Working Together to Put Living First: A Culture Change Process in a Long-Term Care and Retirement Living Organization Guided by Critical Participatory Action Research
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My research begins with the premise that the dilemmas of long-term care homes are rooted in the dilemmas of modernity. Habermas (1984; 1987) contends that modern societies are comprised of two basic spheres of social life – the lifeworld and the system. The communicatively-produced lifeworld represents the social interactions of individuals and groups in everyday life. The system, by contrast, is the realm of formal, functional and instrumental rationality. According to Habermas, certain social pathologies result when the structures and patterns of the system encroach upon, displace and even destroy the social life of the lifeworld. I argue the lifeworlds of long-term care homes have become colonized by bureaucratic, disciplinary and scientific discourses – products of the system – that both control and exclude the experiences and forms of knowledge held by those who live and work on the front lines of struggle. Today, it is widely agreed that deep changes are desperately needed to help long-term care homes progress from dehumanizing, institutional approaches to care and services toward approaches that are more humane and life-affirming. This evolution is known as the ‘culture change movement’. Some proponents of culture change say that long-term care is a broken system, but I argue the chief problem is that long-term care is treated as a system and that systems-thinking and instrumental rationalities have invaded the lifeworld of long-term care like a parasite. Increasingly, we have applied systems-thinking to places of everyday living where people are often treated as either inanimate objects or robots, which must follow predetermined schedules, routines and practices. The task of healing and renewing the lifeworld of long-term care calls for a turn away from the system and toward human action and discourse, where meaningful decisions are made by people, individually and collectively, within a real community. The decolonization of long-term care requires us to break free of the expert discourses that structure and perpetuate it, and to seek, instead, alternative sources of knowledge, those which have been excluded or subordinated. Culture change calls for a revitalization of the public sphere (Kemmis & McTaggart, 2005); that is, a returning of inclusive networks of communication among actual participants who share their life experiences as they work together toward a better tomorrow. My dissertation describes one long-term care and retirement living organization’s journey to decolonize its culture of service delivery, moving from an institutional model of care to approaches that are more relational and life-affirming. This culture change, guided by critical participatory action research (CPAR) (Kemmis & McTaggart, 1988; 2005), engaged residents, family members and team member as my research partners. Our research is about the personal and organizational transformations experienced as Schlegel Villages, a long-term care and retirement living organization located in southern Ontario, embarked upon a culture change process guided by CPAR within its 12 communities. The purpose of my research is to partner with members of Schlegel Villages in the collaborative planning, facilitation, documentation, and critique of a culture change process guided by CPAR. Describing our journey, which spanned 4 ½ years, my dissertation is divided into four parts: Part I: Setting the Stage; Part II: Reconnaissance; Part III: Continued CPAR; and Part IV: Critical Reflections. Part I builds a bridge from my theoretical perspective to my methodology and substantive area of research, illuminating connections between critical social theory, CPAR and culture change in long-term care. I also introduce my research partners from Schlegel Villages and share the story (based on my interpretation) of how I initially partnered with a small group of senior leaders within the organization to explore the possibilities of embarking on a collaborative culture change journey. In Part II, I describe two initial CPAR cycles of critical self-reflection. First, I weave my narrative as a long-term care professional with the culture change literature as I conduct a reconnaissance into my researcher-self (Cycle 1, 2009). Then, I describe Schlegel Villages’ collaborative reconnaissance (Cycle 2, 2009), conducted at an employee retreat in which 140 team members engaged in collaborative learning, discussion, consciousness-raising, and critique regarding the realities of the organizational culture at that time. With the strong support garnered through this reconnaissance, I describe how my partners and I decided to adopt a strengths-based action research methodology and organizational development strategy known as Appreciative Inquiry (AI) (Cooperrider & Whitney, & Stavros, 2008) to guide us in developing shared aspirations for the future. Following this reconnaissance, Part III describes our continued CPAR process. Each chapter describes a CPAR cycle representing approximately one year of Schlegel Villages’ culture change journey, from Cycle 3 in 2010 to Cycle 6 in 2013. In each cycle, as my partners and I worked to strengthen Schlegel Villages’ collective communicative power, the Villages worked to promote a set of eight aspirations. While reflection played an important role in each CPAR cycle, in Part IV, I offer a series of summative critical reflections on our journey, ranging from practical to methodological to theoretical. First, I describe our final CPAR cycle (Cycle 7, 2014); a cycle of collaborative reflection and critique regarding the process and impacts of Schlegel Villages’ culture change journey, which concluded at a Research Reflection Retreat. At this retreat, my partners and I drew upon our own experiences as well as data from in-depth, individual interviews and other sources. Overall, we concluded that through our CPAR culture change process, we opened a space for communicative action, strengthened Schlegel Villages’ collective communicative capacity, made strides in achieving our shared aspirations, and contributed to broader social action by sharing our culture change stories and engaging with people beyond Schlegel Villages. Part IV continues with two final chapters of a more theoretical nature in which I share my researcher-reflections on the overall CPAR process alongside those of my partners in a multi-vocal style aimed at the continued democratization of the research endeavor. First, using the processual requirements of Habermas’ communicative action as a framework (i.e., discourse ethics), I offer reflections on culture change guided by CPAR from a practical perspective by exploring key differences between communicatively-driven and expert-driven culture change, while offering clear and compelling support for the former. Secondly, I offer critical reflections on a culture change process guided by CPAR from a methodological and theoretical perspective, concluding that CPAR is indeed a powerful strategy for the aims of culture change. However, I describe how CPAR could be strengthened through a few post-structural modifications based on Foucault’s (1995; 2000) power/knowledge theme. Reflecting on Schlegel Villages’ CPAR culture change discourse, I describe how organizations can better harness the positive and productive features of power to co-produce new knowledge, which in turn produces even greater power and promotes the greatest prospect for change and transformation.