While this study uses the commonly used term “culture change,” it is the processes and structures promoting person-centered care (and their hypothesized outcomes) that we study. This measurement is guided by the Holistic Approach to Transformational Change (HATCh) model that depicts six interrelated domains needed for NHs to make care more individualized. The Time 2 survey measures five domains, with the sixth domain (Government and Regulations) derived from existing data sources. All time 1 survey items were included in the Time 2 survey. Additional “candidate” items came primarily from existing survey instruments, and are supported through validity testing. Items were refined through extensive cognitive-based testing and through guidance from an expert advisory committee representing provider and culture change organizations. We used an ecological conceptual framework to hypothesize the relationships among domains and how domain processes and structures are influenced by the context in which they are performed.
