Culture Change Is Not a Task

By Kathy McCollett

Kathy is a Change Management Consultant with PHI’s Coaching and Consulting Services team.

In order to create the feeling of “home,” many nursing homes are changing the look and feel of their facilities, removing the objects and other artifacts that scream “institutional.” Perhaps taking their culture change efforts a step further, they have implemented consistent assignment, with the same staff supporting and caring for a specific group of elders. Having made these initial changes, these organizations want to know what to do next.

Culture change is not a task that lends itself to checklists. If we think of it that way, we will be waiting to check each aspect of the change process off our list. Rather, it is a process of making the needs and desires of each person living and working there more important than what has been dictated by institutional history. It’s about creating communities of people in relationship with each other, those who live there as well as those who work there.

Many providers have made changes to their physical environments and operational procedures that support culture change, but these changes aren’t always enough to have actually changed the culture. It is not uncommon to hear, “We did everything we thought we were supposed to do, but the culture still feels the same.” That’s because a culture doesn’t change by moving through a series of tasks.

Cultures change when our way of being with other people is altered from one that focuses on staff or organizational needs first to one that focuses on the needs of the elders first. According to Webster’s, changing a culture means making “the sum total of ways of living built up by a group of people and transmitted from one generation to another something different from what it is or from what it would be if left alone.” This takes an intentional process that is applied consistently and persistently.

Let’s take changing dining services as an example. If a home decides to eliminate tray service and go to family-style dining, that home is often intending this change to shift the culture. However, if staff and elders are “told” this is what they will now be doing — rather than being involved in the decision making — the result may fall short of the goal. Tensions between dietary and nursing may escalate, and staff may even plate the food without asking the elders what they want to eat.

In this instance the home could “check off” that they implemented family-style dining, but they would not have moved decision-making to the elders and those working most closely with them and, therefore, would not have shifted cultural norms.

If you are looking for more information on how to move beyond tasks to a relationship-centered culture, check out Getting Started, a guide to implementing culture change available through the Pioneer Network. In addition to providing guidance on the change process, this handbook includes multiple staff education tools that invite involvement in thinking about the why, what, and how of culture change.