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Artifacts of Culture Change


Pioneer Network is host to this web-based version of the Artifacts of Culture Change. By registering and completing the Artifacts of Culture Change, providers are able to input, score and store their data online. Providers will be able to access current and historical data and are encouraged to:
  • Complete the tool at a minimum of twice a year. Quarterly updating is recommended, because for many homes, organizational reporting occurs quarterly. Adding Artifacts to a quarterly reporting schedule can also help to better analyze incremental changes in benchmark reporting; 
  • Create high involvement of staff, family and residents in completing the tool and solicit feedback from varying perspectives (see below);
  • Although assessments of responses can be approximates (e.g. responders do not need to count every adaptive handle), providers are encouraged to provide close approximate estimates to ensure the best possible measurements of longitudinal change.
  • Visit the How to Use tab for more detailed instructions. 

Tips for High Involvement

By Peggy Bargmann, R.N., B.S.N, Culture Change Coach and Steering Committee Member, Florida Pioneer Network

The Artifacts of Culture Change is a superb tool for collecting data on Culture Change in individual nursing homes. The simplicity of the tool allows for completion by one person but, as I have provided culture change coaching in homes, I have found that when the tool is completed as a group process, the information gained is so much richer. Here are my recommendations based on experience as a Culture Change Coach for the Florida Pioneer Network.

Start by gathering the Culture Change Leadership Team. This team should consist of the administrator, the director of nursing, and representatives from each department in the organization. In order to have complete representation of the home, it is important that there be representatives from all levels of the organization. Be sure to include direct care staff members, and at least one family member and one resident. The team is usually comprised of 15 – 20 people.

Once the team is gathered, have them divide up into groups of 3 – 4 and ask each group to complete the tool ensuring that everyone has input. Once all the groups have completed the tool, a facilitator can bring the large group back together and start down through the tool enlisting input from all groups to form a final consensus score. For some questions, there will be common agreement on the score. For other questions, there will be a wide variance and the resulting discussion will be lively. By listening, there is much that can be learned during these discussions. The facilitator will need to be sure that all voices in the room have equal input – be sure to be listening to the input from direct care staff, residents, and families. As an example, question # 11 states, "Residents can get a bath/shower as often as they would like." The staff may feel that all residents have choice in their bathing times, until a resident informs them that when she moved in she was told what days she was "scheduled" for her shower, and didn't realize that she could ask for other days. This could lead to a discussion of how residents are informed and how choice is encouraged and what impact that has on the day-to-day operations.

The process for completing the tool and facilitating the robust discussion can take up to three hours. It is a great way for the Culture Change Leadership Team to assess where the home is on its culture change journey, celebrate their accomplishments and, as a result of the group discussion, generate goals and action plans for their culture change journey. The Team can decide how often they want to repeat this process (e.g., every 6 months or annually) in order to assess their progress, celebrate their successes and revise their goals and action plans, as necessary, to continue on their culture change journey.

 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.