Empowering Transformation: Revolutionizing Long-Term Care with Culture Change Leadership

Building Culture Leaders Project

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It's no secret that the landscape of long-term care has shifted dramatically in the last five years, since COVID-19 began its widespread havoc in the U.S. One of the hardest hit populations were long-term care communities, who are still struggling to regain a sense of normalcy post-pandemic. At the center of the staff shortages, low morale, and ever-changing leadership that includes less "staff" and more "agency," are the residents that call these communities home. As we struggle to recover, the push for culture-change in long-term care communities has intensified. The phrase "culture change" has been on the forefront for years but what does it really mean? As often as the term is used, depending on who you ask, you will get many different explanations for what "culture change" is the long-term care industry.

What does it look like? How is it achieved? Is it costly? Where do we start?

The answer to all of those questions can be answered many different ways. The basis of 'culture change' is that it is a movement toward person-centered care, where the resident’s values, wishes and practices are all considered in the delivery of care. There is a high value placed on individual choice, purposeful living, self-determination and respect.  

Mark Gogal, Building Culture Leaders

And at the heart of this change is culture change leadership.

Culture change leadership is about fundamentally shifting how long-term care organizations deliver services. It moves away from the traditional, clinical model to a more personalized, human-centered approach. This change is rooted in the belief that everyone deserves respect, dignity, and active participation in their care. The success of culture change heavily relies on leadership. Leaders should model core values, inspire staff, and actively involve residents and their families in the process. An empowered team can significantly enhance the quality of life for residents.

In early 2024, FutureCare NC, a part of the North Carolina Health Care Facilities Association, was awarded a CMP-funded grant to implement their Building Culture Leaders Program, a project aimed at engaging leaders from 40 North Carolina certified skilled nursing facilities over a three-year period.  The project, which began in August 2024, intends to provide leadership and culture building training for these leaders to help them grow into servant leaders and culture change champions who operate their facilities as person-centered homes. This project will help leaders learn how to put caring for others at the forefront of all decisions and processes and how to create environments where everyone can thrive.

The project, developed and implemented by NCHCFA's Mark Gogal and Eric Kivisto, focuses on building leadership through in-person training, individualized coaching, and onsite team building over a three-year period for the 40 participating nursing homes. During each project year, one member of the leadership team from each facility has the opportunity to participate in the in-person training and individualized coaching sessions. On-site team building is provided at each facility throughout the year for up to 25 staff members. The goal of this comprehensive program is to build positive, sustainable workplace cultures that focus on the well-being of residents and create positive environments where staff are able to do their jobs effectively. In years two and three, a different member of the leadership team from each of the 40 facilities is invited to participate in the same in-person training sessions and individualized coaching. This method of training challenges multiple members of the leadership team to view their staff and facilities from a different perspective, which allows them to refine their leadership skills based on things like team members' MBTI personality types, LEAN process training, and 'trust circles.'

I had the opportunity to attend one of the in-person sessions, held at the Koury Center in Greensboro, on May 8th. This group - Cohort 1 - is nearing the end of the project's first year. They have been participating since last August and have attended multiple in-person trainings, had individualized coaching sessions from Mark, and have had site visits to their facilities to have Mark work with their staff. The excitement of this group was palpable!

In the 4 hours that I was able to observe the feedback and interaction of project participants, I was able to walk away with a feeling of excitement. The first hour plus of the training was testimonials of the changes that are being implemented in these facilities. The ability for leaders to learn more about their staff through Myers-Briggs (MBTI) assessments and recognize their strengths, weaknesses and compatibility made a world of difference in their daily workflows, willingness to help one another, etc. Trust circles gave staff the opportunity to open up about things that were bothering them, offer solutions, accountability, setting boundaries, recognize their own flaws and being honest with one another. The LEAN process training was beneficial in helping these leaders to eliminate waste in their facilities and increase workflow and productivity. There was networking among facilities. Excitement. New ideas. Success stories. Renewed energy.

The team-building leadership approach has given these participants an opportunity to begin the culture-change transformations within their own communities begin with their staff. This where culture-change begins and it is a journey that doesn't end. It's a daily goal for continuous improvement, a willingness to always listen to your residents, families and team members, and being intentional in your actions.

"Those that want to intentionally develop, will develop" -Mark Gogal

Culture change will look different for every community, because every community has a different "culture." Deciding what it will look like for your long-term care community should be driven by your residents, families and staff. But in EVERY community, it begins with leadership.

A 2022 report found that facilities with active culture change programs experienced a 15% decrease in staff turnover. Transforming long-term care through culture change leadership is crucial for improving residents' quality of life. By centering care around individuals, engaging staff, nurturing connections, and prioritizing communication, facilities can create warm environments that embody dignity, respect, and compassion. With collective effort from everyone involved, long-term care communities can be vibrant places where individuals thrive.

Congratulations to the following long-term care communities, who have committed to participating in this three-year project. We are excited to see the changes that your culture-change journey will bring the individuals that call your community HOME!

Abernathy Laurels	Ashton Health & Rehab	Autumn Care of Fayetteville	Autumn Care of Statesville
Blumenthal Nursing & Rehab Center	Camelia Gardens Center for Nursing & Rehab	Cary Health & Rehab	Clapp's Nursing Center - Asheboro
Compass Healthcare and Rehab - Hawfields	Elizabeth City Health & Rehab	Fuquay-Varina Health & Rehab Center	Highland House Nursing Center
King Health & Rehab Center	Liberty Commons of Lee County	Liberty Commons of Johnston County	Linden Place Center for Nursing and Rehab
Lotus Village Center for Nursing & Rehab	Magnolia Gardens Center for Nursing & Rehab	Mill Creek Center for Nursing and Rehab	Monroe Rehabilitation
Oak Forest Health & Rehab Center	Pine Acres Center for Nursing & Rehab	Ridge Valley Center for Nursing & Rehab	Rose Manor Health & Rehab
Royal Park Health Center	Sanford Health & Rehab	Silver Bluff Village/Liberty Commons - Haywood County	Southwood Nursing & Retirement
The Lodge at Rocky Mount	The Oaks Health & Rehab	Treyburn Rehab Center	Trinity Elms
Trinity Place	Trinity Ridge	Trinity Village	Valley Hill Health & Rehab
White Oak of Burlington	Willow Creek Nursing & Rehab	Woodhaven Nursing & Alzheimer's Care	Yadkin Nursing Center