132 Annual Meeting Logo - Go to APHA Meeting Page  
APHA Logo - Go to APHA Home Page

Putting culture change into practice:Why good interventions fail to change nursing homes' prevailing culture

Mary A. Lescoe-Long, PhD1, Michael J. Long, PhD2, Robyn I. Stone, DrPH3, John R. Grace, MA4, Debra Zehr, MA BSN4, and Dana Barton, BS ACHA4. (1) Public Health Sciences, Wichita State University, 1845 Fairmount, Wichita, KS 67260-0152, (316) 978-5593, Mary.Lescoe-Long@wichita.edu, (2) Department of Public Health Sciences, Wichita State University, 1845 Fairmount, Wichita, KS 67260, (3) Center for Medicare Education, 901 E Street NW, Suite 500, Washington, DC 20004-2011, (4) Kansas Association of Homes and Services for the Aging, 217 SE 8th Street, Topeka, KS 66603

Organizational culture change in nursing homes is a recognized approach to reducing turnover rates among frontline caregivers. Research suggests that enhancing the nurse supervisor-aide relationship, using proven protocols, is an essential first step toward embedding the empowerment and staff development mind set requisite to transforming nursing home culture. Many such intervention attempts, however, appear to end in failure and are cast aside amidst facility disappointment and disillusionment.

This paper evaluates the implementation and outcome of "The Long-Term Care Workforce Project," a well-conceived and proven intervention protocol fielded by the Kansas Association of Homes and Services for the Aging, to develop superior interpersonal interactions among nurses and aides in Kansas nursing homes. Although the project met with limited success with respect to its terminal objectives of sustained improvements in nurse supervisory skills, nurse-aide interactions, and reduced workforce turnover rates, careful scrutiny of the evaluation data revealed that the apparent failure of the intervention could be traced to a set of interactive and rectifiable facility assumptions and policies that conspired to attenuate the effects of the intervention and ultimately dispel fragile positive impacts. Evaluation results suggest that culture change interventions may be subject to unanticipated barriers that, once identified, can be controlled to allow intervention programs to be nurtured and achieve their full potential. In addition, the evaluation provides a caution to facilities and interventionists to guard against expecting too much and evaluating too little.

Learning Objectives: At the conclusion of this presentation, the learner will be able to

Keywords: Change Concepts, Nursing Homes

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Schmucker Training and Consulting Carlson Learning Company
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Exploring the Social Environment of Older Adults

The 132nd Annual Meeting (November 6-10, 2004) of APHA