Care Settings

Culture Change Journey

For care settings that want to use their outside spaces more actively and meaningfully, a key priority must be to take a deeper look at the subtle and often subconscious processes, attitudes, habits and beliefs that make up their setting’s particular care ‘culture’. Not only could these be holding the care team back from engaging their residents more actively with their outside spaces, but it is through an honest review of care culture practices that they can also gauge how person-centred they are and what they may need to address in order to move forward on their own particular culture change journey to more advanced care practices.

Addressing care culture and embarking on a culture change journey is not a ‘quick-fix’ process. It requires dedication, courage and determination on the part of everyone in the care setting but the rewards are manifold, for both staff and residents. Becoming more person-centred and relationship-centred in care practices results in greater engagement with the outside space naturally, according to our findings, and determines the different ways you may wish to engage the services of a designer too.

For care settings that are positioned in the lower part of the care culture spectrum on the Care Culture Map, it’s really important to avoid the trap of believing that a brand new garden will transform the home’s culture overnight by resulting in more active engagement with the outdoors. Our findings strongly indicate that if the care setting hasn’t been using what they already have outdoors, before the designer has become involved, then it’s unlikely that the new garden will overcome these established and ingrained normative practices, after the novelty value of the new space has worn off.

The care setting has not fully grasped that an understanding of its current attitudes, and practices, with regards to using the outside space has to be in place before the design process starts, and the garden can then be appropriately improved in order to facilitate more active use of the garden for the current resident mix.

Care settings performing at the top of the care culture spectrum appeared to us to have no more money, time or staff than other homes in our study and yet they still managed to create seamless and spontaneous engagement for the residents between the indoors and outdoors. The difference between these higher-performing homes and others in our research study was quite simple: they had worked out that they could not afford not to do this.

It did not require more money, time or staff to open the doors and help residents to cross the threshold for these care settings. It needed a change in culture: focusing on the needs of the individual resident, and replacing fear, from lack of knowledge, with confidence that they knew what their residents wanted to do and were determined to ensure they could fulfil those wishes, in a ‘safely imaginative’ way with them.   

There are many reasons for a care setting to commit to culture change and to become more person-centred in care practices (not least because the CQC demands it). The dividend of practising at this higher level appears to us to result in happier residents who are more fulfilled and contented in their lives, naturally engaging with the outdoors, as and when they wish to, in an enabling and loving care environment.