Deutschman Marian T
Communication Department, Buffalo State College, USA.
J Health Hum Serv Adm. 2005 Fall;28(2):246-81.
The current system of delivery of nursing home care is costly both in dollars and in human terms. Culture change may provide solutions to both issues. Culture change has a different meaning for different organizations depending on where they are in the continuum of change. Detailed observation of staff members "in action" in three long-term care facilities over a period of several months was supplemented by formal and informal interviews of organization members to gain an understanding of the culture of the nursing home organization. Four three-hour observations in each of three facilities, representing privately-held and not-for-profit organizations in urban, suburban, and rural locations yielded insights into the routine, recruitment, training, teamwork, activities, leadership, role-modeling, mentoring, staff and resident satisfaction, weekend staffing and activities, bureaucratic structure, and sharing of best practices. Discussion of each of these issues may provide a starting point for all those facilities that are contemplating significant culture change. If the objective is to have facilities truly embrace a new set of values, then the change begins with the owners and administrators of nursing homes who need to focus on building new relationships with all the stakeholders. In-depth interviews of organization members and six chief executive officers in long-term care in the Western New York area culminated the study with the development of a fifty-question survey for decision makers.
目前的养老院护理服务体系在资金和人力方面都成本高昂。文化变革或许能为这两个问题提供解决方案。文化变革对不同组织有着不同的意义，这取决于它们在变革连续体中的位置。通过对三个长期护理机构的工作人员进行为期数月的“实际工作”详细观察，并辅以对组织成员的正式和非正式访谈，以了解养老院组织的文化。在三个机构中，每个机构进行了四次为时三小时的观察，这些机构分别代表城市、郊区和农村地区的私营和非营利组织，从而深入了解了日常工作、招聘、培训、团队合作、活动、领导力、榜样作用、指导、员工和居民满意度、周末人员配备和活动、官僚结构以及最佳实践的分享。对这些问题的讨论可能为所有考虑进行重大文化变革的机构提供一个起点。如果目标是让各机构真正接受一套新的价值观，那么变革应从养老院的所有者和管理人员开始，他们需要专注于与所有利益相关者建立新的关系。对组织成员和纽约西部地区六位长期护理首席执行官的深入访谈最终形成了一项针对决策者的五十个问题的调查，完成了这项研究。
