Sustaining Culture Change: Experiences in the Green House Model

Health Serv Res. 2016 Feb;51 Suppl 1(Suppl 1):398-417. doi: 10.1111/1475-6773.12428. Epub 2015 Dec 27.


Objective: To describe conditions that influence how Green House (GH) organizations are sustaining culture change principles and practices in a sample of GH skilled nursing homes.

Data sources/study setting: Primary data were collected at 11 skilled nursing GH organizations from 2012 to 2014. These organizations have adopted the comprehensive and prescriptive GH model of culture change.

Study design: To develop an understanding of sustainability from the perspective of staff who are immersed in GH daily work, grounded theory qualitative methods were used.

Data collection methods: Data were collected using semi-structured interviews with 166 staff and observation of house meetings and daily operations. Data were analyzed using grounded dimensional analysis.

Principal findings: Organizations varied in their ability to sustain GH principles and practices. An organization's approach to problem solving was central to sustaining the model. Key conditions influenced reinforcement or erosion of GH principles and practices.

Conclusions: Reinforcing the GH model requires a highly skilled team of staff with the ability to frequently and collaboratively solve both mundane and complex problems in ways that are consistent with the GH model. This raises questions about the type of human resources practices and policy supports that could assist organizations in sustaining culture change.

Keywords: Qualitative research; culture change; geriatrics; health workforce; long-term care; nursing home.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Grounded Theory
  • Humans
  • Models, Nursing
  • Nursing Homes / organization & administration*
  • Nursing Staff / psychology
  • Organizational Culture*
  • Organizational Innovation*
  • Patient-Centered Care / methods
  • Problem Solving
  • Qualitative Research