RESEARCH TO PRACTICE
The Death of Culture Change?
Keane, B. (2005). The death of culture change? Nursing Homes, 54, 11, 30-31.
The transformation from hospital-like care to a resident-centered model of care has been a strong movement in the long-term care industry for over 10 years. Culture change has brought new values and practices that help create homes for residents. Keane (2005) expresses his concern about the pace and degree of dissemination of culture change. He believes that in spite of the richness of education, training, awareness, research, and programming the actual practice of transformation has not been fully effective and has not produced change on a national scale.
Keane is worried that the deeper system changes that truly reflect individual residents’ lifestyles, wants, and needs have not occurred in many nursing homes despite their administration’s perception of success in this area. The principles of the culture and changes it requires are “so subtle”, yet dramatically in contrast to the traditional, hospital model of care culture, that it may cloud their true meaning. To many it represents an expanded opportunity to “do nice things” for residents and to some it has the feel of a temporary fad.
Keane does not want culture change to die. He believes that culture change can be rescued and its growth can be elevated to a national movement. Keane proposes these steps for intervention:
1. Fundamental change has to start in the human heart. Each of us has to work on changing our perception about aging and transforming our fears. Only when we see a person in each resident, and not his or her diagnosis, can we fully embrace culture change.
2. We must learn from each other. Keane is inspired by successes in other movements like civil rights, people with disabilities, the environment and many more. He suggests studying these movements and organizations as potential models for change.
3. Set the nomenclature. Words symbolize our values, and our values drive our behaviors. Perhaps the “culture change” term needs to be replaced with a word that will give the movement its true meaning and take the movement to a national scale. Perhaps the key focus of the new word should be on the quality of life for elders, reflecting the movement’s principal value more clearly and deeply.
4. We, the people. The culture change long-term care leaders need to come together to increase a greater consumer awareness and involvement to inspire and drive the commitment. Keane appeals to the Pioneer leaders to unite in order to create greater consumers’ awareness and involvement. This may inspire and drive organizational commitment for the entire long-term care industry.
5. Leadership from the bottom up. The new role of leaders is to listen, to respect residents’, staff, and other key stakeholders’ decisions in order to “embrace the power of the community”. The new norm for administering a resident-centered model of care is to ensure participation of each community member in decision-making. The ultimate goal is to shift decision making power as close to the elders as possible.
Implications: Culture change is not an easy fix. It requires continuous effort in learning from other organizations and from one’s mistakes, re-organizing concepts, developing innovative strategies, and always listening to team members. Successful culture change leaders must be always open to values clarification, education, skill development, mentoring, team work, and personal re-evaluation.