Changing ‘the way we do things around here’: improving organisational culture for staff and residents in residential aged care.

Introduction: Over the past decade, Australia’s aged care sector has encountered challenges related to an aging population with a high burden of disease, workforce retention, numerous public inquiries into care quality and safety, and the COVID-19 pandemic further exacerbating staff exhaustion and burnout. International research suggests a positive organisational culture may be protective against staff burnout; having a good culture is associated with higher quality care, and residents’ experiencing more positive care experiences and better health outcomes. In this presentation, we describe findings from our research program examining organisational culture in residential aged care facilities (RACFs), to understand the association of culture with contextual factors and workforce, safety and quality outcomes; and how organisational culture can be improved for the benefit of staff and residents.
Methods: We present findings from: an integrative review of 92 studies on organisational culture in RACFs; a policy analysis of the final report of the Royal Commission into Aged Care Quality and Safety; and our ongoing mixed method study in 62 RACFs. Our study includes a longitudinal organisational culture survey, ethnographic fieldwork, and an effectiveness-implementation evaluation of an intervention to address unprofessional staff behaviour and improve culture.
Results: Eleven studies in our review looked at culture in relation to staff outcomes (job satisfaction, organisational commitment) in RACFs. Studies (n=15) looking at clinical governance and care processes also found an association with the organisational culture of the RACF; however, among studies looking at the relationship between culture and clinical
outcomes (n=9), results were more equivocal. The empirical evidence for culture change interventions (n=5) was generally limited and of low quality. In our analysis of the Australia’s enquiry into the quality of care (the Royal Commission report), culture was frequently (n=42) highlighted as a problem in RACFs and aspirational qualities for culture were proposed (n=28). However little guidance was provided on how culture could be improved. We discuss how
these findings have informed the development of our organisational culture survey for aged care and present findings from its first round, including associations between cultural dimensions (e.g., teamwork, leadership, person-centred care), staff outcomes (burnout, intention to leave), quality indicators, and resident wellbeing. We also consider the existing
evidence base for the culture change program and results of the formative research into its implementation.
Conclusion: Despite recognition of the importance of organisational culture in aged care among policymakers and academics, our research highlights numerous gaps in understanding and improving culture. Our longitudinal research aims to address some of these limitations, so that we can better leverage positive organisational cultures, realising their impacts in a more engaged, stable workforce and higher wellbeing among residents.