Understanding culture change

Culture Change is…

  • Championed by strong leaders.
  • Supported by collaboration.
  • Built upon strengths.
  • About being open to new possibilities.
  • An evolving process.
  • Critically reflecting on what is and working towards what can be.

Culture Change is NOT…

  • An end product or outcome.
  • Solely a quality improvement initiative.
  • A specific program or model of care that is implemented.
  • A one-size fits all approach.
  • A top-down mandate imposed by others.

Moving from a medical, institutional model to a community, relational model

One way of understanding what a community, relational model looks and feels like in practice is to contrast it with the traditional medical, institutional model.

Institutional, Medical Model Community, Relational Model
Level of Individual Experience (e.g. staff, volunteers, families, clients)
  • Staff provide traditional care and “treatments”
  • Individualized care and support that nurtures personhood and living
  • Separation of body and mind with primary focus on physical care
  • Focus on holistic wellness where human spirit is nurtured
  • Residents/clients follow facility/organization and staff routine
  • Team members follow the individual’s routine and life rhythms
  • Staff have authority and make decisions for residents/clients
  • Individuals have meaningful choices and make their own decisions
  • Staff have rotating assignments
  • Individual and family supported by familiar team members
  • Staff provide structured activities to residents/clients
  • Spontaneous activities around the clock for all
  • Staff know residents/clients by diagnosis (e.g. bipolar, dementia, etc.)
  • Team members know the person and their family
  • Staff encouraged to be emotionally neutral
  • Team members have close relationships with individual and their family
  • Focus on resident/client care
  • Wellness of all the focus
Organizational or Institutional Level
  • Departmental focus/silos
  • Team focus
  • Focus on care
  • Focus on living life
  • Scheduled routines
  • Flexible routines
  • Staff rotate among different floors, programs and residents/clients
  • Consistent assignment the norm
  • Environment = workplace
  • Environment = home
  • Structured activities
  • Planned, flexible and spontaneous activities around the clock
  • Hierarchical departments
  • Collaborative and inclusive interdisciplinary teams
  • Staff care for residents/clients
  • Team members empowered to work in partnership with individuals
  • Us and them, or us versus them
  • Mutual, reciprocal relationships
  • Individualism
  • Emphasis on community and community-building


 (Table adapted from Fagan, 2003)

Culture change values

Organizations that work towards culture change value the following:

  • Emphasizing abilities, talents, gifts and aspirations
  • Flexibility
  • Choice and self-determination
  • Enabling, normalizing environments
  • Living life
  • Meaningful engagement and collaborative decision-making
  • Close interdependent relationships
  • Knowing and focusing on the person