Addressing the complexity of culture change in long-term care in research: an innovative new framework addressing system-level complexity

This article explores an innovative new framework that addresses system-level complexity in long-term care research through the lens of culture change. We first discuss the current findings and gaps in culture change research and explore how a lack of system-level research may have slowed culture change adoption. After a review of potential system-level theories, we identify a conceptual framework that integrates the theoretical constructs of the Consolidated Framework for Implementation Research (CFIR) and Complex Adaptive Systems (CAS) for a more advanced conceptual modeling of culture change implementation. To illustrate the integration of CFIR and CAS as a conceptual framework to research culture change at a system-level, we create a crosswalk using two prominent implementation tools that support culture change: The Preferences for Everyday Living Inventory and the Artifacts of Culture Change 2.0. We argue for the value of this novel conceptual framework in highlighting the complexity of systems in long-term care research.