Dr. Eleanor Barbera

The team huddled around the nursing station talking in panicked whispers after the management meeting ended.

“How do they expect us to do that?” a young nurse wondered.

“Yeah,” an aide replied, “we’re stretched thin enough already!”

A more experienced worker piped up. “Don’t worry,” he said bluntly. “I’ve seen these ideas come and go. It’ll never happen.”

There was a collective sigh of relief and everybody went back to business as usual.

The scenario above illustrates some of the many ways organizations are resistant to change.

In this situation, the new procedure is viewed as a temporary fad not worth investing time and energy. The workers haven’t been consulted for their input prior to implementation, they fear that they won’t be able to handle the work and the benefits of doing so aren’t clear. In addition, the employees don’t trust their management to guide them through the process of change.

Think of how hard it is to adjust our own routines and then multiply that by, say, every employee, resident and family member. Then cube that number.

Speaking of adjusting personal routines, a few months ago I wrote that I was going to try to meditate daily this year. I haven’t.

Consider trying to make changes in the context of family life, such as going for a walk after dinner (a good idea that never happened) or eating healthy food (I do, she does, he doesn’t). Pushback and inertia can make it difficult for even the most well-intentioned modifications to take hold.

This is why it’s necessary to have a guide along the way for changes to take hold, whether it’s a friend to meet you at the gym or the Pioneer Network to help your organization navigate through the culture change process.

Full disclosure: While I don’t get paid to say this, as a psychologist I find that culture change principles are better for the mental health of the residents, staff and families. As a change agent, I know how important it is to enlist an agent of change.

A culture change guide allows the organization to:

•   Quell fears that the facility will be sanctioned by the state or lose its star rating by using a blueprint that complies with regulations.

•   See a model of what things will look like in the future so leaders and workers know where they’re headed.

•   Turn to experts for help in tackling challenges such as staff resistance.

•   Access educational materials prepared for each stage of the journey.

•   Have a cheering squad to celebrate successes and improve morale when the going gets tough.

For more on their benefits, check out the websites listed in the resource section below. If I missed a resource, please add it in the Comments section.

I worked for several years in a facility that was in an early phase of their culture change journey. An experienced nurse complained in a team meeting about a young-ish resident refusing to get up in the morning. An equally experienced nursing supervisor who had undergone culture change training responded, “This is his home and if he wants to go to bed at 2 a.m. and get up at 10 a.m., we need to find a way to make this happen.”

There was a momentary silence among the team members as they absorbed an entirely new way of looking at things and then came a flood of suggestions about how to implement it. 

As I like to quote to my patients, “When the student is ready, the teacher appears.”


Pioneer Network

Eden Alternative

The Greenhouse Project


Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Gold Medal blogger in the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with more than 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.