MMHA 6501 Week 3 Organizational Culture Diagnosis Example

Finished Tasks or Known Residents? A Three-Level Culture Diagnosis of Maple Terrace's Long-Stay Unit

Student Name

Walden University

MMHA 6501: Leadership Within the Healthcare Sector

Instructor Name

Month Day, Year

Finished Tasks or Known Residents? A Three-Level Culture Diagnosis of Maple Terrace's Long-Stay Unit

Introduction

This paper diagnoses the culture of the second-floor long-stay unit at Maple Terrace Health and Rehabilitation, an invented 120-bed skilled nursing facility, using the three-layer model Schein and Schein (2017) describe, which moves from what can be seen, to what the organization says it believes, to what its members take for granted. The diagnosis draws on what an observer would see over several shifts, on the facility's written mission and orientation materials, and on inferences about what staff must believe for the observed practices to make sense. It ends with a one-page memo recommending a first leadership move. The unit's residents are long-stay, most living with dementia or several chronic conditions, and the unit is staffed by CNAs, licensed practical nurses and a registered nurse unit manager.

Level 1: Artifacts

Several features of the unit are visible to anyone who spends a shift there. The task board at the nurses' station is organized by room number: each CNA's assignment lists rooms, and each room lists tasks such as bath, weights, turn every two hours and meals. Report between shifts happens at the station counter, away from residents' rooms, and residents are referred to mostly by room number, as in "412 refused breakfast again." Bath schedules are posted by day of the week, with each resident assigned two bath days regardless of preference. Meals are served on a fixed schedule from a cart, and residents who are asleep at the time are either woken or given a tray later. Staff take breaks in a room off the unit, and the unit is quiet in the early afternoon, when most tasks are done. Assignments rotate weekly, so residents often see different CNAs from one week to the next.

None of these features explains itself. A task board by room number could reflect efficiency, a staffing shortage or simply habit. The next two levels are needed to understand what these artifacts mean.

Level 2: Espoused Beliefs and Values

Maple Terrace's mission statement, printed in the lobby and in the employee handbook, reads: "We honor each resident's life story and preferences, creating a home where every person is known." New-employee orientation includes a module on person-centered care, which teaches staff to learn residents' routines, call them by preferred names and offer choices about bathing, meals and daily activities. The facility's marketing materials describe "care built around you." These are the values the organization says it holds. Staff, when asked, readily repeat them, and several CNAs described long relationships with particular residents whom they clearly know well.

Level 3: Basic Underlying Assumptions

For the artifacts to make sense, staff and supervisors must share an assumption that differs from the espoused values: that a shift is judged by whether tasks are finished on time. The task board, room-number report, fixed bath days and meal schedule all serve that assumption. A CNA who finishes every bath, turn and weight by two o'clock has had a good shift, regardless of whether any resident was offered a choice. Rotating assignments reinforce the assumption, since a CNA who changes halls weekly cannot know residents' preferences well and must rely on the task list instead.

A second assumption follows: that residents are recipients of care rather than participants in it. Referring to residents by room number is not disrespect by individuals, most of whom care deeply about the people they serve; it is the natural language of a system organized around rooms and tasks. Schein and Schein (2017) note that assumptions are rarely stated and are often defended because questioning them feels like questioning competence. A CNA asked why baths are on fixed days is likely to answer that otherwise they would never get done, which is itself evidence of the assumption.

The Gap Between Values and Assumptions

The gap is between an espoused value that every resident is known and an underlying assumption that the shift is measured by completed tasks. The two can coexist in individual CNAs, who know their favorite residents well while working a task list for everyone else, but the unit's structures reward the assumption. When the two conflict, for example when a resident wants a bath at night, the task schedule wins. This is not hypocrisy, and leadership texts caution against reading it that way, since culture gaps usually reflect what systems reward rather than what individuals intend (Northouse, 2021). It reflects the reality that the unit is staffed and scheduled for task completion, and that no one is evaluated on whether residents' preferences were honored. Research on consistent assignment, in which CNAs care for the same residents across shifts, has found it associated with better quality measures in nursing homes (Castle, 2011), which suggests that structures, not exhortation, are where change begins.

Memo: A First Leadership Move

To: Administrator. From: Administrator in Training. Re: A first move on the long-stay unit's culture.

The long-stay unit's mission language and its daily routines point in different directions. Training and reminders about person-centered care will not close the gap, because the unit's structures reward finishing tasks on time. I recommend a first move that changes one structure and invites staff to see the result. Ask the unit manager and two respected CNAs, one from day and one from evening shift, to pilot bath preferences on one hall for six weeks: each resident, or a family member for residents who cannot say, is asked when and how they prefer to bathe, and the hall's schedule is rebuilt around the answers. The pilot should be judged by the CNAs themselves, at a meeting where they report what changed for residents and for their own workload. If it works, they will be the ones to explain it to the rest of the unit.

This move is small, reversible and visible. It tests the underlying assumption directly, since a schedule built around preferences challenges the idea that the shift is measured by tasks completed on fixed days. It also puts the change in the hands of staff who will have to sustain it. Leaders shape culture most by what they pay attention to and reward (Schein & Schein, 2017), so the administrator's role is to attend the pilot's review meeting and ask what residents noticed, not how many baths were completed.

References

Castle, N. G. (2011). The influence of consistent assignment on nursing home deficiency citations. The Gerontologist, 51(6), 750-760. https://doi.org/10.1093/geront/gnr068

Northouse, P. G. (2021). Leadership: Theory and practice (9th ed.). Sage.

Schein, E. H., & Schein, P. A. (2017). Organizational culture and leadership (5th ed.). Wiley.