This paper presents an organizational behavior case study analyzing how a residential care facility overcame serious operational challenges including high staff turnover, poor quality of care, low occupancy, and widespread absenteeism. After a company-wide culture survey revealed deeply negative results at this one facility, management hired a new manager with a background in health and community management rather than nursing administration. The paper examines the cultural problems identified, the leadership and change management strategies employed — including participative management, open communication, and the Supportive model of organizational behavior — and the measurable improvements achieved in employee satisfaction, attendance, occupancy rates, and quality of care within months of the new manager's appointment.
Residential care facility staff play an important role in the daily lives of residents. Unfortunately, these facilities are often faced with organizational obstacles and a lack of information that prevents staff from providing proper care (Smith, 1998). This organizational behavior case study examines a residential care facility that is part of a parent company operating six different residential care facilities. Management observed that this particular facility was facing serious problems: turnover rate was high, performance was poor, and economic losses were significant.
To diagnose and address these problems, the parent company conducted a culture survey across all of its residential care facilities in which every member was required to participate. The results were satisfactory for all facilities except this one, which produced entirely negative results. In response to this serious situation, management hired a new manager in April 2012 — the third new hire in that same year. This time, however, management did not seek someone with a nursing or residential management background. Instead, they hired a person with a pure management background in health and community services. This new manager was assigned the responsibility of bringing about a positive change in the facility's culture and improving its performance and economic condition.
The new manager set out to identify the cultural problems within the facility. She observed that the environment was far from friendly, and that staff members, leaders, residents, and their family members were all experiencing significant difficulties. The following cultural problems were identified:
Employee Satisfaction Level: Employees were highly dissatisfied, had numerous complaints, and were working with very low morale.
High Turnover: The turnover rate was very high at all levels of the facility, including nurses, team leaders, senior staff, and management.
Low Quality of Care: The continuous changing of staff members, team leaders, and managers had badly affected the quality of clinical care. Staff often did not know what type or stage of clinical care was required for individual residents.
Absenteeism and Frequent Sick Leaves: Absenteeism was very high and taking sick leave was extremely common. Surprisingly, staff did not take responsibility for calling in to inform management of their absence. Agency staff was heavily relied upon, but there was no proper system for brokering staff, so other organizations had to be approached to fill gaps.
Community: A pastoral service was available for staff, families, and residents but was used only by residents on a referral basis.
Lack of Reporting and Monitoring: There was no proper monitoring system for overseeing contractors such as podiatrists, pathologists, and dieticians. Moreover, unlike at other residential care facilities in the parent company, this facility had no culture of reporting facts — despite having a system in place to do so.
Irresponsible Attitude: No notes were made in residents' files regarding regular activities, meaning there was no recorded history of problems or clinical issues for which residents had been treated.
Low Occupancy: Due to poor performance, unhygienic conditions, irresponsible staff, and a lack of quality care, the facility suffered from low occupancy, with approximately 10% of beds remaining vacant.
Confronted with these wide-ranging problems and the facility's deteriorated condition, the new manager decided to implement an appropriate change in the organization's culture. She recognized that staff members, team leaders, residents, and their family members all required proper attention and monitoring. She developed new strategies and worked to transform the culture of the facility so that employee behavior could be improved.
To accomplish this, she adopted a participative style of change management and formulated a new management approach for the facility. Literature supports the use of participative management as a means of bringing about successful change (Nakata and Saylor, 1994). According to Atchison (1998), staff structures at residential care facilities are typically hierarchical, which can prevent staff from providing quality care to residents. Therefore, the first and most important step taken by the new manager was the removal of restrictions and barriers that had prevented staff, team leaders, residents, and others from approaching management.
Unlike the previous situation — in which managers were unapproachable and complaints were directed to the Department of Health and Ageing (DHA) — she invited everyone to communicate openly with her and share their concerns, problems, and issues. To foster positive and frank relationships among the people of the facility, she introduced family and staff fun days. These events gave staff, residents, and family members the opportunity to meet and interact informally. Participants not only developed good relationships but also began to feel a genuine sense of community.
She also replaced the traditional laissez-faire leadership style — under which previous managers had given staff near-complete freedom in running the facility — with a structured system of accountability, ensuring that all staff and employees performed their duties responsibly. She recognized that a delegative leadership approach is not appropriate in a residential care environment, as it consistently results in low productivity and poor performance that cannot be tolerated in healthcare settings.
Robbins (1986) argued that in order to bring about change in an organization, management should promote a new culture and encourage staff to embrace those changes. Because the new manager was skilled in management and finance, and had no prior affiliations with anyone at the facility, she was able to implement positive change effectively. Through consulting, communicating, and sharing, she successfully managed different sectors of the facility — from health services to fundraising. Her management and leadership style produced the following changes in organizational culture:
Employee Satisfaction Level: Reports showed that the number of employee complaints decreased dramatically over time, and staff reported feeling satisfied working at the facility. A noticeable improvement was observed in their attitudes towards their work.
Attendance: A significant improvement was seen in employee attendance. Sick leave reduced by 52%, agency staff usage decreased by 50%, and employees began taking responsibility for acknowledging and reporting their availability.
"Measurable improvements in staff and facility performance"
"Staff survey and motivational strategies implemented"
"Training programs, communication reforms, and policy changes"
Robbins, S. R. (1986). Organizational behavior: Concepts, controversies, and applications (3rd ed.). New Jersey: Prentice Hall.
Smith, D. (1998). The culture of long-term care: Impact on a continence care program. Urologic Nursing, 18(4), 291–295.
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