Jane Banaszak-Holl, PhD, is Associate Professor, School of Public Health and Institute of Gerontology, University of Michigan, Ann Arbor. E-mail:
Health Care Manage Rev. 2013 Oct-Dec;38(4):295-305. doi: 10.1097/HMR.0b013e3182678fb0.
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.
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.
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.
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.
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.
文化变革倡议旨在通过解决行业中缺乏管理支持和普遍存在的紧张工作环境来改善护理，但对于文化变革设施与未选择加入以患者为中心的护理运动的行业设施有何不同，知之甚少。
本研究旨在使用竞争价值观框架评估美国疗养院设施中组织文化价值观的代表性，确定组织价值观是否与以患者为中心的文化变革倡议的成员资格相关。
我们在对全美所有州的疗养院管理员和护理主任进行的随机调查中，使用成熟的竞争价值观框架工具收集文化价值观报告。我们收到了邮寄调查的设施中 57%的回复。护理主任和管理人员在报告的文化和设施措施方面没有显著差异，他们的回答结合在一起。
护理设施平均倾向于以市场为重点的文化价值观，而创新的关键——发展价值观在所有疗养院中最为罕见。大约 17%的设施报告称，其设施内所有文化价值观都很强。只有高发展文化价值观与参与文化变革倡议有关。在组织文化方面，如群体文化价值观所强调的，以员工为重点的文化变革设施与非文化变革设施没有不同。同样，文化变革设施也不像非文化变革设施那样更有可能具有层级或市场重点。
我们的结果反驳了文化变革设施比一般设施更注重内部员工的观点，但确实表明文化变革设施报告的发展文化比非文化变革设施更强，这表明在其战略中有创新的潜力。设施在文化上已准备好以患者为中心，并且可能面临采用这些实践的其他障碍。
