Culture Change in Long Term Care
Culture is a word we hear a lot and goes hand in hand with the concept of culture change. In this article I’d like to touch on how to facilitate culture change and why it is beneficial to your long term care setting. Let’s face it, aged residential care in New Zealand is changing rapidly and this impacts the experience of residents, staff and visitors to long term care settings. It impacts their desire to be in your care facility or to move somewhere else. This applies to be both residents and staff. Families often choose the care provider for their elderly relatives. What do they perceive when they visit you?
There are also barriers and challenges to creating and sustaining a definable and deliberate culture. The experience of the residents and staff is a result of the culture (behaviours) which should be aligned to your organisation values, mission and goals. There are well publicised workforce shortages and high turnover of staff. Long term care is also in the middle of change from paper-based systems to electronic storage and management of information. The environment in which care is being provided is also changing through new construction of buildings from a institution to non-institutional. The atmosphere being created by those within the long term aged care residential setting is changing to a more relaxed feel.
Nursing care and direct support is now also being provided within retirement village studios, apartments, villas, homes. This means a change of not only the context of care. Ensuring person centred care where each individual feels seen, heard and respected takes consistent focus and strong leadership. Not always easy in a industry that is changing in so many ways. I wrote in a previous article on workplace culture that behaviours could be a better point of focus rather than simply focusing conversation on culture as a concept.
The behaviours which support a culture you can be proud of and one that sets you as an industry leader, require a long term focus and not just a one time exercise. The strong leadership needed along with education and ongoing communication is key to setting a desirable culture. Have you aligned your staff, management and Governance behaviours with your organisation 
vision and mission statements? Behaviours reflect actions and they can be optimal actions, good actions, poor actions or non-action. All will have an outcome which impacts the residents experience and determine how they feel about residing in your long term aged residential care setting.
For change to occur there needs to be a focus on improvement, a reason to change which residents and their families see as beneficial. We tend to stick to doing what we’ve always done unless we can see a personal gain or something which provides a sense of satisfaction on a personal level. What’s in it for me? Culture change is not something that’s going to be achieved from a top-down approach. It’s going to take engagement from all levels of the organisation and create wins for those involved. Without perceived gains or wins, people stay stuck in old habits which don’t fit the new expectations of those seeking care and support.
If you’re the manager or CEO and delegate a ‘change management’ process to someone else, then expect to check in later to find wonderful results without your direct involvement and engagement, you may be disappointed. Culture change is a team effort. To achieve change, everyone needs to participate. They need to believe in the outcomes you’re trying to achieve with whatever strategies or initiatives you put in place.
Who is going to lead change? There is an old saying that everything flows from the top down and this is also true of culture. If the Board are dysfunctional then there should be no surprise when staff working at all levels of the organisation are dysfunctional. How is communication about strategies of change being done to gain buy-in? How are you going to measure your change initiatives to find out if you’ve been successful? How are you going to ensure the desired culture is maintained? There are a number of tools (mostly overseas based) which can be used to start this process. Here is a free online culture change assessment tool you could use.
What is the experience of your resident and your staff on a daily basis? Would they recommend you to others in a way to reflects loyalty to your care facility as a preferred place to live or work? If not, what are you going to do about it?