Be Willing To Collaborate

Before presenting the strategies, it is important to identify the attributes required to successfully usher an organization through change. Because it is important for leaders to invite and integrate the insights of multiple stakeholders, collaboration is key in charting the course.

Yet, this can be very difficult for many. Keith Knapp, PhD, chief executive officer of a long term and post-acute care company, sums it up very well when he says, “The key element in culture change is getting people who are accustomed to being at the helm to get over it, to get over being in charge.”

His company uses a novel approach to help leaders become more humble. Administrators and senior managers have to serve as certified nurse assistants (CNAs). They have to actually go through the CNA training. And during CNA Appreciation Week, executives, including the chief executive officer, switched roles with the assistants for a shift.

Knapp says this honored the assistants, provided comic relief, and humbled many executives. It also allowed executives to experience life from another perspective. It reminded them of what it is humanly possible to accomplish when it comes to providing quality care.

They now know it is about far more than mandated staffing ratios. Knapp says the experience gave decision makers valuable information for resource allocation during the budgeting process.

Persuasion, Accountability

The second attribute of a good leader is the ability to inspire people to want to change their behavior and their thoughts. Leaders able to convince and persuade others have a significant advantage when working to transform their organizations. They can build a critical mass of like-minded innovators much more quickly than less compelling leaders.

This inspiration happens through deeds, not rhetoric or elegant calls to action.

The third attribute is what Michael Mankins and Richard Steele describe as “the ability to demonstrate ethics, integrity, and compliance.” In an era where playing fast and loose with rules has become the norm, employees easily become disheartened when they discover that their leaders have questionable ethical standards.

In order to be credible as a change leader, it is important to uphold the highest standards. This means taking the high road even when it is difficult. Compliance is of critical importance in a profession such as long term care.

The fourth and final attribute also comes from the work of Mankins and Steele. They suggest that leaders must be able to innovate resourcefully. 

Few companies have limitless resources so it is vital that the scarce assets available be used with care. Note that a scarcity of resources does not have to translate into a scarcity of innovations. Creative executives can work within the confines presented to develop advancements.

Sustainable Change

An excellent starting point for creating sustainable change includes building realistic plans with realistic expectations.

Reality-based planning begins with the analysis of available resources—financial, human, and technological—and then devises strategies based on what is accessible.

This reduces frustration because everyone involved in the change initiative is clear on what they have to work with. They can also begin a quest for identifying additional resources, such as tapping into networks of vendors, professional associations, and academics to help garner additional resources.

The next strategy is to utilize a comprehensive approach to change. A string of disconnected, one-shot improvements that are not linked to larger initiatives do not produce lasting change at the core of the organization.

Tie Changes To Results

A comprehensive change initiative is one that clearly reflects the organization’s strategy, mission, and core values. It involves a well-developed multi-year, multi-level approach to altering services, systems, and structures. It also includes methods for measuring success and for recalibrating as needed.

Knapp says that measurement is critical. He contends that people are caught up in describing activities but have not connected the dots in terms of key metrics like retention, employee engagement, and resident and family satisfaction. Any change effort should positively impact these important measures. According to Knapp, the follow through and fortitude to circle back and track whether it sticks or whether there has been backsliding is often a missing link.

Additionally, the best comprehensive approaches involve multiple stakeholders. Their insights are blended and thoroughly integrated into the entire change effort. The involvement of stakeholders is an important consideration when launching large-scale change initiatives such as the culture changes currently touted in long term care. It is essential that stakeholders’ voices be heard. The change must have meaning to multiple constituencies if it is to be widely adopted.

It is tempting to allow a visionary with a forceful personality to lead the charge. But if that visionary lacks the capacity to connect with the people on the receiving end of the change and the people responsible for day-to-day execution, the change will be short lived.

Grow Your Leaders

Building leaders at all levels is an essential strategy in creating sustainability in any change initiative. Tampa-based Opis Management Resources operates 10 skilled nursing facilities and one assisted living center throughout the state of Florida. They have built multiple levels of leadership by launching a multi-year Managing in the Middle program to build the competence of middle managers and supervisors. The customized sessions were designed to reinforce the corporate mission, establish sound management principles, and create a service-oriented culture characterized by coaching.

Recognizing the continuing need to build leadership, the company utilizes Leadership Learning Circles to build the strengths of the executive team. Each executive participates in in-depth learning of the principles required to advance the corporate culture.

Discern And Pursue

The final strategy for developing real culture change is exercising discernment. While it is tempting to follow every trend that emerges in the profession, the most successful organizations determine what is best for them. By having a keen understanding of the organization’s strengths, weaknesses, and peculiarities, leaders are able to divine which innovations are really suitable for their company. Resist the temptation to adopt a flavor-of-the-month approach to culture change.
Joanne Smikle
Discern which approach is best for the situation and then faithfully pursue that course. Better still, draw on the innovators within the organization and craft ingenious approaches. If the strategies are developed from within, they are more likely to take root and blossom.

Joanne L. Smikle provides insightful consulting and leadership education to long term care companies across the country. Visit or reach her at or (301) 596-3140.