Is Culture in Long-Term Care Getting in the Way of Progress?

There is recognition that critical changes in healthcare services are needed across the continuum for our aging population, but more specifically within long-term care.  We need to progress from current institutional models of care to more humane and life-affirming social models of living. For this shift to occur we need leaders with confidence to lead culture change.

To meet this need CHA Learning and the Schlegel-UW Research Institute for Aging have partnered to create a Culture Change case-study as part of CHA Learning’s existing Change Leadership Certificate course.  See the Questions and Answers below about how Schlegel Villages rose to the challenge of changing culture to put resident preferences over process and organizational structure.


What do we mean when we talk about culture change?

In long-term care there are many structures, processes and routines. Too often we expect residents to accommodate to these routines rather than their own self-determined needs and choices.  Culture change is about shifting from this institutional model of care towards a more social model of living where needs are met in more flexible ways. This is transformational work at the individual and organizational level. Formally, we define culture change as “an ongoing, holistic journey that includes re-examining values, beliefs, attitudes, language, practices and policies.  It involves exploring the full range of efforts needed to transform the culture into a community where everyone thrives.”

At the inaugural national culture change conference in 2014, we collectively created our seven Canadian Culture Change values. These deepen our definition and collective understanding of what we mean by culture change:

  • the personhood of each individual is honoured
  • each person is the primary authority of his or her life and personal choices
  • the focus is on living life to the fullest
  • accessible and enabling environments support continued engagement and connections in community
  • the body, mind and spirit of each person are nourished
  • close relationships and authentic partnerships involving collaborative decision-making are at the core of compassionate communities
  • all care partners have the knowledge and information, skills, resources, authority and accountability to provide respectful, flexible and life-affirming care and support

Why is culture change in long term care important?

Good quality of life is no different for those living in long-term care than it is for older adults everywhere.  It is about much more than physical health and safety. Everyone needs and deserves respect, dignity, purpose and independence. Sadly, institutional structures and processes, and an overabundance of concern for safety at the expense of independence and choice, compromise these basic needs for many older adults who live in long-term care. Residents are required to eat meals at specific times, wake up/go to bed at specific times, have decisions made for them instead of with them and have little opportunity for spontaneous activities.  Often different staff provide care making it impersonal and even invasive to privacy and dignity. These are the things that change when culture shifts to a social model of living with shared decision-making and collaborative teams, and these changes are the indicators of success. 

How can small and large organizations move toward this culture?

Schlegel Villages embarked on a culture change journey in 2009 and that journey continues today. We have made great strides in the way staff and residents across the organization speak, act and relate to each other.  Decision making is closer to the resident.  Hierarchical siloed structures have been replaced with collaborative teams and decision-making is made with residents not for residents.  We have reflected on our journey and documented it in a guidebook. The guidebook outlines 10 steps in our journey, and each step has several activities:

  • Build a Foundation
  • Raise Collective Awareness
  • Form an Advisory Team
  • Mobilize an Organization-Wide Inquiry
  • Identify the Organization’s Positive Core
  • Dream about an Ideal Future
  • Design Aspiration Statements
  • Work Together to Achieve the Organization’s Destiny
  • Share Successes, Broader Engagement and Keep the Momentum Going

What are enablers of culture change – what led to your success?

Several things contributed to the success of our culture change journey. Three I would highlight are:

  • We had buy-in from the key leaders of the organization
  • We engaged the entire organization at all levels (residents and family, direct care staff, management, leadership)
  • We took an appreciative, strengths-based approach to change

What do you hope participants will take away from this case study?

I hope that participants will learn about long-term care, see the potential for making long-term care the best it can be for those who live and work there and learn how to do exactly that through culture change. Most importantly, I hope they will be inspired to join the journey!


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Josie d’Avernas is Executive Director of the Schlegel-UW Research Institute for Aging.  She has been a leader and active participant in Schlegel Villages’ culture change journey since 2009. She was one of three learning partners who helped lay the groundwork that led to the collective, organization-wide decision to embark on this journey.