Table 2.

Suggested assessment methods for Nursing Home IMPACT domains.

Domain	Suggested assessment methodsa
	Observation					Interview			Focus group					Survey		Document review
	1a	1b	1c	1d	1e	2a	2b	2c	3a	3b	3c	4a	4b	5a	5b	5c	5d	5e	5f	5g	5h
Ownership of culture change efforts						X	X
Unlearning established practices	X					X	X		X	X
Ensuring both safety and a home environment						(x), (y)	X	(x), (y)	(x), (y)	X	(x), (y)	Y	Y							X
Aligning culture change goals and resources				(x)	(x)	X	X
Promoting the resident’s voice	X		X			Y	Y	Y	Y	Y	Y	Y		(x), (y)	(x), (y)				Y
Improving the resident’s quality of life	X					X	(x)	X	X	(x)	X
Meaningful use of time for residents	X					Y	(y)		Y	(y)						X, Y
Resident-centered medical care		X	X			X		X	X		X				(x)
Decentralization of authority and  new organizational processes				X		(x)	(x)		(x)	(x)							X
Consistent staffingb	Y					Y	Y	Y	Y	Y	Y				(y)		X
Prioritizing both culture change and quality							(x)			(x)										X
Existence and functioning of interdisciplinary  teams							X			X								X
Staff communication	X					(x)	(x)	(x)	(x)	(x)	(x)							X			X
Staff empowerment							X			X			Y					X, Y			X, Y

X, Y = potential assessment strategies; Xs represent one method/group of methods and Ys represent an equally viable, alternative method/group of methods.

(x), (y) = possible complementary strategies to X or Y–(x) or (y) may not be sufficient by themselves.

1 = direct observation of: a = residents’ daily life; b = residents’ medical care; c = treatment team meetings; d = staff meetings; e = resident committee meetings.

2 = interviews with: a = residents; b = staff; c = family.

3 = focus groups with: a = residents; b = staff; c = family.

4 = surveys of: a = residents/family; b = staff

5 = review of documents relating to: a = treatment team meetings; b = notes in residents’ charts about specific issues; c = records of residents’ use of time; d = facility organizational structure and processes; e = staff meetings; f = resident committee meetings; g = quality and safety concerns; h = staff training.

^aNumbers in the column sub-headings represent suggested assessment methods and are defined as follows (note that “staff” refers to any or all of the following, as appropriate for the needs of the assessment: leadership, managers, direct care staff, other; also note that the numbers in the column sub-headings also correspond to the numbers presented in Table 1).

^bUse of a structured calculation for consistent assignment is the preferred strategy listed as X.