BUILDING A THEORETICAL FOUNDATION FOR COMMUNICATIVELY-DRIVEN CULTURE CHANGE IN LONG-TERM CARE
Bibliographic record
Abstract
The culture change movement is an international effort to transform inhumane health care institutions into person- and relationship-centered homes and communities. Recent decades have seen a proliferation of approaches, ranging from implementation of expert-developed models to grassroots community organizing. However, theories to guide specific approaches remain underdeveloped. This session addresses this theoretical gap by elucidating key differences between communicatively-driven and expert-driven approaches, offering clear and compelling support for the former. Schlegel Villages, a long-term care organization with 12 communities in Ontario, Canada, embarked on organization-wide culture change guided by critical participatory action research (CPAR) based on Habermas’ theory of communicative action and Foucault’s power/knowledge theme. The research component of this initiative spanned 4 ½ years. Among other CPAR activities designed to engage all Village members, the research concluded with a series of critical reflections including active interviews with 29 members of the CPAR team. Using the requirements of communicative action as a framework for analysis of these interviews, findings demonstrate the relevance of these requirements for culture change, including: 1) generality: inclusion of all affected parties in discussion and action; 2) autonomy: assurance of equal possibility to present and critique ideas; 3) ideal role-taking: willingness and ability to empathize with another’s perspective; 4) power neutrality: protection against power differences in decision making; and 5) transparence: full disclosure of intentions and suspension of individual agendas. This session provides a theoretical foundation and highlights how a group of people, committed to collaborative reflection and action, can co-create effective and sustainable culture change.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.013 | 0.074 |
| Scholarly communication | 0.013 | 0.014 |
| Open science | 0.004 | 0.011 |
| Research integrity | 0.005 | 0.006 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".