Culture Change in Nursing Homes: The Perception of Leaders Versus Staff

Abstract

The elderly population in Kansas is growing, leading to an increased need for nursing home care. To improve the quality of life for residents and staff, many facilities have implemented care models called culture change that are focused on resident-centered care and staff empowerment. The Kansas Culture Change Instrument (KCCI) was developed using six constructs using the 2006 Commonwealth fund definition (Doty, Koran, & Sturla, 2009) as the theoretical framework. The six constructs were: resident-centered care, a homelike environment, staff/resident relationships, staff empowerment, nursing home leaderships, and quality improvement with an added seventh construct, share values. The purpose of this study was to determine: a) how leader and staff perceptions differed on the seven subscales of culture change in nursing homes; and b) whether staff and leaders scores vary differently in culture change nursing homes when compared to non-culture change nursing homes. The study is a secondary analysis using data from the Kansas Nursing Home Project. Staff and leaders employed at 100 randomly selected nursing homes in Kansas comprised the sample. The response rate was 72% (n=72). Data were collected using the KCCI. Paired t-tests and Pearson Correlations (r) were used for data analysis. The results indicated statistically (p < .01) different scores between the staff and the leaders on the total culture change score and the seven subscales Mean differences ranged from .08 to .38 on average subscales scores that ranged from 1 (never) to 4 (always). There were stronger correlations between staff and leader scores in nursing homes that had undergone extensive culture change. Collecting information from all staff and leaders in nursing homes can be time consuming and expensive. Nursing homes that had extensively implemented culture change had more consistent findings than the nursing homes that had partial or limited implementation. Consequently, it is important to assess where the nursing home is on the continuum of culture change implementation before determining who will be involved in the data collection.