For more than 20 years, America’s nursing homes have struggled to live up to the goals of the “culture change” movement, which would transform nursing homes from clinical institutions into home-like settings in accordance with person-centered federal standards established in the 1980s.

A new manual from the Advancing Excellence in America’s Nursing Homes campaign created with support from the Commonwealth Fund seeks to address this issue by offering nursing home staff an evidence-based guide to preparing, implementing, and sustaining clinical and cultural changes.

Implementing Change in Long-Term Care: A Practical Guide for Transformation (pdf) is a 134-page manual written by Barbara Bowers, Ph.D., R.N., Kim Nolet, B.S., Tonya Roberts, B.S., R.N., and Sarah Esmond, M.S., of the University Wisconsin–Madison School of Nursing, and published in April 2009.

In its introduction, eight chapters, and four appendices, the manual offers various strategies for developing:

• person-centered care and culture change models
• strong leadership
• effective teams
• skilled staff
• preparation activities and organizational assessments
• accountability systems

Each chapter provides an overview of its topic, practical suggestions, and hands-on exercises. The manual also provides clinical training materials in the form of case studies, organizational assessment sheets, and more.

The authors lay out their hopes and intentions in the introduction:

Despite our desires and efforts, serious quality issues continue to plague long-term care. When we look closely, most of us can find care quality problems in our own facilities that we would like to correct. This manual was designed to assist organizations, and the staff who work there, to implement changes that will improve care quality. Whether you are contemplating a comprehensive, organization-wide culture change, or implementing a best-practice protocol in a single clinical area, knowing something about how to implement and manage change will help you achieve your goal.

Implementing Change in Long-Term Care arrives just as the Centers for Medicare and Medicaid Services have issued new interpretive guidelines for surveyors intended to affirm efforts by facilities to create more homelike and person-centered environments for residents.

NOTE: PHI is collaborating with the Pioneer Network and CMS on a national webinar series for early June that will provide an opportunity to learn more about the new guidelines. More information will be available in early May.