The following reprints discuss case studies and key culture change concepts. Most offer the perspectives and experiences of Judd and Robert Allen. They are not required reading for this online course. However, they do provide a sense of the power and history the culture change approach to address organizational and societal problems. Additional resources, such as books and videos can be ordered at the www.healthyculture.com website.  

General Model of Culture Change

A Tool for Tapping the Organizational Unconscious

This book chapter examines the scale development of the Norms Diagnostic Index (NDI). The NDI is designed to assess organizational functioning and has seven scales: (1) performance facilitation; (2) job involvement; (3) training; (4) leader-subordinate interaction; (5) policies and procedures; (6) confrontation; and (7) supportive climate. The article also includes a discussion of the role of the NDI in implementing a systematic culture change program. This book chapter first appeared in the Personnel Journal and was reprinted in the Corporate Culture Sourcebook. 8 pages.

Changing Community and Organizational Cultures

Sometimes case examples make it easier to understand social science concepts. This article uses four case studies to illustrate the value of adopting the four-phase Normative Systems Culture Change Process. Each phase is illustrated with compelling results drawn from four case studies: (1) an agricultural operation; (2) a supermarket; (3) a community-wide litter reduction campaign; and (4) a food distribution warehouse. Reprinted from Training and Development Journal of the American Society of Training and Development. 7 pages.

Changing the Corporate Culture

This discussion of the Normative Systems Culture Change Process features seven case studies designed to illustrate program development. The cases address issues of quality, customer service, employee theft, morale and organizational learning. In addition to discussing the importance of change processes, the article recommends a number of change principles that have been useful in achieving sustained and positive results. Reprinted from the Massachusetts Institute of Technology’s Sloan Management Review. 17 pages.

Confronting the Shadow Organization: How to Detect and Defeat Negative Norms

Freud determined that people are influenced by psychological factors that lie outside their general awareness. Do organizations have an unconscious? This article focuses on the power of norms in determining organizational success and failure. Ten general norm areas are examined: (1) organizational and personal pride; (2) performance/excellence; (3) teamwork/communication; (4) leadership and supervision; (5) profitability and cost effectiveness; (6) colleague and associate relations; (7) customer and consumer relations; (8) honesty and security; (9) training and development; and (10) innovation and change. In addition to describing cultural assessment, the article discusses cultural systems that influence normative behavior. The article is   reprinted from Organizational Dynamics, a publication of the American Management Association. 17 pages.

Four Phases for Bringing About Change

How does one plan a culture change project? This book chapter discusses the four-phase Normative Systems Culture Change Process: (1) analysis, objective setting and leadership commitment; (2) introducing change; (3) integration at the individual, group, inter-group and organizational levels; and (4) ongoing evaluation, renewal and extension. The chapter also covers change principles that have been useful in successful culture change. Reprinted from Gaining Control of the Corporate Culture. 10 pages.

Transformations that Last: A Cultural Approach

Frequently innovations fail to take root in the culture. This book chapter discusses the role of a cultural unconscious in bringing about sustained change. Norms are identified as the building blocks of cultural transformation. Eight cultural influence mechanisms, such as modeling and rewards, are reviewed. The history of cultural approach is examined with specific reference to the contributions of Kurt Lewin, Abraham Maslow, Eric Fromm, and Albert Bandura. The chapter also explains the Normative Systems Culture Change Process and humanistic guidelines for program development. The book chapter concludes with a discussion of the role of small groups in cultural transformation as well as a case illustration. Reprinted from Transforming Work. 20 pages.

When Are Results Not Results?

Illusionary and short-term "results" usually end up creating more problems than they solve. This paper examines the impact of failed change efforts on individuals and organizations. It discusses the importance of three types of organizational objectives—performance, programmatic and cultural—in achieving sustained change. A case study of a new company is used to illustrate the Normative Systems Change Process in achieving all sustained results. The article also explains how cultural norms and values can be measured through the development of a Cultural Norm Indicator. Reprint of a Selected Paper of the American Society for Training and Development. 9 pages.

Organizational Development

Getting Started: The Development of a New Company

This article discusses the value of consciously creating the culture when developing a new business location. A case study from a new pharmaceutical plant was used to illustrate key points. Data from the case study was used to explain the four-phase culture change process. The article is reprinted from Business magazine. 9 pages.

Group Norms: Their Influence on Training Effectiveness

This book chapter from The Training and Development Handbook discusses the role of culture in supporting or undermining training programs. The chapter examines what culture teaches employees. It discusses how culture influences training outcomes through orientation, work group support, leadership commitment, modeling, information feedback and rewards. A variety of training applications are reviewed, including introducing new organizational programs, strengthening existing programs, solving perplexing human factor problems, launching new work groups or work teams, and organizational innovation. The four-phase Normative Systems model is reviewed. In addition, the chapter examines culture change principles as they apply to training effectiveness. The chapter concludes with a discussion of the trainer’s role in bringing about sustained culture change. 6 pages.

The Absenteeism Culture: Becoming Attendance Oriented

Taking the day off or calling in sick is encouraged in many workplace subcultures. This article discusses how to create a culture that is attendance oriented. It explains the cultural factors that have been found to influence absenteeism. The article also reviews how the Normative Systems Culture Change Process is applied to the issue of absenteeism. A case study illustrates key concepts. Reprinted from Personnel, a publication of the American Management Association. 6 pages.

The Ik in the Office

Under severe pressure, an East African tribe called the Ik relinquished their basic humanity—sinking finally into depravity and near extinction. This article examines the parallels between the experience of the Ik and contemporary corporate cultures. Survey data and case studies are used to illustrate how business culture has come to treat people as expenses rather than important resources. The author discusses how we can avoid losing our capacity to care by consciously building corporate cultures that value their members and their performance. Case studies of Normative Systems culture change programs are used to illustrate the potential of allowing employees to shape their social environments. Reprinted from Organizational Dynamics, a publication of the American Management Association. 16 pages.

Health Care Applications of Culture Change

The Alexian Leadership Program; In Era of Cuts and DRGs, St. John's Focuses on Values; Reexamining our Values

These three brief articles discuss a Normative Systems application designed to better integrate shared values into health care cultures. The Alexian Brothers Health System and the Catholic Health Corporation recognized that they would need to make a conscious effort to maintain values such as compassion, community service, and stewardship. The article explains how a cross-section of employees and the sponsoring communities of nuns and monks identified core values for their health care settings. Behavioral norm statements were devised so a culture’s members could better understand how to "walk the talk." Employees completed a cultural norm indicator. Cultural influences such as rewards, modeling and communication systems were examined and modified. Commitment workshops were offered to help employees plan their roles in maintaining a values-driven culture. The article, "Re-examining Our Values," is reprinted from Lifecare. "In Era of Cuts and DRGs, St. John's Focuses on Values" is reprinted from Catholic Health World, a publication of the Catholic Health Association. The Alexian Leadership Program article is reprinted from The Alexian Way. 9 pages.

Discovering Your Hospital's Unconscious

This article explains the role of frequently unseen cultural factors in undermining those seeking improvements in health care settings. The authors discuss cultural norms and cultural influence factors such as rewards, modeling and confrontation. They also discuss the development of a cultural norm indicator for examining the cultural unconscious. The Normative Systems Change Process is offered as a successful approach to bringing about sustained change in the underlying culture. Reprinted from Hospital Forum. 6 pages.

From Burn-Out to Turn-On: Improving the Quality of Hospital Work Life 

This article examines how the culture causes burn-out in health care settings. It reviews research on burn-out among health care professionals and offers a culture-based process for establishing new norms. The Turning On People (TOP) program targets four broad norm areas for change: (1) dependence, overprotection and acquiescence; (2) non-helpfulness; (3) dehumanization and false professionalism; (4) bureaucratization and stratification. The article explains how the four-phase Normative Systems Culture Change Process used in the TOP program creates a culture that reduces burn-out, lowers costs and improves morale, teamwork and patient care. Reprinted from Hospital Forum. 6 pages.

General Model of Culture-Based Health Promotion in Organizations

Achieving Health Promotion Objectives Through Cultural Change Systems

This article addresses the problems associated with lifestyle change failure rates in excess of 80 percent. Cultural norms are identified as a major determinant of long-term behavior. Nine principles of cultural change are proposed. The Normative Systems Culture Change Process is reviewed. A case study of a health promotion program for migrant workers is used to illustrate key concepts. Reprint from the American Journal of Health Promotion. 9 pages.

Breaking the Cycle of Broken Promises: The Role of Supportive Cultural Environments

Few organizations stay in business with an 80 percent failure rate. Health promotion activities are no exception. This brief article discusses the growth of workplace health promotion activity. The author shares research findings and case studies that show how the culture undermines program effectiveness and jeopardizes the health promotion movement. The author recommends that health promotion programs seek to improve long-term success rates by adopting culture change principles. In addition to offering the change principles, the author defines five cultural factors: values, norms, peer support, organizational support and climate. Reprint from the Worksite Health Promotion Practitioners’ Forum of the American Journal of Health Promotion. 2 pages.

Mentoring Can Bring Needed Vitality to Wellness Programming

What is the wellness program equivalent of a medical doctor, therapist, personal trainer or athletic coach? This article defines a new health promotion role, the Wellness Mentor. Six primary mentoring skills are reviewed: (1) goal setting; (2) identifying role models; (3) eliminating barriers to change; (4) locating supportive environments; (5) working through relapse; and (6) celebrating success. Incorporation of Prochashka’s Stages of Change model is discussed. The article explains the potential use of Wellness Mentors in program design. A professional Wellness Mentor role is also explored. Reprinted from Wellness Management, the newsletter of the National Wellness Association. 3 pages.

Wellness Management Monographs

Nine brief monographs explain features of culture-based wellness program development. Two of the monographs offer an overview of program design. A third monograph reviews the parallels between wellness goals and other organizational development initiatives such as quality improvement. Other monographs discuss: (1) identifying core program themes; (2) translating core program themes into behavioral norm goals; (3) mobilizing organizational support factors such as rewards and modeling to shape wellness norms; (4) mobilizing peer support; (5) creating a healthy work climate by nurturing a sense of community, a shared vision, and a positive outlook; and (6) using a systematic culture change framework to implement program elements. Reprinted from Wellness Management, the newsletter of the National Wellness Association. 16 pages.

Culture-Based Health Promotion in Business Settings

The Corporate Health Buying Spree: Boon or Boondoggle?

What makes health promotion worthwhile? Research shows that corporate expenditures on health promotion are not resulting in healthier lifestyle practices. The article presents evidence that the culture is undermining employees' lifestyle change efforts. Organizational Support Indicator findings reveal low support for healthy lifestyle choices. Primary reasons for program failure and a list of recommended project principles are presented. The suggested program model includes culture-based self-help materials, coworker support programs and organizational task forces. Reprinted from S.A.M. Advanced Management Journal. 10 pages.

Union Pacific Railroad Pioneers a Culture-Based Approach to Wellness; Measuring Culture: One Hospital’s Experience; and Wellness Survey Reveals Strengths and Opportunities 

How healthy is your organizational culture? These three brief research reports explain Lifegain Health Culture Audit survey results in three organizations—a railroad, a hospital and a university. The Lifegain Health Culture Audit measures wellness values, norms, organizational support, peer support and work climate. The implications for health promotion program design are discussed. "Union Pacific Railroad Pioneers a Culture-Based Approach to Wellness" is reprinted from Worksite Wellness Works. "Wellness Survey Reveals Strengths and Opportunities" is reprinted from Focus on Health, a University of Vermont newsletter. "Measuring Culture: One Hospital’s Experience" is reprinted from Lifegain: A Cultural Lens for Health Promotion. 3 pages.

Culture-Based Health Promotion for Medical Care Delivery

From Short-Term Compliance to Long-Term Freedom: Culture-Based Health Promotion by Health Professionals

What should doctors, nurses and other health care professionals do to support wellness? This article offers an alternative approach to medical care professionals seeking to help their clients achieve healthier lifestyles. Following a review of the patient compliance literature, the authors conclude that the concept of patient compliance is flawed in that: (1) it does not promote self-responsibility; and (2) it incorrectly assumes patients will successfully modify their behavior without supportive cultural environments. Very few patients adopt the lifestyle change recommendations of doctors and other medical professionals. This high failure rate alienates the patient from health care professionals and has forced these professionals to adopt second choice treatment strategies such as surgery and drugs. The authors suggest two culture-based approaches to promoting lifestyle change: (1) a six-step individual action plan; and (2) a four-phase culture change process. The article also offers a cultural norm indicator designed to determine the extent to which community and family norms support wellness lifestyles. Reprinted from the American Journal of Health Promotion. 10 pages.

Culture-Based Health Promotion for Colleges and Universities

Key Concepts in Culture Change; and Wellness Survey Reveals Strengths and Opportunities

These two brief articles discuss culture change at colleges and universities. The "Key Concepts" article discusses how campus cultures interfere with healthy lifestyle choices. The article defines norms, values, peer support, organizational support and climate. It also discusses the four-phase Normative Systems Change Process. The second article discusses findings from a Lifegain Health Culture Audit survey conducted among faculty and staff at the University of Vermont. Survey results were used to plan a culture-based wellness program. "Key Concepts in Culture Change" is reprinted from Wellness Connections, a newsletter of the Ball State University’s Fischer Institute for Wellness. "Wellness Survey Reveals Strengths and Opportunities" is reprinted from Focus on Health, a University of Vermont newsletter. 3 pages.

Culture-Based Approaches to Community Health Promotion

Achieving Primary Prevention Program Objectives Through Culture Change Systems

How does our culture influence our mental health? This article is about adopting a culture change approach to the prevention of mental disorders. In order to address prevention issues, the culture will have to support new behavior associated with environmental hazards, stress, exploitation, coping skills, self-esteem and group support. Core project principles, the role of norms, and the Normative Systems Culture Change Process are explained. The article illustrates a culture-based primary prevention approach through programs developed for delinquent youths and migrant workers. Reprinted from the Journal of Primary Prevention. 9 pages.

Adios to Migrancy; A New Life for Migrant Workers; and Migrants No More

These three articles discuss the problems of migrant workers and a culture change project developed with Coca-Cola’s Minute Maid group. The project employed the Normative Systems Culture Change Process to transform racist, unhealthy and unproductive cultural norms. Project results include a doubling of worker productivity and profitability as well as the development of vibrant communities and year-round employment. "Adios to Migrancy" is reprinted from Manpower. "Migrants No More" is reprinted from Reader’s Digest. "A New Life for Migrant Workers" is reprinted from The Atlanta Journal and Constitution magazine. 18 pages.

Community Activation for Risk Reduction

Healthy communities lead to healthier individuals. This article discusses the Pawtucket Heart Health Program, a six-year, community-wide culture change program funded by the National Institutes of Health. Basic project principles are explained, as is the four-phase culture change process. The article discusses the relationship between professional staff and various community groups. It also discusses the evaluation plan. Reprinted from the Proceedings of the Society of Prospective Medicine. 7 pages.

You Can Mobilize Communities Toward Health: Part One and Part Two

These two reprints discuss how the YMCA can play an important role in reducing lifestyle risk at the community level. A review of past community-wide efforts reveals widespread failure due to fragmentation of efforts, overemphasis on initial motivation, undue focus on unapplied knowledge and information, misdirected emphasis on illness and the avoidance of illness, appeal to individual heroics as opposed to cooperative mutual support, overemphasis on activities and a lack of attention to results, and a "we will do it for you" approach. Culture change principles and a culture change process are suggested. A case study of culture-based health promotion efforts at the Frost Valley YMCA is presented. Reprinted from Perspective magazine. 6 pages.

Culture-Based Approaches to Family Development

Here's to Your Health: A Family Planning Guide for Getting the Most out of Life; and Changing Our Health Cultures: A Family Guide to Wellness and Positive Health

For better and for worse, household and family subcultures can influence almost all our day-to-day lifestyle behavior. These two articles discuss the importance of family support in achieving lasting lifestyle change. The articles review research findings on lifestyle success rates and report that the health revolution is failing not from a lack of interest, but rather because fewer than 20 percent of lifestyle change attempts succeed. A cooperative action plan to achieve family health is suggested. The following change principles are recommended: (1) it’s all of us together; (2) no blame; (3) get the facts; and (4) have fun. The articles include two survey instruments, a Lifegain Health Norm Indicator and a Lifegain Family Support Indicator. "Here's to Your Health: A Family Planning Guide for Getting the Most Out of Life" is reprinted from Parents magazine. 12 pages.

Culture-Based Approaches to Working with Older Adults

Culture-Based Health Promotion for Older Adults

It's never too late to benefit from a healthier lifestyle. This article discusses how senior citizens benefit from successful lifestyle change. A review of the literature reveals that the culture undermines the change efforts of older adults. Based on the gerontology work of M. Powel Lawton, it is suggested that seniors need to be challenged in a way that takes activity limitations into consideration. The article offers a four-phase culture change process for creating more supportive cultural environments. Reprinted from The Council for Health and Human Service Ministries Report of the United Church of Christ. 7 pages.

New Lives for Old: Lifestyle Change Initiatives Among Older Adults

Seniors try to adopt healthier lifestyle practices, but most of their efforts do not achieve their goals. This article presents research findings drawn from interviews of all the senior citizens living in a small town in upstate New York. Nearly all of these seniors attempted lifestyle changes, but as is true in the general population, less than one-half of these attempts resulted in lasting lifestyle change. The findings also indicate that peer support works with cultural norms to determine both whether older adults attempt lifestyle change and the success of those efforts. The article includes a literature review on the lifestyle practices of senior citizens. Reprinted from Health Values. 12 pages.

Culture-Based Approaches to Youth Development

Lifegain: A New Way of Helping Young People Create Positive Health-Supporting Cultures; and An Adventure that Leads to a Healthier Lifestyle

It is now widely understood that family, school, peer and community subcultures influence the lifestyle choices of children. These two articles explain strategies for designing health promotion programs that create supportive cultures for young people. The authors recommend that young people choose their own lifestyle goals. An emphasis on having fun and being positive is also recommended, as is a four-phase model for program design. The second article, "An Adventure that Leads to a Healthier Lifestyle," discusses the use of outdoor experiences to plan and to experiment with lifestyle change. "An Adventure that Leads to a Healthier Lifestyle" is reprinted from Perspective magazine. "Lifegain: A New Way of Helping Young People Create Positive Health-Supporting Cultures" is reprinted from New Designs for Youth Development. 10 pages.

The Influence of Peer Culture on Delinquency and Delinquency Rehabilitation

This article examines the cultural roots of delinquency. A process of acculturation to delinquent behavior is discussed. Twelve cultural norm areas are identified: (1) anti work; (2) anti school; (3) anti delayed need gratification; (4) anti law; (5) anti introspection; (6) anti trust; (7) anti show of weakness; (8) anti authority; (9) pro exploitation; (10) pro tough guy; (11) pro stealing; and (12) pro drug and alcohol. Suggestions are made for the establishment of a rehabilitative culture. Reprinted from the book From Delinquency to Freedom. 3 pages.