Negotiation of person-centred values and change perception within organisational culture: a case in Dutch elderly care
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This qualitative study explores how organisational members perceive person-centred change in an elder care home in the Netherlands and negotiate about the change related values in the change process. Fifteen in-depth interviews are conducted through all organisational levels and at its three unique locations to shed light on the relationship between organisational change and organisational culture. This study shows how values that prioritise “the person behind the patient” interact with a variety of values from different organisational cultures, and how these values are embedded within societal values. This study draws on the theoretical model of Williams (1980), which notes that dominant culture is defined by daily negotiations between residual, dominant and emergent cultures. That perspective respectively holds past, present and potential future values. This study emphasises that dominant values serve as a lens through which emergent values are evaluated, and therefore affect how change based on emergent values is perceived. Traditional health care values that are disease- and task-centred, which are still present in dominant organisational culture, offer challenges. It is found that through the process called selective tradition, person-centred values that conflicted dominant values got excluded or diluted. Other conflicting values related to organisational culture, like giving centre-stage to collegial relations or following protocols, enforced this. When (diluted) person-centred values were espoused, this could also challenge person-centred culture, because change was perceived not necessary. Findings also indicate the importance of leadership, and how societal embeddedness of the values influence the change process. The study contributes to the discussion of person-centred culture change, by highlighting the complex, multi-layered and embedded nature of value negotiation during organisational change. From a practical perspective, the study highlights case-specific challenges for person-centred culture change and the importance of the consideration of various sets of values that are at the root of these challenges.