifting blame for care problems from structural resource limitations onto the attitudes of nursing aides.

Conceptualising Body Work in Health and Social Care

“…Body work can take place both within and outside of designated workplaces, with the same task taking on very different features depending on where it occurs. For example, a care assistant who washes the body of an older person in a residential care home will be subject to the institution's schedule, conscious of the other bodies awaiting attention and perhaps subject to direct surveillance by a manager or to intervening demands from other residents (Diamond 1992, Lopez 2006. The same tasks may be performed in a private home and may be similarly rushed, with the timetable determined by the minutes allotted to each visit, but the spaces and times of work are here produced and managed not only by an external manager but in direct relationship with the person being washed, and the family or friends who form their social network (as England and Dyck explore in this volume).…”

“…Building on the work of Dorothy Smith (1988), Campbell argues that embodied clients come to exist only on paper, as the 'textualised' creations of bureaucratised systems of service delivery. According to Lopez (2006) timepressed workers have less latitude to adapt their routines to patients' wishes, and will need instead to push them through their daily routines. Hence improvements in the treatment of care home residents depend much more on dealing with structured constraints, especially understaffing, than on changing organisational cultures.…”

Privatização e mudanças organizacionais: um estudo de caso sobre transformação cultural e comportamental

“…Esses elementos argumentam a favor do surgimento de várias subculturas dentro da mesma empresa, o que tende a comprometer a construção de uma realidade uniforme que permita às pessoas ver e compreender, da mesma forma, eventos, ações, objetos, expressões e situações particulares (LOPEZ, 2007;MORGAN, 1996 Nessa ordem de ideias, entende-se que a maneira como os indivíduos constroem seus valores e crenças, os quais irão determinar a cultura da organização, influencia as estruturas formais da mesma. Assim, considera-se que a cultura organizacional é constituída por suposições elaboradas pelos membros da organização, que servem de fundamentação para validar suas atitudes e considerá-las como a maneira correta de interpretar a realidade (SCHEIN, 1992).…”

“…Esses funcionários sentiam-se humilhados e desprezados pelos novos donos, a quem acusavam de tratá-los com preconceito e de desqualificá-los. Essas explicitações de mensagens de demérito contra ações do passado demonstram juízo de valor negativo que levou a um sentimento de raiva e ressentimento entre os funcionários remanescentes, dificultando o processo de mudança (LOPEZ, 2007;WETZEL, 2000).…”

“…Dessa forma, fica difícil conseguir mudar qualquer elemento da cultura organizacional (WOOD JR., 1995). Lopez (2007) ou Morgan (1996) entendem que as organizações podem ser vistas como um grupo integrado que acredita no trabalho conjunto ou estarem divididas em grupos que interpretam a realidade de forma diferente, com aspirações distintas quanto ao que a empresa pode ser. Assim, esses padrões de crenças ou significados compartilhados, na sua integridade ou de forma fragmentada, baseados em várias normas e rituais, influenciam a habilidade da organização em lidar com os desafios que enfrenta.…”