Volume 51 | Number S1 | February 2016

Abstract List

Barbara Bowers, Kimberly Nolet M.S., Nora Jacobson Ph.D., , Patrick Brown B.S., Lauren Cohen, David Grabowski, Susan Horn Ph.D., Sandy Hudak, David Reed, Sheryl Zimmerman


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

Data Sources/Study Setting

Primary data were collected at 11 skilled nursing organizations from 2012 to 2014. These organizations have adopted the comprehensive and prescriptive model of culture change.

Study Design

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

Data Collection Methods

Data were collected using semi‚Äźstructured 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 principles and practices. An organization's approach to problem solving was central to sustaining the model. Key conditions influenced reinforcement or erosion of principles and practices.


Reinforcing the 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 model. This raises questions about the type of human resources practices and policy supports that could assist organizations in sustaining culture change.