The culture change movement in long-term care attempts to foster an atmosphere where residents come first. Consequently, many of today’s culture change efforts begin with dining enhancement and other operations affecting the residents. However, that approach has not consistently produced the desired results. The reason is simple: operational changes do not affect the underlying culture of the organization.

Culture is created by the standards of behavior that are modeled by management. However, the standards they model are not always the ones they preach. Residents can not come first in an organization where in-fighting, disrespect, and complaining are an accepted way of life, as is the case in many long-term care organizations. Culture can only be changed by first taking an honest look at the organization’s accepted behavior. This requires courage on the part of the leaders, and a commitment to the truth that many management teams are not ready to make. For that reason, our culture change process begins with the leadership and employees of the organization.

The Role of Core Values and Employee Perception  in Culture Change

Culture may be thought of as a pyramid, the foundation of which is formed from the values and beliefs of the organization. Values and beliefs lead to policies and practices. Implementation of those policies and practices results in the culture-defining behaviors that your employees witness (and imitate) in their daily work. Just as the child reflects the example of the parent, your employees reflect the attitudes and values exemplified by their managers and supervisors. To change an organization’s culture, we must change the example set by the organization’s leadership.

We begin with the organization’s Core Values as the foundation for a new culture, defined in terms of behaviors, both supporting and nonsupporting. Then we measure how well the managers have been living those values in the eyes of the employees. Employee perception provides a powerful mirror for leaders to understand the true culture of the organization, and their own contribution to it.

The Employee Perception Survey is an anonymous feedback mechanism we use to measure management’s ability to “Walk the Talk” in the eyes of the employees. Feedback from the survey, sometimes painful, always eye-opening, is used as the basis for executive coaching. The purpose of coaching is to help managers become the model for new standards of behavior for all employees. When the leader’s behavior changes, the employee’s behavior follows.

A Difficult Process

Vicki is an executive from Redstone Highlands, an organization that has been engaged in culture change for several years. She was a cheerleader at the beginning of the process, and believed it was in the best interest of the organization. Before the Employee Perception Survey, she believed that she was well-liked, and a very effective leader at modeling the organization’s Core Values of Truth, Teamwork, and Respect for All. However, she was shocked to learn that people thought of her as a dictator and someone who could not be trusted. This painful awareness allowed Vicki to change how she interacted with people on all levels, making her an impressive example for the rest of the organization to follow. She has since become one of the organization’s leading coaches, and regularly discusses her “scars” with other employees to help them through the process.

The value of culture change was as significant to Redstone financially as it was to Vicki personally. Employee turnover was reduced by 25%, agency use was nearly cut in half, and the functioning of the executive council improved.

Our culture change process is not easy, but in the words of David Brinkley, “A successful person is one who can lay a firm foundation with the bricks that others throw at him."