Barriers to culture change | Partnerships in Dementia Care

How can organizations overcome barriers to culture change?

Shifting to a relational model of living isn’t easy. The PiDC Alliance has identified a number of roadblocks to culture change along with potential strategies to address them (ramps to opportunity).

For each of the barriers listed below, we provide examples of how some organizations have attempted to deal with them. Some barriers and strategies may apply to your organization more than others.

More detailed, step-by-step advice is available in the PiDC Alliance’s Culture Change Toolkit.

Perceived barrier	Potential strategy or ramp to opportunity
Individual level
Assumptions and misunderstandings about the capabilities of older adults and people living with dementia	Provide opportunities and safe spaces for everyone in your organization to critically reflect on their assumptions. Share videos from our Getting Started with Culture Change feature in order to challenge assumptions. Have older adults whom your organization serves talk about their experiences in front of staff.
Task focus	Promote the importance of individual choice for older adults through a culture change coalition (that consists of staff, older adults and families). Collectively agree what an interaction that values individual choice looks like. Develop demonstrations that can be shared with others. Review and adjust organizational routines and expectations. Nurture team building so that staff can support each other in situations where more time is needed. Reward activities that go beyond the fulfilment of tasks and that build relationships.
Attitudes: “It’s not my job”	Make sure that everyone’s job description supports relational living and that everyone understands their responsibilities in this regard. Evaluate staff performance based in part on their ability to demonstrate relational caring.
Focus on disease, symptoms and bodies	Show how clinical needs can still be met when a relational model of living is used (using examples for organizations that have shifted their culture). Provide opportunities for staff, older adults and families to get to know one another. Rework policies and procedures to balance symptom management and the care of bodies with the need to support older adults in living life to the fullest. Find ways to hide/disguise things that are clinical (e.g. med carts) to create a more home-like atmosphere while continuing to provide quality care.
Sense of powerlessness	Make sure that management values the recommendations from culture change coalitions. Implement and support recommended changes. Celebrate successes. Empower staff to try new things that contribute to building strong relationships.
Not clear on the intent of culture change	Provide relevant and accessible training on person-centred and relational caring. Show videos from organizations that have already made the shift to relational caring. Provide opportunities to participate in the culture change process. Include everyone in the determination of a preferred vision for the future so all feel ownership of the vision and are energized by the possibilities. Develop a range of ways to communicate the culture change work to diverse groups throughout the organisation.
Unclear how culture change will improve working / living environment	Collaborate with staff, families and older adults to better understand needs of each group and how they potentially overlap. Develop and implement staff-centred and family-centred wellness programs. Share outcomes from other culture change initiatives that demonstrate an improved working / living environment.
Organization level
Limited staff time to complete tasks	Explore ways that communication during interactions between staff and older persons can be more open and respectful (without necessarily taking more time). Provide staff with training to help them be “in relationship” while doing tasks. Show them how they can simply and practically allow more opportunities for individual choice. Nurture team building so that staff can support each other in situations where more time is needed.
Funding / resource constraints	Learn from organizations that have implemented a relational model without increasing their operating costs. Develop partnerships with others outside the organisation who can help move the culture change work forward.
Resistance to change	Make relationship building the #1 priority. Provide regular opportunities to get together (e.g. for shared meals, community celebrations, mourning, etc.). Provide opportunities for all in the organization to contribute to the culture change work and have a voice. Include everyone in the development of a shared vision and plan for moving forward. Make sure that leaders model the behaviour they’re espousing. Recognize and celebrate actions that reflect the desired culture.
Lack of continuity of care	Consider dedicated assignment of staff to individuals and staff choice in assignments.
Lack of an identified point person	Assign culture change champions who can lead the process.
The scope of culture change seems overwhelming	Start small and build momentum. Show staff what they are already doing that supports relational caring. Look at how this can be built upon during the culture change process.
System level
Regulatory obstacles	Meet with compliance officers early and help them understand how culture change can improve outcomes. Where a regulation presents a real impediment to change, initiate advocacy efforts in partnership with like-minded organizations to get it changed.
Union skepticism	Involve union representatives in discussions from the outset. Make a case for how culture change can improve the work environment and job satisfaction.