title: An assessment of cultural values and resident-centered culture change in U.S. nursing facilities.
abstract: BACKGROUND
  Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements.
  
  
  OBJECTIVE
  The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives.
  
  
  METHODS
  We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses.
  
  
  RESULTS
  Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities.
  
  
  CONCLUSIONS
  Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident centered and may face other barriers to adopting these practices.
authors.affiliation: Jane Banaszak-Holl, PhD, is Associate Professor, School of Public Health and Institute of Gerontology, University of Michigan, Ann Arbor. E-mail: janebh@umich.edu. Nicholas G. Castle, PhD, is Professor, School of Public Health, University of Pittsburgh, Pennsylvania. Michael Lin, PhD, is Assistant Professor, School of Public Health, University of Pittsburgh, Pennsylvania. Gretchen Spreitzer, PhD, is Professor, Ross School of Business, University of Michigan, Ann Arbor.
authors.forename: Jane
authors.initials: J
authors.lastname: Banaszak-Holl
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: Michael
authors.initials: M
authors.lastname: Lin
authors.forename: Gretchen
authors.initials: G
authors.lastname: Spreitzer
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D006270:Health Facility Administrators; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration*; D012945:Social Values; D014481:United States