Longstanding concerns about quality care provision, specifically in the area of long-term care, have prompted calls for changing the culture of care to reflect more client-driven and relationship-centred models. Despite an increase in culture change initiatives in both Canada and the United States, there is insufficient information about the theories and approaches that guide culture change. The purpose of this paper is to describe a culture change initiative currently underway in Canada, the Partnerships in Dementia Care Alliance, and the theoretical foundations informing our work. More specifically, we describe how the theoretical and philosophical underpinnings of the Alzheimer Disease and Related Dementias framework, the authentic partnership approach, participatory action research and Appreciative Inquiry have been integrated to guide a culture change process that encourages working collaboratively, thinking and doing differently and re-imagining new possibilities for changing the culture of dementia care.

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This paper highlights the possibilities for transformation that exist when a diverse group of participants interested in working together to change the culture of dementia care in long-term care and community care settings use appreciative participatory action research to guide their culture change efforts. These transformations happened throughout the culture change process using appreciative participatory action research. For instance, using appreciative participatory action research to guide the culture change process provided participants with the opportunity to build stronger professional and personal relationships in their respective care communities. Culture change transformations also stemmed from the appreciative participatory action research process, as participants recognized the importance of finding ways to include persons with dementia/residents in the process and they developed an appreciation for the valuable contributions persons with dementia/residents can make to culture change work. These culture chance possibilities demonstrate the value in using appreciative participatory action research to guide culture change in long-term care and community care contexts. These possibilities also illustrate the importance of paying closer attention to the culture change process itself, rather than solely the outcomes of the process, given that the possibilities for transformation that can take place throughout the process can help to build momentum, propelling culture change efforts forward in healthcare contexts.