Book of the Week: Successfully Surviving Culture Change

“Successfully Surviving Culture Change” is an abstract that has been published by Diane L. Dixon. She is Managing Principal of D. Dixon & Associates, LLC and Faculty Associate at University of Maryland, Office of Continuing and Extended Education and Faculty Associate, Johns Hopkins University, Business of Medicine Program. The abstract has been published by The Haworth Press, Inc. in 2003.

Successfully surviving culture change is a multifaceted process. It requires leaders to have a good understanding of “self” which helps build resilience needed during challenging times. Exploring old assumptions and beliefs about the field is groundwork for adopting new mindsets that can transform long-term care. Managing the personal side of change includes being able to let go of old behaviors and mindsets, face resistance, manage stress, and maintain balance during the unsteady times of transition. Continuous learning throughout the change process is essential. Working towards alignment of key aspects of the internal and external environment enables the whole system to change effectively.


  • Little is written about what leaders need to do to survive leading and managing culture change.
  • Culture change is a major organization development intervention that requires capabilities in effective change management.
  • Culture change is particularly difficult because it requires changing shared assumptions, beliefs, and values that have been deeply held for a long time.
  • Positive relationships and communication become even more important.
  • Changing culture is a whole system intervention. Leaders and staff must have a shared vision of the future and commitment to achieving it.

Finding Strength from within

There are several ways to engage in this type of self-inquiry:

  • Solitary approach requires taking time for reflective thinking, asking and answering the tough introspective questions.
  • Another alternative is to work with a trained personal coach who can facilitate a guided inquiry and development process in a safe environment.
  • A professional colleague or friend can also play this role if they have the ability to coach and mentor effectively and maintain confidentiality.
  • Knowing self is the Tao of Leadership Strategies (Heider 1985):

“The leader who is centered and grounded can work with erratic people and critical group situations without harm. Being centered means having the ability to recover one’s balance, even in the midst of action. A centered person is not subject to passing whims or sudden excitements. The centered and grounded leader has stability and a sense of self. One who is not stable can easily get carried away by the intensity of leadership and make mistakes of judgment or even become ill.” Shifting paradigms and mindsets becomes a little easier from a grounded center.

Shifting Paradigms and Mindsets

  • Real paradigm shifts require a common framework and belief set by the entire industry about the field.
  • There is always a push and pull between old and new among multiple constituencies.
  • Gaining consensus on the common ground is rarely easy.
  • Mindsets have a powerful influence on how leaders see themselves and their roles.

Understanding Mindsets
Before leaders can move to a new mindset, they must first understand their current one.

  • Traditional Mindset –> New Mindset
  • Organizations as Machines –> Organizations Adaptive Systems
  • Tight Hierarchy –> Flat and Fluid Hierarchy
  • Functional/Silo Thinking –> Cross-Functional Teams/Across Boundaries
  • Centralized Decision-Making –> Decentralized Decision-Making
  • Command and Control –> Participative Management/Empowering
  • Certainty and Predictability –> Uncertainty and Unpredictability
  • Order –> Complexity/Radical Change
  • Linear, Stepwise Thinking –> Non-Linear, Cyclical Thinking

Letting Go
Moving to different worldviews is difficult because it requires letting go of portions of the old that do not work in the new context. Contraries are –> Questions to ask individually:

  • Disengagement –> What are the behavioral cues associated with the institutional model? What are the behavioral cues associated with the resident-centered model? What do I need to do to shift my behavior to become more resident-centered?
  • Disidentification –> What was the old identity? Why am I experiencing difficulty in letting go of the old identity? What is the new identity? What aspects of the new identity are difficult for me? Why? What will help me adapt to the new identity?
  • Disenchantment –> Was I a “bad” administrator a decade ago? What can I do to manage my feelings about change more effectively? What can I do to cope with my feelings of loss? What can I still hold to while embracing the new?
  • Disorientation –> What is the source of confusion? Am I moving too fast? What action plan can be developed to help organize my thoughts and learning needs? Do I have a personal change management strategy and action plan?

Adopting New Mindsets

  • “Habits of Mind”: persisting; thinking and communicating with clarity and precision; managing impulsivity; gathering data through all senses; listening with understanding and empathy; creating, imagining, innovating; thinking flexibly; responding with wonderment and awe; thinking about thinking; taking responsible risks; striving for accuracy; finding humor; questioning and posing problems; thinking interdependently; applying past knowledge to new situations; and remaining open to continuous learning.
  • Think is the practice of developing an acute awareness of thoughts: reflect in action on current thoughts and reflect on action about past thoughts
  • Personal introspection and self-assessment: How often do I think that I am the only one who can make the best decisions?
  • “Your belief system and the way you conceptualize your management role, that is, your ‘mindset,’ powerfully influence your managerial behavior and effectiveness.”
  • Actions and results affect each other and thereby create a dynamic process that individuals have the power to influence and change.
    Care must examine their mindsets before they can affect real change in the industry and in their facilities.

The personal Side of Change Management

  • Effective change management must balance both organizational system and personal journeys (including shared vision, mission and values; redesign of facility structures, systems, and processes; and staff changes.)
  • Managing the personal consequences involves individuals reviewing their purpose and vision and determining whether they are aligned with the culture change initiative.

Managing Resistance to Change

  • The typical response to resistance to change is to resist it, to avoid dealing with it either as an individual or as a leader dealing with staff reactions to change.
  • A more effective response is to embrace resistance and manage it.

Leaders can engage staff in meaningful dialogue and ask these questions: Did you get the information that you needed? Do you disagree with the information or ideas? Are you confused about information or ideas? Are you afraid that you will lose control or status? Do you feel that you do not have the skills and knowledge? Are your reactions based on prior events that have nothing to do with this current change?

Maintaining Balance and managing Stress

  • Can be a real challenge.
  • But it is also an opportunity to enhance life/work balance by engaging in positive life practices
  • It is essential to balance expending energy with energy recovery. Taking time to stop, breathe, and meditate for a few minutes can have a restorative effect that is re-energizing.
  • There is a mind-spirit connection: it must be nurtured as a key part of the balancing process.
  • What keeps my inner light burning? What motivates me to live and work? What can I do to maintain my spirit?
  • Being able to balance emotions is a vital source of positive direction and energy that moves people to a higher level of purpose.

Creating balances Environments

  • Surviving culture change is a collective effort shared by everyone in the facility.
  • They must role model the behaviors that they expect.
  • Leaders can also provide individual coaching and mentoring as needs are identified on any aspect of wellness.
  • Positive results from culture change are more likely in healthy, balanced environments in which holistic wellness is practiced.

Continuous Learning

  • Is the transparent currency of personal change management
  • Learning is a key to surviving change.
  • Leaders and staff can benefit from making a personal commitment to acquire new knowledge, skills and competencies needed to work in the new long-term care paradigm.
  • Learning can be in several forms.
  • What are the lessons learned from our experience?

Managing the “In-Between” Times

  • This is the phase during which traditional mindsets and attendant behaviors related to long-term care culture have not been completely relinquished and new mindsets and behaviors have not been adopted.
  • From the internal perspective, strategy, staff, skills, structure, systems, and procedures may be incongruent with a social model of care.
  • Regulations and a survey process that mirror the traditional institutional model of long-term care create external misalignment.

Managing internal Misalignment

Staff misalignment can impede progress towards the new culture and create unrest in the facility. Options:

  • What is in it for them?
  • Involvement early in the change process helps ensure a higher level of commitment.
  • Education and training are essential for supporting staff and helping them to gain confidence needed to meet new expectations.
  • Periodic performance feedback along with adequate mentoring and coaching helps staff to adjust to different roles.
  • Teambuilding further aids staff with the adjustment to new relationships in a more interdisciplinary, cross-functional care delivery structure.

Managing external Misalingnment

  • The board of directors play a key role in facilities that are transforming their cultures.
  • Senior leaders enhance relationship with effective communication and education.
  • Issues are regulations and the survey process.

Pacing Change

  • The “in-between” times can be paradoxically fast and slow.
  • Fast times because so much must be accomplished in a short timeframe.
  • Leaders and staff often struggle with adapting to the internal demands of transitioning to a new environment while simultaneously keeping up with the external changes that impact facilities.
  • These can be slow times when the different components of the facility and staff do not move quickly enough to adopt the new way.
  • Facility cultures do not change overnight.

Closing Reflections
Surviving culture change is a multifaceted process. It requires the discipline of self-management. The keys to managing self are positive thinking, practicing self-responsibility, being purposeful, communicating effectively, building positive relationships, living a balanced life, and demonstrating personal integrity. A continuous process of inquiry, reflection, and learning are tools for ongoing resilience and focus. The obstacles faced are teachers and lessons for how to move forward. Remaining focused in unsteady times requires being centered and grounded as the Tao of Leadership described. Personal and professional alignment are ingredients of integrity and authenticity. Perseverance, passion, and energy are needed to make a difference in the field. This is meaningful because contributing to the transformation of long-term care provides a vital service to the frail elderly, families, and the community.

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