Sustaining Culture Change: Experiences in the Green House Model

Abstract

Reinforcing the GH model requires a highly skilled team of staff with the ability to frequently and collaboratively solve both mundane and complex problems in ways that are consistent with the GH model. This raises questions about the type of human resources practices and policy supports that could assist organizations in sustaining culture change.

New Evidence on the Green House Model of Nursing Home Care: Synthesis of Findings and Implications for Policy, Practice, and Research

“…Barriers to implementation and sustainability of the GH model arose as staff responded to critical events (e.g., survey citations), business challenges (e.g., staff hiring), daily routines (e.g., care provision), and gradual changes over time (e.g., resident decline); they were associated with leadership (e.g., insufficient support provided to direct care workers, bypassing direct care workers when solving problems and instead reverting to hierarchical decision making, unclear roles and lack of time to coach direct care workers, and/or not fully supporting the GH model); direct care workers themselves (e.g., insufficient skills for problem solving); budgetary concerns (e.g., to purchase certain foods); an insufficient pool of qualified staff ; and concerns about regulation (e.g., when homelike features allowed autonomy that could put residents at risk; Bowers, Nolet, and Jacobson ).…”

“…); characteristics of the GH workforce compared to other nursing homes, including staff perceptions about care, stress, and satisfaction (Brown et al. ); and issues related to sustaining the GH model (Bowers, Nolet, and Jacobson ). Table summarizes the objectives, sample, methods, and key findings from each of these papers.…”

Promoting an Alternative to Traditional Nursing Home Care: Evaluating the Green House Small Home Model. An Introduction from the Funders and the Green House Project

“…Bowers and team look at the sustainability of the GH model and into the “black box” of hospital transfers to explore differences in GH homes that have lower and higher hospital transfer rates (Bowers et al. ,b). In two papers, Afendulis et al.…”

“…); and Bowers et al. (,b) look at the factors that influence the ability of organizations to maintain the prescriptive GH model. Finally, Zimmerman presents a synthesis and critical examination of the evidence related to the GH model of nursing home care (Zimmerman et al.…”

The Green House Model of Nursing Home Care in Design and Implementation

“…Semistructured interviews were transcribed verbatim, entered into NVivo10 (QSR International), and coded thematically; additional details regarding these analyses are available elsewhere (Bowers et al. ; Bowers, Nolet, and Jacobson ). These coded interviews were then reanalyzed using a directed content analysis, with analytic categories prescribed by the structured interview findings (Hsieh and Shannon ).…”