Green House Blog

Thrive Research: Culture Change Sustainability in the Green House Model

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.


One of the broad concepts that long term care researchers, practitioners, and consumers are interested in is culture change. It’s hard to find a long-term care setting that doesn’t claim to be engaged in culture change in some way.  Many see it as a shift from the traditional institutional “one-size fits all” model of providing care to one that focuses on “person centered” care.  But are people walking the walk, or just talking the talk?  What extent of change is necessary to really change the culture?

The Green House is one model of culture change that uses a comprehensive approach to culture change, including creation of specific environmental features, alteration of traditional care practices, and re-organization of staff roles.  Alternately, some nursing homes have changed by adopting a single practice, such as consistent assignment of staff, or resident choice about what time to awake  in the morning. Some have changed the environment to offer private rooms, more intimate dining rooms, or more private lounge spaces.  Also, environmental changes using a “hotel amenity” approach are becoming particularly common to attract people who need short-stay rehabilitation.

Does any or all of this equal “culture change”? Can smaller changes achieve the same outcomes as more extensive changes? Are there specific practices or environmental changes that are necessary to achieve certain outcomes?  When are changes sufficient to suggest that culture change has occurred?  Is all culture change equal? 

Research suggests that change in an organization occurs only when a new way of doing things is generally accepted throughout an organization, and when policies, procedures, and routine practices are aligned with the new way of operating.  So, when implementing culture change, it’s important to ask:

1)     Do we generally agree about what is important?

2)     Are we all moving in the same direction, toward what we believe is important?

3)     Do our policies and procedures support this new way of operating or are they at odds with where we say we’re going to do?

The THRIVE research team will be exploring some of these questions with culture change organizations, many of which are Green House homes, and strives to understand how culture change is achieved and sustained within these organizations.


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

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