Purpose
The culture change (CC) movement aims to transform the traditional nursing home (NH)
that is institutional in design with hierarchical management structure into a homelike
environment that empowers residents and frontline staff. This study examines differences
in adoption of CC practices according to a NH's self-reported extent of CC implementation
and its duration of CC adoption. Furthermore, it examines differences in adoption
by whether a CC practice is considered less versus more complex, using complexity
theory as the theoretical framework for this classification.
Design and Methods
Using data from a 2007 Commonwealth-funded study, we analyzed a national sample of
291 US nursing homes that identified as being “for the most part” or “completely”
CC facilities for “1 to 3 years” or “3+ years.” Also, using a complexity theory framework,
we ranked 16 practices commonly associated with CC as low, moderately, or highly complex
based on level of agreement needed to actuate the process (number of parties involved)
and the certainty of intended outcomes. We then examined the prevalence of CC-associated
practices in relation to their complexity and the extent and duration of a NH's CC
adoption.
Results
We found practices ranked as less complex were implemented more frequently in NHs
with both shorter and longer durations of CC adoption. However, more complex CC practices
were more prevalent among NHs reporting “complete” adoption for 3+ years versus 1
to 3 years. This was not observed in NHs reporting having CC “for the most part.”
Conclusions/Implications
Less complex practices may be more economical and easier to implement. These early
successes may result in sufficient momentum so that more complex change can follow.
A nursing home that more completely embraces the culture change movement may be more
likely to attempt these complex changes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The nursing home culture-change movement: Recent past, present, and future directions for research.Gerontologist. 2008; 48: 142-148
- Measuring culture change: Literature review.Colorado Foundation for Medical Care (CO QIO). 2006;
- Evolution of Eden.in: Weiner A.S. Ronch J.L. Culture Change in Long-Term Care. Hawthorn Press, Inc., New York2003: 141-158
- Radical redesign of nursing homes: Applying the green house concept in Tupelo, Mississippi.Gerontologist. 2006; 46: 533-539
- Creating Innovative Places: Organizational and Architectural Case Studies of the Culture Change Movement in Long-Term Care. Southern Gerontological Society Annual Meeting.Lexington, KY. 2006;
- Implementing culture change in health care: Theory and practice.Int J Qual Health Care. 2003; 15: 111-118
- Culture change management in long-term care: A shop-floor view.Politics and Society. 2006; 43: 55-79
- Culture Change in Nursing Homes: How Far Have We Come? Findings from The Commonwealth Fund 2007 National Survey of Nursing Homes.The Commonwealth Fund, New York, NYMay 2008
- Calling for an International Dialogue on Quality of Life in Care Homes. Journal Compilation.Blackwell Publishing Ltd, Hoboken, NJ2008
Severance J. Culture Change in Illinois Nursing Homes. June, 2006. Report from Midwestern University. IL. June 2006.
- Case study research: The view from complexity science.Qual Health Res. 2005; 15: 669-685
- The challenge of complexity in health care.BMJ. 2001; 323: 625-628
- An overview of complex adaptive systems.Mansoura J Math. 2005; 1: 1-26
- Using chaos theory: The implications for nursing.J Adv Nurs. 2002; 37 (462–269)
- Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes.Nurs Res. 2003; 52: 12-21
- Nursing homes as complex adaptive systems: Relationship between management practice and resident outcome.Nurs Res. 2003; 52: 12-21
A Rhode Island organization promoting person-centered care in nursing homes. Available at: http://regenerations.com/default.aspx. Accessed August 14, 2009.
- State differences and facility differences in nursing home staff turnover.J Appl Gerontol. 2008; 27: 609-630
- Investing in culture change.Provider. 2008; 34 (22–3, 26): 18-20
Article info
Publication history
Published online: April 09, 2010
Footnotes
This study was made possible through funding from the Retirement Research Foundation (#2008-086), and by the Commonwealth Fund's generous sharing of its survey data.
The authors have no conflicts of interest.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
