Culture Change: Let's Not Make it a Cliché

Wednesday, November 7, 2007

Reissued September 5, 2018

There is a wonderful revolution taking place in (albeit all too few) nursing homes across the country. As long as there are parents who say to their children, ‘Promise me you’ll never put me in a nursing home,” or any of us groan to think that we may spend our last days in a medical institution that is foreign to any feel or sense of “home” with all its deep and deeply personal implications, then there is need for this revolution – this transformation to spread.

It goes by several names: Culture Change; Transformative Nursing Homes: Resident-Centered Care; Person-Centered Care; Green House Model; Household  Model, Wellspring

What all these terms have in common is a philosophy that holds to the following values and attitudes:

• The resident is put back into the driver’s seat, making as many choices about his/her daily life as possible. One implication is that activities and care revolve around the resident as much as           possible, as contrasted with an institutional schedule and staff convenience.

• It is an environment that honors the culture of aging as life-affirming, satisfying, humane and meaningful.

• The place has the feel and look of HOME. Just two evidences of change in the environment:
            No medical carts rumbling down the hallways.
            No nurses' station.

Although the culture is not transformed by merely instituting programs, studies have shown that in communities where the culture has transformed to a resident-first culture, certain  practices/programs are present. That information can be used as somewhat of an evaluation of how far along on the journey of culture change a community has come.  It is accessible at this link:  http://www.artifactsofculturechange.org/ACCTool/  . Once on that site,scroll down to the,"Artifacts of Culture Change Downloadable Version".

Culture change is not about rearranging the furniture. Far from it. It is a deep, challenging transformation of attitudes and values which is dependent on strong, knowledgeable leadership. The leader must have a deep belief in these transformative values and the leadership ability to shape staff so that these values permeate every cell of their being. Anything short of this is not transformative change and the result will not be ‘culture change.’

The win-win part of culture change is that this transformative mode of operation costs no more than traditional, institutional care. In fact, there are many reasons why the cost is probably lower. That’s a topic for another day.

Steve Shields, CEO of a transformative community in Manhattan, KS speaks of what made it possible for him and his staff to move forward in their journey of transformative change. He is quoted in Beth Baker's book, Old Age in a New Age:  When Action Pact consultants first introduced the concepts of culture change, "The vision was painted so strongly and in front of everybody that it became holy. Truly."

I spoke with Steve about that quote and asked him what he meant by  saying that culture change is ‘holy.’ He said simply and straightforwardly, “It is holy because it liberates our elders and returns hope to them.”