Changing the ward culture in a clinic during the implementation of person-centred care

Abstract

Objective: The purpose of this study was to explore the impact of an intervention on the organizational culture in five hospital wards in Sweden. The organizational culture was measured at the start of the project and compared with data collected five years later. The intervention was aimed at changing activities towards a new evidenced-based care model called the Gothenburg Person-centred Care model (PCC). Methods: In total, 230 registered nurses and assistant nurses participated in this cross-sectional health-care culture survey during 2009 and 2014. The Organizational Values Questionnaire was used. Results: The results indicated cultural change in all five wards at the clinic. A dominating culture of flexibility decreased and a culture of routines and structure increased. The wards moved towards a higher degree of cultural uniformity. The combination of cultural dimensions also seems to have become more equal during the study period. Conclusions: Few studies have focussed on the development of organizational culture in health-care contexts over time. The results suggest that the implementation of a new model of care has an impact on organizational culture. This implies that health-care managers should have confidence in the outcomes from change projects. It seems that systems of dual logic can develop over time to facilitate change and sustainability. However, if a new working model is to change the culture profoundly, it requires years of zealous implementation.

Through the lens of work-integrated learning: Staff experiences of participating in person-centredness coach training in a Swedish hospital

“…Another facilitating factor was training, which reflects the focus of the present study and the importance of WIL. Wolf, Ulin and Carlström [27] argue that the implementation of PCC affects organisational culture, but it requires time, practice and dedicated staff, which is in line with the results of this study, in which the PC coaches highlighted time as an important factor in developing person centredness in health care. The aspect of dedicated staff [27] can be related to the PC coaches themselves, who considered that coaches should have the characteristic of enjoying change projects.…”

Learning from Gothenburg model of person centred healthcare

“…The early trials were supported by a 10 week education and implementation process6 that was tested in five hospital wards in Gothenburg during 2012-14 (fig 1) and later in other settings. The process was influenced by Kotter’s change management ideas7and the notion of deliberate and emergent strategies—that is, both top-down and bottom-up approaches 8.…”

Characteristic of person-centered care as documented in medical records at a medical department – a mixed methods

“…The movement from standardized to person-centred is expected to be documented in a mutual care plan within 24-72 hours from arrival to the caregiver. [17] 2.2 Sample and data collection Inclusion criteria were medical records regarding the two diagnostic groups (COPD and CHF) was divided into four wards (50% practicing PCC, 50% non-practicing PCC) at a medical department, university hospital in western part of Sweden. The medical records were selected and followed from January 2015 to December 2015 (121 medical records were included, see Table 1) and were divided into two parts, patients with hospital stay in a medical wards practicing PCC (COPD = 39, CHF = 30) and wards with no PCC (COPD = 49, CHF = 3).…”

“…[5][6][7][8] The impact of PCC has been questioned regarding routines and procedures in the clinic. [17] Consequently, the aim was to study the impact of PCC by describing and comparing medical records from two diagnostic groups, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) at a medical department in a hospital in Sweden.…”