Organizational & environmental complexity: Evaluating positive deviance in long-term care

This research was conducted to gain a better understanding of discrete consumer-driven "culture change" care strategies to facilitate a broader range of adoption within the LTC industry. This is the first study to engage a broad LTC stakeholder group (including residents, staff, family members and national experts) in evaluating, manipulating and prioritizing individual strategies for culture change within four complex cultural domains, including: 1) foundation, 2) organization, 3) environment and 4) operations.;This study began by conducting a qualitative analysis of the findings from the 2010 Stakeholder Survey: Culture Change and the Household Model Delphi survey. Previously vetted strategies for culture change were further refined by interpreting strategies as complex positive deviance (intentionally and honorably deviating from the norm) in long-term care resulting in 96 items for evaluation. Mixed-method research was carried out in 5 long-term care provider settings that were peer nominated, and subsequently qualified, as "household model exemplars" successfully advancing the most innovative culture change strategies. These organizations' internal stakeholders (staff, residents, and resident's family members) were engaged in reflecting upon and evaluating the positively deviant strategies prioritized by a multi-disciplinary expert CC in LTC panel. A post-occupancy evaluation was also carried out within each of the LTC. communities to appraise variations for engaging in PD strategies.;Research outcomes relate to the overall prioritization of PD strategies as well as the exploration of divergence for PD strategy prioritization based on the role of the stakeholder and/or LTC provider's contextual variations. The conceptual model and construct definition for positive cultural deviation that guided the study were also critically evaluated.;Different stakeholder groups demonstrated between-group variations for prioritizing PD strategies in LTC. Experts demonstrated a more liberal support for PD strategies while residents tended to be most conservative. Several noteworthy trend reversals were revealed. Further, several instances demonstrated stakeholder mean rating variations based upon LTC provider's contextual variations for employing the PD strategies.