Artifacts of Culture Change
The CMS Artifacts of Culture Change is a tool for providers to assess readiness, implementation and sustainability of person-directed care. The Artifacts of Culture Change tool fills the purpose of collecting the major concrete changes homes have made to care and workplace practices, policies and schedules, increased resident autonomy, and improved environment. It results from study of what providers and researchers have deemed significant things that are changed and are different in culture changing homes compared to other homes. The tool was developed by Carmen S. Bowman, the owner of the culture change consulting business, Edu-Catering: Catering Education for Compliance and Culture Change in LTC (click here for details) and Karen Schoeneman, Deputy Director of the CMS Division of Nursing Homes.
The Artifacts is one of several tools available to assess culture change transformations. The Development of the Artifacts of Culture Change Tool (click here to download) lists other assessment methods (pg. 5), describes the development of the Artifacts, and provides additional helpful information to support the use of the tool. The full Artifacts tool is available in Appendix A of the Development document or click here to download the tool separately.
In the featured column below, Peggy Bargmann, a Culture Change Coach working extensively with the Artifacts in nursing homes, outlines several valuable tips derived from her experience using the tool.
Tips for Using the Tool
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.