A Tool to Prioritize and Track Culture Change in Nursing Homes
Designed to transform hospital-like institutions that approach elders as medical patients into communities, nursing home comprehensive culture change initiatives are the definition of radical change. Staff are trained and coached to not only provide medical and supportive services, but also on how to consistently prioritize resident choice and quality of life. Although over the last four decades significant work to develop approaches that foster a person-centered model of care have been designed, little has been done to measure the effectiveness or standardize different culture change protocols.
Altarum’s Center for Eldercare Improvement (CEI) is committed to implementing, evaluating, and advocating for best practices that ensure quality of life in old age. To advance the work on person-centered care we developed the Systems Change Tracking Tool (SCTT). A uniquely purpose-designed QI instrument that allows all members of the nursing home staff, from administrators through care aides and household staff to track their accomplishments and challenges implementing person-centered care over time. By completing and reflecting on the SCTT regularly, staff understand more clearly where they are moving the needle on person-centeredness and how they can make culture change a reality for their residents.
The need for more person-centeredness in the nursing home sector has become starkly clear during the COVID-19 pandemic. Nursing homes nationwide struggled not only to curb high rates of morbidity and mortality, but also with significant resident decline and premature death directly traceable to social isolation and loneliness. As residences where 1.3 million elders live their final years, those in public health are called to refine and amplify practices and protocols that can be used to enhance residents’ quality of life. With the further benefit of making the job of care aides more rewarding.
As culture change training proceeds, the SCTT assesses changes that occur in the residential long-term care setting by measuring staff-led shifts in person-centered practices and protocols using 58 items. To ensure its cogency and usefulness, the SCTT underwent cognitive testing and an iterative review process by long-term care, culture change, and survey methodology experts. Importantly, the tool’s instructions acknowledge that not all changes discussed in the instrument will happen quickly—and some may not happen at all.
The SCTT features questions that are grouped into six domains, as established by the Holistic Approach to Transformational Change (HATCh) theoretical model.
The six HATCh domains1,2 are:
Completed quarterly, the tool has four possible responses options: the home has a plan for implementation; the home has a plan that is partially implemented; the home has a plan that is fully implemented; or the home has no plan for implementation.
The SCTT tool is publicly available and free to use. We invite anyone who is interested in learning more about how we implemented the SCTT protocol in our own on-going comprehensive culture change initiatives to reach out. We would be pleased to discuss how other organizations might use the tool for their own purposes including for Quality Assurance and Performance Improvement (QAPI) projects. We believe this tool can be a valuable asset in advancing best practices in eldercare nationwide.