Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

Corazzini, Kirsten; Twersky, Jack; White, Heidi K.; Buhr, Gwendolen T.; McConnell, Eleanor S.; Weiner, Madeline; Colón‐Emeric, Cathleen

doi:10.1093/geront/gnt170

Cited by 86 publications

(104 citation statements)

References 19 publications

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“…However, technical solutions will not suffice for PDCP to be implemented across nursing homes. Making care planning person‐directed also will require adaptive solutions to adaptive challenges (Corazzini et al, 2015). Adaptive solutions that develop the strengths of individuals involved to facilitate changes in attitudes and skills are essential to PDCP; however, high turnover is one of multiple challenges to implementing adaptive solutions for PDCP (Donoghue, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Because PDCP is predicated on reshaping fundamental relationships in nursing homes, we drew upon the adaptive leadership framework from complexity theory to guide our scoping review, including the selection of search terms, the development of our coding scheme and the identification of themes (Corazzini et al, 2015). The adaptive leadership framework differentiates between adaptive and technical challenges, the associated adaptive versus technical work to address these challenges, and the importance of distinguishing between the two to succeed in change efforts (Corazzini & Anderson, 2014; Heifetz, Grashow, & Linsky, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Thus, addressing adaptive challenges implies openness to shifting the values that underlie a system and demanding changes to the system itself (Anderson et al, 2015; Glover, Friedman & Jones, 2002). Both technical challenges (e.g., scheduling care plan meetings at times when residents and aides can attend) and adaptive challenges (e.g., debunking the belief that nursing home residents are unable to provide useful insights regarding their care needs) are relevant to PDCP in nursing homes (Corazzini et al, 2015), and both may require collaborative work among nursing home staff, residents, and family members to develop effective solutions (Corazzini & Anderson, 2014). We drew upon this framework to understand the current conceptualisation and practices of PDCP.…”

Section: Introductionmentioning

confidence: 99%

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Person‐directed care planning in nursing homes: A scoping review

Lepore

Scales

Anderson

et al. 2018

Int J Older People Nursing

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AimFederal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person‐directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person‐directed care planning (PDCP).MethodsA multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis.ResultsSeveral themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end‐of‐life care. Essential elements of PDCP include knowing the person, integrating the person's goals in care planning and updating care plans as individuals’ needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies.ConclusionThis study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP.Implications for practiceThese findings can be used to guide implementation of PDCP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Person‐directed care planning in nursing homes: A scoping review

Lepore

Scales

Anderson

et al. 2018

Int J Older People Nursing

Self Cite

View full text Add to dashboard Cite

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“…One way of reconciling this discomfort is to acknowledge that many of the problems for which technical solutions prove inadequate are inherently adaptive challenges, and such situations often result in frustration when a technical solution does not accomplish the desired outcome. The adaptive leadership framework provides a useful explanation of why such solutions fail, and it challenges us to develop a new way of thinking about problem solving [7].…”

Section: Preparing Clinical Leaders To Support Adaptive Workmentioning

confidence: 99%

Adaptive Leadership and Person-Centered Care

Corazzini¹,

Anderson²

2014

North Carolina Medical Journal

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“…Some challenges have no obvious single solution, are difficult to identify and describe, and require revising norms and beliefs; these are referred to as adaptive challenges [13]. For example, improving the satisfaction of residents, family members, and staff members with the quality of dining services is an adaptive challenge.…”

Section: Current Trendsmentioning

confidence: 99%

Long-Term Care in North Carolina

White

2014

North Carolina Medical Journal

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Much of long-term care is not considered health care, as it is custodial, social, and supportive. But excellent longterm care is also preventive, timely, and accessible, and it provides space for long-term care recipients to find joy and meaning in their lives. This issue of the NCMJ provides a broad overview of long-term care, practical information about programs in our state, and tips for how to make use of these programs. Commentaries and sidebars in this issue also highlight new ideas, innovation, and transformation.This issue brief sets the stage by describing major events that have shaped the current framework of long-term care services and supports. It also discusses current trends that are influencing long-term care, including the emphasis on quality improvement methods, culture change, health care reform, the influence of geriatrics in primary care, and the desire for home-based care. Although we are not yet where we want to be in North Carolina, we are moving toward a long-term care system that will serve all North Carolinians well. Long-term care is an important aspect of health care, and the need for long-term care is increasing. The projected growth rate (as a percentage of the 2012 population) for individuals 85 years of age or older in North Carolina is 97% from 2012 to 2032, and 269% from 2032 to 2050; both of these estimates are well above projected national rates, which are 69% and 224%, respectively [1] (see Figure 1). In addition to the frailty and disability that are prevalent among these "oldest old" individuals, other factors that affect the need for long-term care services include living alone and the frailty of family caregivers, many of whom are spouses and who experience high rates of emotional and physical stress. Older people are less likely than children and working-age adults to have household incomes below the federal poverty guidelines, but many of them, especially those aged 85 years or older, have incomes low enough that they qualify for public assistance with respect to long-term care supports and services.Ideally, long-term care should be defined broadly to include medical and nonmedical care that is provided in the community, in congregate housing, in a residential care facility (eg, assisted living), or in a nursing home. It should include transportation services, congregate and in-home meal services, social supports, and medication support services. Currently, the scope and nature of these services are changing to meet the needs of a diverse older adult population, and services are facing economic, regulatory, and alignment pressures as health care reform continues. Sadly, our medical schools, nursing schools, pharmacy schools, and other health professional training programs provide little exposure, experience, or explanation to prepare graduates to assist patients in navigating and utilizing these services.The articles in this issue of the NCMJ cover a lot of ground, and much of the content is practical information that can be shared with older adults and their families (...

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Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

Cited by 86 publications

References 19 publications

Person‐directed care planning in nursing homes: A scoping review

Person‐directed care planning in nursing homes: A scoping review

Adaptive Leadership and Person-Centered Care

Long-Term Care in North Carolina

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