Customized learning, culture change

If your company only educates to fulfill mandatory licensure requirements, you are missing potential opportunities to grow staff which can dramatically impact the perceptions of long-term care and deliver on the promises of culture change. It is more than just paying lip-service to person-centered care (PCC). Culture change requires all staff to have a deep awareness and keen understanding of what PCC really means.

Raising the bar and developing that type of talent requires a different approach to staff education and organizational learning overall. Moving to a comprehensive approach requires realigning resources so that they are consistent with the organization’s mission and vision.

First, comprehensive development encompasses the entire organization—from senior managers to the frontline employee. This is more than creating snappy propaganda about culture change. Every employee must have the competencies required to create sustainable change throughout the enterprise.

Second, becoming a learning organization is essential to culture change. Simply checking the boxes on mandated training is not enough. The focus must be on creating a culture that values professional development. Those are the hallmarks of learning organizations and integral to culture change.

The third assumption is that the organization creates alignment between its core values and the tenets of the culture change it wishes to adopt.


Culture change is more than spa baths, breakfast bars, bathing on demand and huge capital improvements to facilities. Real change begins in the minds and hearts of LTC professionals. It is about putting the person first in person-centered care. The corporate mission must revolve around the facility’s residents—the top of the priorities pyramid. While the margin is critical to corporate survival, it cannot be the most compelling performance driver. According to Jeb King, director of Learning and Organizational Development for Maryland-based Encore Healthcare, LLC, “A company that succeeds in altering its culture will have well-articulated values.” Begin the process of inculcating employees with those values at orientation. Continue the process through discussions, training and structured education throughout an employee’s tenure.

As we consider what person-centered care really means, those who deliver care must become more important in the equation. The organization’s mission, vision and core values must emphasize an environment that is as affirming for care recipients as it is for care providers. This shift cannot just be in words. It must be in thought and deed as well. Dissatisfied caregivers have little chance of fulfilling the mandates of a mission that revolves around higher levels of care and concern for residents.

Understanding culture change requires an understanding of the fundamentals of sustainable change. It is not as simple as modernizing an old, tired building. Instead, it is about teaching the people in the building new ways of approaching the business of long-term care. Invite all employees to become actively engaged in devising new approaches to all aspects of care. The most effective innovations are simple and focused. They do not all originate at the management level; they can be spawned anywhere in the organization.

The real LTC culture change creates a collaborative internal culture that fosters high levels of employee engagement, creativity and collaboration as well as external collaboration with regulators, families and other stakeholders. This type of transformation gets to the nucleus of how long-term care operates. It requires a different set of competencies at the most senior leadership levels. These leaders must become innovators, meaning that they feel a personal responsibility not just for spawning new ideas, but for encouraging that same behavior from others.

These leaders grasp the importance of ongoing professional development for every employee. They do not use staff development simply as a tool for delivering mandated licensure courses.


A comprehensive approach to staff development is inherently linked to organizational development. It addresses how the company will meet the mandates of its mission through its human capital. The process begins with defining the strategic intent of culture change in the organization. Begin by determining where the organization wants to be. This enables the company to begin with the end in mind. If it is on a transformative path, begin defining what the transformation is going to look like and how that will translate into mission, vision and values. Goals, objectives and a clear statement of strategic intent are formulated at this initial stage.

Next, thoroughly analyze the organization’s long- and short-term developmental needs in light of its transformational goals and objectives. This needs assessment must include qualitative data gathering (focus groups, interviews and other structured discussion groups), as well as a quantitative method (survey). The analysis must measure needs of each category of employees, from managers to direct care staff to ancillary services to senior executives.

Once the needs are clearly defined, begin strategic planning to meet those needs. Create Individual Development Plans (IDPs) for each job category. These customized developmental maps reflect the competencies required to transform the company. They detail the education, training and developmental experiences required to correctly position each job category for success in the organization as it evolves.

IDPs provide a multiyear map for each position. For instance, a CNA’s map will include mandatory clinical education to maintain licensure. If the organization is committed to raising its profile on service, the IDP for the CNA employee category will include customized courses in customer service, stress management and effective communication.

Let’s assume that the organization is committed to growing the bench strength of mid-level managers. The IDP for managers and supervisors will include experiential training in coaching, conflict management and change leadership. IDPs provide a framework for planning, implementing and evaluating comprehensive employee development activities.

Beyond IDPs, an organization needs to develop a series of customized, connected, collective learning experiences designed to clarify, reinforce and build commitment to the strategic goals of the culture change. These learning experiences should allow for discussion, questions and free-flowing communication about the direction of the culture change.


Technology plays an important role in sustaining culture change. While it does not replace interactive, face-to-face learning, technology is an important component of a comprehensive approach to organizational learning—e-learning is meant to complement in-person, interactive education.

Webinars, podcasts and other e-learning vehicles can reinforce the strategic objectives of culture change. Like every other element of a transformational initiative, these tools must be highly customized. All instruction, whether face to face or through an electronic medium, must clearly reflect and reinforce the strategic aims of the initiative. A well-crafted, comprehensive approach integrates multiple modalities to expand competencies throughout the entire LTC organization.


All staff development must have an element of continuous quality improvement, which means ongoing monitoring of the results of learning. Measures have to be implemented to gauge how well people are transferring principles into their workplaces. If it appears that employees are not developing mastery, it is back to the drawing board. Different approaches to learning have to be designed or mixed delivery methods used to help employees master the skills required not only to change the culture, but also to demonstrate excellence in care delivery. Other measures of staff development effectiveness include retention statistics. Education is a tool that can forge lasting bonds between employee and employer.

Considering the complexities of this inclusive approach, the staff developer must have different competencies than we typically see. An approach such as this requires more than cursory knowledge of organizational change models, adult learning theory, leadership development and even instructional systems design. According to King, staff developers must dramatically enhance their clinical competencies with the aforementioned skills to implement culture change. They must have a keen interest in learning, beginning with their own. They must have strategic, interpersonal, technical and organizational development skills.

Don’t rely solely on clinical competencies. Staff development practitioners must be able to convey the what, why and how of culture change through comprehensive learning anchored in the organization’s unique mission. It is essential that staff development practitioners raise the bar on their own competence by advancing their education so that they can better serve the profession.


Culture change is more than a savvy public relations campaign to improve the image of the profession. It is the deliberate effort to enhance every aspect of long-term care. That objective can best be met when staff development goes far beyond clinical education. Adopt a comprehensive approach that includes every job category in the LTC arena. This comprehensive approach challenges the organization not only to rethink the staff development function, but to move it to a more prominent position in the organization.

Transforming this profession requires a clear appreciation of the complexities of change. It is a process, not an event. It emerges in developmental stages, each stage more difficult than the preceding. Most important, change that lasts starts with people first; that is the people receiving the care and each person charged with any element of delivering care. Staff development has tremendous prospects for changing the landscape of long-term care. Using a deliberate, strategic approach will yield lasting results. 

Joanne L. Smikle provides consulting and leadership education to LTC companies across the country with special emphasis on leadership development, collaboration and customer satisfaction. She can be reached at (301) 596-3140 or visit

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