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