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Implementing Change in Long-Term Care: A Practical Guide to Transformation

Implementing Change in Long-Term Care: A Practical Guide to Transformation by Barbara Bowers, Ph.D., R.N., Kim Nolet, B.S., Tonya Roberts, B.S., R.N., and Sarah Esmond, M.S., of the University Wisconsin–Madison School of Nursing, is a manual created with Commonwealth Fund support that is designed to help nursing home staff put what they know or have learned into action in order to improve quality of care and quality of life for residents and staff.

The Issue

While person-centered federal quality standards for the nursing home industry were established more than 20 years ago, experience has shown that fully meeting those standards remains an elusive goal for all too many facilities. The "culture change" movement is working to help nursing homes transition from institutional to home-like places where people want to live and work. But it is often hard to transform the culture of a nursing home, in part because there is little guidance available on just what has to be done to follow the common directives to empower staff or promote innovation. Nursing home administrators and staff are looking for practical advice on how to reach their goals, which may range from implementing a single initiative, such as a new protocol to reduce pressure ulcers, or an organization-wide transformation of the very culture of the facility. 

Target Audience

Nursing home administrators and staff.


The Tool


Implementing Change in Long-Term Care: A Practical Guide to Transformation is a manual for nursing home staff that offers evidence-based recommendations on preparing a nursing home to take the first steps toward clinical and cultural changes, as well as methods to implement and sustain those changes. One of the most useful aspects of the manual is that it doesn’t promote any specific model but rather encourages each organization to use the information in a way that best aligns with their particular needs and goals. 


The manual is divided into chapters that address different strategies for developing:


  • person-centered care and culture change models;
  • strong leadership;
  • effective teams;
  • skilled staff;
  • preparation activities and organizational assessments; and
  • accountability systems.


Each chapter provides an overview of the topic, followed by practical suggestions and exercises to establish practices that will bring the nursing home closer to their goal. For example, the chapter on developing effective leaders addresses common staff concerns, such as not feeling supported by management or being part of decision-making processes. The authors offer suggestions on how to encourage staff to communicate with managers. These include creating safe spaces for employees, such as unit meetings where they can prepare short presentations on their accomplishments to deliver at all-staff meetings and boxes where employees can anonymously suggest topics for discussion that are then carefully considered by management.


The manual also includes clinical care training materials, which include reading materials, case studies, organizational assessment worksheets, and an appendix with additional tools. 


For More Information


Visit the Advancing Excellence in America's Nursing Homes Web site at