Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework.

Journal Article (Journal Article)

PURPOSE OF THE STUDY: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. DESIGN AND METHODS: The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. RESULTS: Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. IMPLICATIONS: Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges.

Full Text

Duke Authors

Cited Authors

  • Corazzini, K; Twersky, J; White, HK; Buhr, GT; McConnell, ES; Weiner, M; Colón-Emeric, CS

Published Date

  • August 2015

Published In

Volume / Issue

  • 55 / 4

Start / End Page

  • 616 - 627

PubMed ID

  • 24451896

Pubmed Central ID

  • PMC4542586

Electronic International Standard Serial Number (EISSN)

  • 1758-5341

Digital Object Identifier (DOI)

  • 10.1093/geront/gnt170


  • eng

Conference Location

  • United States