Why and how do nursing homes implement culture change practices? Insights from qualitative interviews in a mixed...

Area of Science:

• Gerontology
• Healthcare Management
• Organizational Behavior

Background:

• Nursing homes (NHs) face increasing pressure to adopt innovative practices.
• Culture change (CC) is a recognized model for improving care quality and resident experience in NHs.
• Understanding the implementation process is vital for successful adoption of CC.

Purpose of the Study:

• To investigate the process of instituting culture change (CC) practices within United States nursing homes (NHs).
• To identify facilitators and barriers to CC implementation from the perspective of NH leadership.

Main Methods:

• A national survey of 4,149 NH Directors of Nursing (DONs) and Administrators (NHAs).
• In-depth follow-up interviews with 64 NHAs.
• Qualitative analysis by a multidisciplinary team using an audit trail to reconcile interpretations.

Main Results:

• Motivations for CC implementation varied across NHs.
• Diverse strategies and approaches were employed, considering resident mix.
• NHAs reported benefits and minimal costs, but implementation challenges were common.
• Education, communication, and strong leadership (NHA and staff) were identified as key to success.
• Tailored strategies were developed to overcome implementation hurdles.

Conclusions:

• Successful implementation of CC innovations in NHs relies on diverse, adaptable strategies.
• Effective leadership, robust communication, and targeted education are critical components for fostering culture change in NH settings.
• Tailoring implementation approaches to specific NH contexts and challenges enhances the likelihood of successful reform.