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Artifacts of Culture Change


ARTIFACTS BENCHMARK REPORT: Surveys Completed September 2009 –August 2012

Number of organizations represented: 473

Organizations in 48 states and the District of Columbia have completed the online Artifacts. Most organizations use the Artifacts longitudinally and the Online Artifacts contains 1,698 surveys though August 2012. If organizations completed more than one survey over the three year time frame, data from the most recent survey was incorporated into the benchmark report.


  • Homes completing the online Artifacts average 292.59 points (50.44% implementation rate)
  • Care Practice and Family & Community measures represent the highest implementation rate at over 60% of possible points.

  • The Environment section averages the lowest implementation rate (40%) due in large part to low completion rates of measures worth more points in this section including Measure #15 (Households).

  • Homes completing the Artifacts of Culture Change report relatively stable outcome measures achieving an average of 83% of possible points. It is unclear whether stability is a predecessor to change or as a result of change.


  • What measures are homes FULLY implementing? Homes report 100% implementation of more minor environmental
    transformations such as an extra lighting source, policy supports (residents can decorate their own rooms), and some process changes such as job development opportunities.

  • What measures are homes NOT implementing? Most homes completing the Artifacts do not have Households and still utilize traditional nurses stations. Residents are not able to bring pets into the homes. Staff still wear uniforms and use an overhead call system.

  • What staffing outcomes do homes report? Over 90% of homes report no (zero percent) use of agency staff for CNA or nurse positions. 44% of homes report CNA turnover in the 0-19% range; 53% of home reports LPN turnover in the 0-12% range and 59% of homes report RN turnover in the 0-12% range.

Top 10 Measures by Number of Surveys Reporting 100% Implementation (Maximum Points Awarded)

Bottom 10 Measures by Number of Surveys Reporting NO Implementation (Zero Points Awarded)

Average Points by Measure

Note: Point averages are affected by the response type (e.g. Y/N, ordinal scale, interval scale)

 The Artifacts of Culture Change Downloadable Version - A blank version of the tool for download.

 The Development of the Artifacts of Culture Change Tool - This is the full report written for CMS who funded the project explaining rationale for the tool, how the tool was developed including the point scale selected, and a large Source Information table which gives backup for each item such as where that practice can be located around the country and any research found supporting items.

 The Artifacts of Culture Change Privacy Policy

 Vol.1, No 1 Artifacts of Culture Change Benchmark Reports, 4/1/10-3/31/11

 Colorado Culture Change Collaborative (CCCC) Grant Project Summary - This document summarizes an almost one year project funded by the Colorado Culture Change Accountability Board CMP Grants and managed by Carmen Bowman of Edu-Catering. The summary goes into great detail about the project which sought to work with 20 nursing homes who voluntarily chose three culture change practices as identified by the Artifacts of Culture Change measurement tool. Homes agreed to meet as teams every other week to implement the three practices and share their story at the end of the project. They also completed the Artifacts tool at the beginning and end of the project. An increase in points, approximately a total of 15 for three practices (at 5 points each) was anticipated. However, the average point increase of 47 points was shocking and showed the value of joining such a project, a little support and mostly the power of making a commitment. The Artifacts tool also proved to do accomplish one of its identified goals by co-developers Karen Schoeneman of CMS and Bowman of Edu-Catering to serve as an educational tool. Many teams stated that the Artifacts tool opened their eyes to all that could be and that "it was the right thing to do" to incorporate more of the represented culture change practices for the residents they serve. Learn more about Edu-Catering and Artifacts initiatives here: http://www.edu-catering.com/artifacts_of_culture_change

 Colorado Culture Change Coalition (CCCC) Technical Assistance Project Report of Year One 2012

Colorado Culture Change Coalition (CCCC) Technical Assistance Project Report of Year Two

Colorado Culture Change Coalition (CCCC) Assisted Living Technical Assistance Project 2014

Arkansas Culture Change Project Summary - Through the work of Arkansas Foundation for Medical Care's AR Innovative Performance Program (AIPP) a quality improvement program was implemented to teach nursing facility and assisted living facility staff processes to implement culture change and individualized person-centered care. This report summarize the projects results.

Florida Pioneer Network: Advancing Culture Change in Florida Nursing Homes - Advancing Culture Change in Florida Nursing Homes was developed out of the exploration of culture change practices in 40 Florida nursing homes over 18 months in 2008-2009, using the Artifacts of Culture Change as a group interview tool. The project elicited both barriers and facilitators of culture change practices. Results are documented in this brief.

Artifacts of Culture Change DVD - Available through HaveAGoodLife.com, this DVD features a presentation by Carmen Bowman with in-depth discussion of Artifacts questions and implementation.

Just in Time Toolkits (Resources, Regulations and Results) - Creating and sustaining change isn't easy. While some adopters are like master chefs sprinkling various methods into the mix, others prefer "recipes for change" to support implementation. In reality, the most successful changes will vary by setting, organization, leadership, staff and the elders affected. There is no one recipe, but we have identified wonderful ingredients that can help cater an experience just right for you. That's the essence of the Just in Time Toolkits – RESOURCES, REGULATIONS, RESULTS. We highlight wonderful implementation resources,  identify relevant regulations and point you to results to help you find just the right path.  Toolkits address environmental, dining and staffing transformations.

Missouri Department of Health and Senior Services Letter of Support

The Artifacts of Culture Change was developed for public use by the Centers for Medicare & Medicaid Services and Edu-Catering, LLP. For more information on the development of the tool contact Karen Schoeneman or Carmen Bowman. Pioneer Network does not claim any rights to the Artifacts of Culture Change. Alterations to content are made with the consent of the developers.