Barriers and Enablers to Changing Organizational Culture in Nursing Homes

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To discuss the barriers and enablers of changing organizational culture in 3 nursing homes undergoing a culture change initiative, and suggest actions for program enhancement.


Interview data with staff (n = 64) and families (n = 14) from 3 culture-change facilities in a larger mixed-methods pilot study were used to identify barriers and enablers.


The 3 sites ranged from 120 to 139 beds and did not differ in staff characteristics. Barriers included exclusion of nurses from culture-change activities, perceived corporate emphasis on regulatory compliance and the “bottom line,” and high turnover of administrators and caregivers. Enablers included a critical mass of “change champions,” shared values and goals, resident/family participation, and empowerment at the facility level.


Involve all levels of staff, residents, and community in culture-change activities. Align incentives and rewards with the new values. Empower individual homes to make decisions at the facility level. Work with corporate partners to enable rapid translation and implementation of recommendations based on the findings.

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