title: Why and how do nursing homes implement culture change practices? Insights from qualitative interviews in a mixed methods study.
abstract: To understand the process of instituting culture change (CC) practices in nursing homes (NHs). NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail.
  
  
  RESULTS
  The themes include: (a) Reasons for implementing CC practices vary; (b) NH approaches to implementing CC practices are diverse; (c) NHs consider resident mix in deciding to implement practices; (d) NHAs note benefits and few costs to implementing CC practices; (e) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; (f) Education and communication efforts are vital ways to institute change; and (g) NHA and other staff leadership is key to implementing changes. Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations.
authors.affiliation: Brown University, Providence, RI, USA Renee_shield@brown.edu.
authors.forename: Renée R
authors.initials: RR
authors.lastname: Shield
authors.affiliation: Brown University, Providence, RI, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Looze
authors.affiliation: Brown University, Providence, RI, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Tyler
authors.affiliation: Brown University, Providence, RI, USA Planetree, Inc., Derby, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lepore
authors.affiliation: Brown University, Providence, RI, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
mesh_terms: D018864:Cultural Diversity; D003625:Data Collection; D006270:Health Facility Administrators; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009718:Nurse Administrators; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D011787:Quality of Health Care; D014481:United States
keywords: culture change; leadership; nursing home; resident-centered care