S. C. Miller, E. A. Miller, H.-Y. Jung et al., “Nursing Home Organizational Change: The ‘Culture Change’ Movement as Viewed by Long-Term Care Specialists,” Medical Care Research and Review, Aug. 2010 67(4 Suppl.):65S–81S.
The nursing home "culture change" movement aims to transform both nursing home physical environments and organizational systems by employing a less hierarchical structure and encouraging residents and frontline staff to be more involved in decisions that affect them. Published in a special supplement to Medical Care Research and Review, results from the Commonwealth Fund Survey of Long-Term Care Specialists document the barriers to culture change perceived as the most important by those specialists and highlight the factors associated with their perceptions.
Survey results indicate that long-term care specialists perceive the chief barrier to nursing home culture change differently, depending on their employment and familiarity with culture change. Among the 1,147 survey respondents overall, “senior leadership resistance” was most often ranked as the most significant barrier to nursing home culture change, followed by cost and regulation. Among provider representatives, however, those representing nursing homes ranked regulation as being the number-one barrier and those representing other long-term care providers ranked cost as number one. Survey respondents who are “extremely familiar” with nursing home culture change most often ranked senior leadership as the principal barrier, while those "not at all familiar" most often ranked cost above all else.
“Gaining a better understanding of the factors associated with perceived barriers [to nursing home culture change] is an essential first step to understanding the actions needed to promote initial and sustained adoption,” the authors write.