Reinventing Management Practices in Long-Term Care

How Cultural Evolution Can Effect Workforce Recruitment and Retention

Recruiting and retaining direct care providers, and therefore ensuring quality of care in nursing homes, is challenging because direct care providers lack adequate salaries, opportunities for advancement and respect. As a result, there is a move afoot to make structural and regulatory changes in nursing home culture, such as including direct care staff in decision-making and creating of more homelike environments. Lasting changes, however, must come via gradual changes to the organizations’ cultural artifacts.

An organization’s culture has three layers: artifacts, values and assumptions. When visible artifact changes occur in an organization–such as changes to policies about which staff can access what information–they create value changes among employees, and over time can lead to changes in the baseline assumptions that dictate employees’ behaviors.

Few nursing homes have undertaken rapid culture change, opting instead to make incremental changes that are consistent with preexisting values and assumptions. Incremental change via specific interventions may be a useful approach to culture change because it is non-threatening, and therefore potentially more sustainable than radical change.

Introducing new ways of caring for patients and giving authority to employees within existing organizational structures are ways of gradually introducing new cultural artifacts into an organization. Organizational leaders must actively sustain their organization’s positive features while also instituting and sustaining changes over time.