Organisational culture exists in every organisation, whether we intentionally shape it or not.

It is reflected in the way people interact, the decisions they make, the routines they follow, and the values that guide their actions.

Yet, despite its influence on everyday life, organisational culture has not always received the attention it deserves, particularly in long-term care communities.

And in long-term care, the consequences reach far beyond the workplace.

Because people do not live in our workplace. We work in their home.

Over the years, long-term care in South Africa, as in many parts of the world, has largely developed around medical, institutional and system-focused approaches. Structures, routines and procedures have often taken priority over the preferences, choices and everyday lives of the people receiving support.

This may sound contradictory. After all, we are talking about the CARE sector, where caring for PEOPLE should surely be at the heart of everything we do.

Yet we know that good intentions and compassionate individuals do not automatically result in a person-directed culture.

The systems within which people work have a powerful influence on how they think, behave and interact.

Some years ago, I came across an article by Mike Temple, If You Get The Culture Right, The Other Stuff Will Take Care of Itself.

One observation particularly caught my attention: organisational culture develops whether we actively influence it or not.

That thought has stayed with me.

There is growing awareness in parts of the South African aged care sector of the importance of dignity, relationships, wellbeing and person-directed support. This is encouraging.

But being aware of organisational culture is not the same as actively working to develop it.

Culture is not something we address through a once-off workshop, a new policy or a statement of organisational values.

It is lived and experienced every day.

It is reflected in whether an older person is involved in decisions about their own life, whether employees feel heard and valued, whether routines can adapt to individual preferences, and whether relationships matter as much as tasks.

For people living in residential aged care communities, organisational culture is not something they encounter for a few hours each day.

It surrounds them. It shapes their home, their relationships, their opportunities and their sense of self.

They cannot simply leave an organisational culture that does not support their wellbeing.

This is why I believe organisational culture should be a standing item on the agenda of every board and leadership team responsible for long-term care communities.

Not simply to ask whether policies are in place or standards are being met, but to reflect on the lived experiences of the people who live and work within the community.

What does our culture feel like?

Whose voices influence the decisions we make?

Do our systems support dignity, autonomy, meaningful relationships and a sense of purpose?

And are we creating an environment where those providing support can also experience wellbeing, belonging and value?

For new communities, organisational culture should be considered from the very beginning, shaping the design of services, systems, leadership practices and everyday life.

For established communities, there is an ongoing opportunity to pause, reflect and question practices that may have become so familiar that we no longer notice their impact.

Person-directed support offers a different starting point: seeing, knowing and valuing each person, and allowing that understanding to guide how we work and live together.

The challenge is not simply to provide good care.

It is to create communities where people are supported to live their lives, rather than having their lives organised around the delivery of care.

And that requires us to make organisational culture a priority.

Not once, but continuously.

Further reading: A South African perspective

A 2025 study by Naomi Hlongwane and Lieketseng Ned explored older people's experiences of quality of life in five long-term care settings in Gauteng, South Africa.

The findings highlight the importance of dignity, autonomy, meaningful relationships and social connection, and how institutional practices, policies and resources influence these experiences.

The research offers a valuable South African perspective on why we need to look beyond the delivery of care and consider the everyday lives of people living in long-term care communities.

Read the research: Quality of life in long-term care facilities in Gauteng, South Africa

Hlongwane, N. & Ned, L. (2025). BMJ Open, 15(5), e099448.