Leadership

Leadership refers to the actions of formal leaders on a unit that influence change and promote excellence in practice and resident care. Formal leaders will vary according to the care provider completing the ACT; for example, with care aides, a variety of: care managers, RNs, and/or LPNs can be selected as ‘formal leaders’. Individuals completing the ACT are asked to rate this leader by answering six items using a 5-point Likert agreement scale ranging from 1 (strongly disagree) to 5 (strongly agree). The final leadership score obtained for each individual is an average of his or her scores on the six items. Higher scores reflect a more positive perception of the leadership on the care unit.

Culture

Culture refers to the way that “we do things” on care units. Individuals completing the ACT are asked to rate their unit’s culture by answering six items using a 5-point Likert agreement scale. The items generally describe a supportive work culture. The final culture score obtained for each individual is an average of his or her scores on the six items. Higher scores reflect a more positive perception of the culture on the care unit.

Evaluation

Evaluation refers to the process of using data to assess team performance and to achieve positive (resident) outcomes on care units. Individuals completing the ACT are asked to rate the evaluation on their care unit by answering six items using a 5-point Likert agreement scale. The six items are hierarchical in nature and represent a process. The final evaluation score obtained for each individual is an average of his or her scores on the six items. Higher scores reflect a more positive perception of the feedback process mechanisms on the care unit. 

Social Capital

Social Capital refers to active connections and interactions among individuals on a care team. These connections are of three types: bonding (horizontal connections between individual team members on a care unit), bridging (connections between individuals on different care teams), and linking (vertical connections between individual team members and individuals in positions of authority, e.g., care managers). Individuals completing the ACT are asked to rate the connections on their care unit by answering six items using a 5-point Likert agreement scale. The final social capital score obtained for each individual is an average of his or her scores on the six items. Higher scores reflect a more positive perception of social capital on the care unit.

Informal Interactions

Informal Interactions refer to the informal exchanges that occur between individuals working on a care unit. Individuals completing the ACT are asked to indicate how often they interact in a variety of informal exchanges with individuals on their care unit by answering nine items using the same 5-point frequency scale. The final informal interactions score obtained for each individual is the number of individuals with whom he or she reported interacting. Higher scores reflect a higher number of informal interactions on the care unit.

Formal Interactions

Formal Interactions refer to formal exchanges that occur between individuals working on a care unit through scheduled activities. Individuals completing the ACT are asked to indicate how often they interact in a variety of formal exchanges on their care unit by answering four items using a 5-point frequency scale: 1 (never), 2 (rarely), 3 (occasionally), 4 (frequently), 5 (almost always). The final formal interactions score obtained for each individual is a count of the number of items in which he or she indicated they participated. Higher scores reflect higher numbers of formal interactions engaged in on the care unit.

Structural / Electronic Resources

Structural and Electronic Resources refer to the structural and electronic elements of a care unit that facilitate the ability of individual team members to use best practice (or research) knowledge. Individuals completing the ACT are asked to indicate how often they use a variety of structural and electronic resources on their care unit by answering eleven items (7 items on structural resources and 4 items on electronic resources) using the 5-point frequency scale. Final structural resources and electronic resources scores are obtained for each individual by obtaining a count of the number of resources he or she indicated using. Higher scores reflect the use of more structural and electronic resources on the care unit.

Organizational Slack

Organizational Slack refers to the cushion of resources, which allow a care unit to adapt successfully to internal pressures or changes or adapt to external pressures or changes. Organization slack has three components (or concepts):

1. Staffing (availability of adequate staffing levels to provide resident care; 3 items);
2. Space (availability and use of adequate space to provide resident care and share best practice knowledge; 3 items);
3. Time (availability of time to provide resident care and share best practice knowledge; 4 items).

A variety of scoring methods are used to obtain final scores for each of the three organizational slack components. Higher scores reflect a more positive perception of staffing levels, the availability and use of adequate space, and the availability and use of time on the care unit to carry out resident care and share knowledge.