Nursing home culture, teamwork, and culture change

Aims: Most developed countries are taking steps to move away from institutional models of care for the aged, in an attempt to both improve quality of life for those receiving care and improve the work of those providing care. In the USA, the concept of ‘culture change’ (CC) encompasses a variety of philosophical and practice models being employed to de-institutionalise skilled nursing facilities, also known as long-term care (LTC) facilities. Teamwork among direct-care workers is often promoted as an important aspect of culture change. However, a recent study found that, among facilities attempting CC, teamwork was the least commonly implemented CC component. This suggests that facilities may be having difficulty implementing teamwork and also raises questions about the link between teamwork and facility organisational culture. This study examined the relationship between teamwork and organisational culture in the LTC setting. Methods: Observations in 20 LTC facilities were used to identify facilities with high and low amounts of teamwork. Interviews with nursing staff from four high-teamwork and five low-teamwork facilities were compared to determine the aspects of organisational culture associated with teamwork, and explore how teamwork might be sustained in LTC facilities. Findings: Aspects of culture, including positive staff attitudes toward co-workers, were associated with high-teamwork facilities. Managerial modelling of these attitudes may be one factor that helps sustain teamwork. Conclusions: LTC facility managers may need to adjust their own attitudes and behaviour to support teamwork in their facilities. This has implications for facilities attempting to de-institutionalise.