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VOLUME 51 | NUMBER 1.2 | FEBRUARY 2016


Sustaining Culture Change: Experiences in the Green House Model

Keywords: Qualitative research; long-term care; nursing home; geriatrics; health workforce; culture change.

Objective: To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH.

Objective: To describe conditions that influence how Green House (GH) organizations are sustaining culture change principles and practices in a sample of GH skilled nursing homes.

Data Sources/Study Setting: Primary data were collected at 11 skilled nursing GH organizations from 2012 to 2014. These organizations have adopted the comprehensive and prescriptive GH model of culture change.

Study Design: To develop an understanding of sustainability from the perspective of staff who are immersed in GH daily work, grounded theory qualitative methods were used.

Data Collection Methods: Data were collected using semi-structured interviews with 166 staff and observation of house meetings and daily operations. Data were analyzed using grounded dimensional analysis.

Principal Findings: Organizations varied in their ability to sustain GH principles and practices. An organization's approach to problem solving was central to sustaining the model. Key conditions influenced reinforcement or erosion of GH principles and practices.

Conclusions: Reinforcing the GH model requires a highly skilled team of staff with the ability to frequently and collaboratively solve both mundane and complex problems in ways that are consistent with the GH model. This raises questions about the type of human resources practices and policy supports that could assist organizations in sustaining culture change.

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