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

JHHSA, Vol. 28 No. 2, (2005)

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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