Turn, Turn, Turn: A Circular Model for Culture Change Education

The group circle has not been a particularly fashionable structure for holding meetings between adults. In the U.S., sitting in a circle is chiefly reserved for preschool and kindergarten students, tucked somewhere between snack time and nap time. However, no other group formation naturally lends itself to an egalitarian and open discussion quite as well a circle. This premise was the starting point for a pair of researchers who designed a program about culture change for long-term care staff.

The culture change movement is committed to reinventing long-term care facilities as homes instead of institutions. A key component of this vision is resident-centered care, a practice that allows more autonomy for residents to determine their own schedules and lives. It has been shown that residents, staff, and administrators all benefit from adopting culture change principles, yet these changes remain difficult to make. Part of the problem is awareness.

The researchers studied the effect of a learning circle program on staff knowledge about culture change concepts and practices. A group of long-term care staff met once a week for four weeks and then again for a follow-up session one month later. The basic format consisted of a question posed by the facilitator, followed by responses going around the circle, giving everyone the opportunity to speak. Then, the conversation continued as an open discussion. A few ground rules were set up to smooth out the process: participants can pass or skip their chance to speak up; no interruptions are allowed; and there is no right or wrong answer. This simple formula created an open dynamic in which staff shared personal experiences normally outside of a typical work relationship, such as family traditions.

Using pre- and post-tests to compare knowledge gains, the researchers determined the program increased staff knowledge of culture change ideas. The researchers also suggested the learning circle format enhanced staff cohesiveness while acknowledging ethnic diversity. As long-term care administrators try to reinvent their facilities for the future, they would be smart to remember that the same methods produce the same results. The learning circle offers a new model for spreading culture change.


LaCroix AL, Hammerman J (2011). Evaluation of a Culture Change-Focused Learning Circle Program in a Long-Term Care Setting. Seniors Housing and Care Journal (19):121-130.

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