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An Ethnographic Study of Nursing Home Culture to Define Organizational Realities of Culture Change

Published in JHHSA, Vol. 28 No. 2

The current system of delivery of nursing home care is costly
both in dollars and in human terms. Culture change may provide
solutions to both issues. Culture change has a different meaning for
different organizations depending on where they are in the continuum
of change. Detailed observation of staff members “in action” in three
long-term care facilities over a period of several months was
supplemented by formal and informal interviews of organization
members to gain an understanding of the culture of the nursing home
Four three-hour observations in each of three facilities,
representing privately-held and not-for-profit organizations in urban,
suburban, and rural locations yielded insights into the routine,
recruitment, training, teamwork, activities, leadership, role-modeling,
mentoring, staff and resident satisfaction, weekend staffing and
activities, bureaucratic structure, and sharing of best practices.
Discussion of each of these issues may provide a starting point for all
those facilities that are contemplating significant culture change.
If the objective is to have facilities truly embrace a new set of
values, then the change begins with the owners and administrators of
nursing homes who need to focus on building new relationships with
all the stakeholders. In-depth interviews of organization members and
six chief executive officers in long-term care in the Western New York
area culminated the study with the development of a fifty-question
survey for decision makers.

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