Culture Change in Skilled Nursing: An Exploratory Comparison of a Traditional Home to a New Model

Rill, Lisa; Gonzalez, Lori

doi:10.1080/02763893.2019.1604463

Cited by 7 publications

(11 citation statements)

References 32 publications

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“…13 The caregiving staff of small house models are expected to provide living support over and above any health-related responsibilities (e.g., cooking, cleaning, grocery ordering, social engagement). 4,30,31 Although the staff profile includes the usual positions -nurses, nursing assistants, housekeepers, and cooks -staff are typically cross-trained so that each is capable of executing a range of tasks. 25,32 The exact staffing levels vary between the different facilities and locations and are influenced by the total number of residents in a home unit, the resident acuity, and any prevailing industry regulations.…”

Section: Philosophymentioning

confidence: 99%

“…To support a shift to person-centred care, the small house model has had to re-envision the organizational structure of LTC. 10,11,30,31 Traditionally, LTC homes installed a management hierarchy with set protocols and well-defined roles for individual staff members. Decisionmaking was exclusively led by management.…”

Section: Organizational Structurementioning

confidence: 99%

“…23 Small house models eliminate the strict delineation of roles; staff at all levels are included in the decision-making process. 31,37 Staff in the small house model have reported having more job autonomy and feeling more empowered, more flexibility with less time pressure to complete their job, 7,28,35 and a significantly lower workload and job demands compared with caregivers in the traditional model. 30,31,35,38,39 However, whether this translates to higher job satisfaction and lower turnover for small house model staff is inconclusive because some studies report better outcomes for the small house model whereas others did not identify a significant difference.…”

Section: Organizational Structurementioning

confidence: 99%

“…31,37 Staff in the small house model have reported having more job autonomy and feeling more empowered, more flexibility with less time pressure to complete their job, 7,28,35 and a significantly lower workload and job demands compared with caregivers in the traditional model. 30,31,35,38,39 However, whether this translates to higher job satisfaction and lower turnover for small house model staff is inconclusive because some studies report better outcomes for the small house model whereas others did not identify a significant difference. 35,40,41 In the 2 studies that reported on wages -conducted in the US and Australia -wages did not differ significantly between the small house models and the comparator traditional LTC homes.…”

Section: Organizational Structurementioning

confidence: 99%

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The Small House Model to Support Older Adults in Long-Term Care

Longstaff¹,

Filkowski²,

Severn³

2022

cjht

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The small house model of long-term care (LTC) is identified internationally by several model names. Although some differences exist between the characteristics of these models (e.g., number of residents, degree of resident freedom, facility design), there are 3 recurring components: functional units with a small group of residents, replication of familiar domestic routines, and some form of decentralized staff. The key philosophic difference between the small house model and the traditional LTC model is the heavy focus on person-centred care. This approach to care in the small house model is firmly rooted in freedom of choice and autonomy for the residents. Small house models eliminate the strict delineation of roles; staff at all levels are included in the decision-making process. Self-managed and universal work teams are prominent features of the small house model. Frontline staff with strong interpersonal skills are essential for successful implementation. No strong trend emerges from the literature with respect to the impact of the small house model on resident-centred outcomes compared with more traditional models of LTC. This is likely due to lack of consistency in the outcomes that are measured and variability among the different small house models. This finding is consistent with other reviews on the topic. Literature exploring the Canadian experience with small house models is limited. The majority of identified studies used data from the US or European jurisdictions, which potentially limits its generalizability to the Canadian context.

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Section: Philosophymentioning

confidence: 99%

Section: Organizational Structurementioning

confidence: 99%

Section: Organizational Structurementioning

confidence: 99%

Section: Organizational Structurementioning

confidence: 99%

See 2 more Smart Citations

The Small House Model to Support Older Adults in Long-Term Care

Longstaff¹,

Filkowski²,

Severn³

2022

cjht

View full text Add to dashboard Cite

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“…It has been shown that through a culture change it is possible to achieve desirable goals and improve quality within nursing home organizations. 3,4 To understand the function of an organization, it is important to study the culture of the organization. 5 Organizational culture may be defined as 'a complex set of values, beliefs, assumptions, and symbols' that define the way of conducting the activity.…”

Section: Introductionmentioning

confidence: 99%

Change agents’ experiences of implementing a new organizational culture in residential care for older people: A qualitative study

Ericson-Lidman

Strandberg

2021

Nordic Journal of Nursing Research

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Culture change in organizations may affect employees and change agents are often a forgotten resource; their perspective is often overlooked in research. The aim of the study was to illuminate experiences of being a change agent in order to improve residential care of older people. Interviews were performed with 15 change agents who participated in a large culture transformation in residential care for older people. The study followed COREQ guidelines and content analysis was used to interpret the text. The analysis revealed that the change agents felt chosen when they accepted the challenge to become a change agent, but they also felt that transferring the message to co-workers was demanding. Conflicting demands about measuring care and aggravating circumstances to implement change were described. The results indicate that change agents benefit from preparation for the role itself as they have a great responsibility on their shoulders. In making the process more successful, all co-workers should be involved in the change process from the beginning.

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