Green House Blog

Is There a Recipe for Culture Change?

Is there a recipe for culture change? The Green House ‘recipe’ for culture change uses many ingredients. These include specific environmental features, like an open kitchen and private bathrooms, and also re-conceptualized staff (or Shahbazim) roles. Other nursing homes that have embraced culture change have a different recipe. Some, for example, have retrofitted, remodeled households, while others have more traditional environments; some utilize universal workers, but others do not. If culture change can appear unique on so many levels, what is it about the philosophy that really makes a difference? Are there any key ingredients for culture change? To better understand these questions, the THRIVE research team surveyed culture change adopters to learn more about their practices and environments.
What do most adopters report? These adopters most often reported certain relationship-based practices such as the use of staff consistent assignment or family member participation in care conferences. They also reported similar components of work organization and decentralized decision-making such as non-activity staff helping to choose activities and the ability of staff to fulfill requests without prior approval from an administrator. Adopters also reported similar mixtures of ingredients to enhance resident choice including dining in the small house or household to support choice in mealtime.
Are there differences in the culture change components that adopters report? Yes. There were distinct differences in the recipes of small houses, households and more traditional environments.  For example, small house models were more likely to report that direct care staff schedule themselves and choose care assignments, but these were some of the least adopted practices for other adopters. Small houses are also more likely to have CNAs attend care conferences and less likely to use overhead pagers or med carts than other adopters. Meal preparation varied for all three models. For example, small houses were more likely to prepare food in a kitchen in the home while households were more likely to use steam tables with food prepared in a centralized kitchen.
The THRIVE research team is in the process of studying the survey results to better describe the recipes of culture change adopters. As pay-for-performance and policy programs are developed to incentivize culture change, understanding the core ingredients in implementation can promote a recipe for change that is attainable for a broad range of providers.
The Green House Project has partnered with the Robert Wood Johnson Foundation’s
THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood
Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes.  Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Questions about THRIVE can be directed to Lauren Cohen ( or 919-843-8874).

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