Digging deep: how organisational culture affects care home residents' experiences

Abstract

Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the 'right' leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.KEY WORDS -residential care, nursing homes, culture, quality of care, dementia.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…the NVQ, now the Quality and Credit Framework initiative) to improve skills of the workforce; clarity about commissioning purpose, as, for example, in determining training needs and relevant support associated with general person-centred dementia training versus the more specialised higher order problem-solving 333 approach required for interventions for dementia with CB; and, finally, within models of specialist 'in-reach' support services, 190 an appreciation of the often locally produced shifting and delicate cultures, which often require careful consideration. 334 Supportive cultures are important because even skilled managers need to employ a lot of effort to support their staff to deal with the daily challenges in the care homes. 334 The wider 'context' of specialist NHS services to people with dementia was also important in the delivery of the FamCare study, where the changing landscape of services across England undermined the CRT of an intervention that was planned for delivery by mental health nurses working in their CMHTsOP (see Chapter 5 and Appendix 3).…”

“…334 Supportive cultures are important because even skilled managers need to employ a lot of effort to support their staff to deal with the daily challenges in the care homes. 334 The wider 'context' of specialist NHS services to people with dementia was also important in the delivery of the FamCare study, where the changing landscape of services across England undermined the CRT of an intervention that was planned for delivery by mental health nurses working in their CMHTsOP (see Chapter 5 and Appendix 3). Of concern were the findings from our review of every new case referred to CMHTsOP that a number of patients referred by their GP to these specialist services were returned to the care of their GP or signposted elsewhere without evaluation by the specialist mental health services (see Appendix 3, Table 67).…”

Physical activity promotion in care homes

“…Changing the culture of an organisation is broadly considered to be a slow and complex process (Stone, 2003;Pendlebury et al, 1998) which is realised through the 'everyday practice' of those within the setting (Killett et al, 2016). Change initiatives are usually aimed at bringing about improvements.…”

Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)‐study

“…philosophy of care), making sure residents engage in meaningful activities, empowering care staff and changes in the physical environment (i.e. a more home‐like environment) (de Boer, Hamers, Zwakhalen, Tan, & Verbeek, ; Brownie & Nancarrow, ; Grabowski et al, ; Killet et al, ; Kim & Park, ; Koren, ; Te Boekhorst, Depla, De Lange, Pot, & Eefsting, ; Verbeek, van Rossum, Zwakhalen, Kempen, & Hamers, ). It is important to study both the actual person‐centredness of the care provided and these key values, attitudes, and behaviours to advance and improve the implementation of person‐centred care in care homes.…”