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Is the Systemic Agency Capacity of Long-Term Care Organizations Enabling Person-Centered Care during the COVID-19 Pandemic? A Repeated Cross-Sectional Study of Organizational Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095045. [PMID: 35564440 PMCID: PMC9103543 DOI: 10.3390/ijerph19095045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemic has strained long-term care organization staff and placed new demands on them. This study examines the role of the general ability and power of a long-term care organization to act and react collectively as a social system, which is called systemic agency capacity, in safeguarding the provision of person-centered care during a crisis. The question of how the systemic agency capacity of long-term care organizations helps to ensure person-centered care during the pandemic is an open research question. We conducted a pooled cross-sectional study on long-term care organizations in Germany during the first and second waves of the pandemic (April 2020 and December 2020–January 2021). The sample consisted of 503 (first wave) and 294 leaders (second wave) of long-term care organizations. The top managers of these facilities were asked to report their perceptions of their facility’s agency capacity, measured by the AGIL scale, and the extent to which the facility provides person-centered care. We found a significant positive association between the leaders’ perceptions of systemic agency capacity and their perceptions of delivered person-centered care, which did not change over time. The results tentatively support the idea that fostering the systemic agency capacity of long-term care organizations facilitates their ability to provide quality routine care despite environmental shocks such as the COVID-19 pandemic.
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Larkey FA. Situating Eden-Culture change in residential aged care: A scoping review. Australas J Ageing 2021; 41:188-199. [PMID: 34939304 DOI: 10.1111/ajag.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 05/14/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This review explored the knowledge of the Eden Alternative [Eden] as a well-being model for aged care and the current research of relationship-centred care in a residential setting to identify gaps in the literature. METHODS The search commenced in July 2017 and was updated in January 2020. Eight electronic databases were systematically searched for peer-reviewed studies published in English between 2000 and 2020. The search revealed 13 papers for final inclusion. RESULTS The Eden model has the potential to reduce loneliness, helplessness and boredom in older people. Implementation requires committed leadership and the inclusion of residents, families and staff in decision-making. CONCLUSIONS There remain gaps in the empirical evidence of the benefit of the Eden model. The challenge is for researchers to provide rigorous study design that can evidence well-being outcomes for residents with complex needs.
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Affiliation(s)
- Frances Anne Larkey
- Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
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Rodríguez-Gázquez MDLÁ, Basurto Hoyuelos S, González-López JR. Countries' cultures and professional nursing values: Cross-cultural evidence from Spanish and Colombian nursing students. Nurse Educ Pract 2020; 50:102953. [PMID: 33373879 DOI: 10.1016/j.nepr.2020.102953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/20/2020] [Accepted: 12/12/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to identify countries' cultural values associated with the importance given to certain professional nursing values by nursing students from Spain and Colombia. Weis and Schank's Nurses Professional Values Scale-Revised (NPVS-R) in its Spanish version and the Hofstede cultural classification were used for this purpose. The sample was composed of 880 nursing students. Nursing students from both countries showed a greater importance for professional nursing values compared to evidence from other countries. Significant differences were also found in the total score, dimensions, and items, always being higher for Colombian students. Based on regression results, the impact that the academic year had on the importance given to NPVS-R is non-linear (U-inverted). Both groups of students gave the highest importance to the same group of items. Those showing the largest difference in the rankings were associated with country culture differences based on the scores identified by Hofstede. Colombian and Spanish societies present similarities in Power Distance and Uncertainty Avoidance, as well as differences in the other cultural dimensions.
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Affiliation(s)
| | - Salomé Basurto Hoyuelos
- School of Nursing of Vitoria/Gasteiz, Spain. C/ Jose Atxotegi, s/n. 01009, Vitoria-Gasteiz, Álava, Spain.
| | - José Rafael González-López
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Spain. C/ Avenzoar, n° 6, 41009, Seville, Spain.
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Exploring the Organizational Culture in Adult Day Services (ADS) and Its Effect on Healthcare Delivery in Taiwan. Curr Gerontol Geriatr Res 2020; 2020:4934983. [PMID: 32099544 PMCID: PMC7040394 DOI: 10.1155/2020/4934983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/07/2019] [Accepted: 01/21/2020] [Indexed: 11/17/2022] Open
Abstract
Studies conducted in nursing homes/hospitals have shown that organizational culture plays an important role in care delivery and group culture leads to better quality of care. To explore the organizational culture and care delivery in adult day services (ADS) centers in Taiwan, we used both quantitative and qualitative research methods. Quantitative data from the Competing Values Framework (CVF) assessment showed that the group culture was dominant at all three centers. Qualitative data from observation and staff interviews uncovered both group and nongroup cultural elements. The group cultural elements, such as flexible management, teamwork environment, and sharing the same values, contributed to good care; however, the nongroup cultural elements, such as the staff-centered view, hierarchy, and conflicts within the leadership, led to negative staff-staff and staff-clients interactions. Further research is needed to untangle the complexity between quality care delivery and organizational culture.
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Tappen RM, Wolf DG, Rahemi Z, Engstrom G, Rojido C, Shutes JM, Ouslander JG. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program. Health Care Manag (Frederick) 2018; 36:219-230. [PMID: 28650872 PMCID: PMC5533173 DOI: 10.1097/hcm.0000000000000168] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.
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Affiliation(s)
- Ruth M Tappen
- Author Affiliations: Christine E. Lynn College of Nursing (Dr Tappen and Ms Rahemi), and Charles E. Schmidt College of Medicine (Drs Engstrom, Rojido, and Ouslander, and Ms Shutes), Florida Atlantic University, Boca Raton; Health Services Administration, School of Professional and Career Education, Barry University (Dr Wolf), Miami Shores, Florida; and School of Nursing and Midwifery, Kashan University of Medical Sciences and Health Services (Ms Rahemi), Kashan, Isfahan, Iran
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Roberts E, Pulay A. Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/02763893.2018.1431586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Emily Roberts
- Department of Design, Housing and Merchandising, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Alana Pulay
- Department of Design, Housing and Merchandising, Oklahoma State University, Stillwater, Oklahoma, USA
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Tetui M, Coe AB, Hurtig AK, Bennett S, Kiwanuka SN, George A, Kiracho EE. A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda. Health Res Policy Syst 2017; 15:110. [PMID: 29297346 PMCID: PMC5751402 DOI: 10.1186/s12961-017-0273-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. Methods This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. Results The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Conclusions Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0273-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda. .,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Anna-Britt Coe
- Sociology Department, Umeå University, 901 87, Umeå, Sweden
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America
| | - Suzanne N Kiwanuka
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Asha George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America.,School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa
| | - Elizabeth Ekirapa Kiracho
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
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Sjögren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study. BMC Nurs 2017; 16:44. [PMID: 28808426 PMCID: PMC5550941 DOI: 10.1186/s12912-017-0240-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. METHODS A cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi2 test, Eta Squared and Phi coefficient were used to analyse data. RESULTS Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. CONCLUSIONS It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.
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Affiliation(s)
- Karin Sjögren
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden.,Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.,Division of Caring Sciences, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Karin Zingmark
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.,Region of Norrbotten, Luleå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Berridge C, Tyler DA, Miller SC. Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey. J Appl Gerontol 2016; 37:419-434. [PMID: 27566304 DOI: 10.1177/0733464816665204] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. Data from 2,034 nursing home administrators from a 2009/2010 national nursing home survey and ordered logistic regression were used. After adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention (odds ratio [OR] = 1.44; 95% confidence interval [CI] = [1.15, 1.81], p = .001) and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention (OR = 1.64; 95% CI = [1.34, 2.00], p < 001). Greater opportunities for CNA empowerment are associated with longer CNA retention. This research suggests that staffing empowerment practices on the whole are worthwhile from the CNA staffing stability perspective.
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Kowalski C, Lee SYD, Schmidt A, Wesselmann S, Wirtz MA, Pfaff H, Ernstmann N. The health literate health care organization 10 item questionnaire (HLHO-10): development and validation. BMC Health Serv Res 2015; 15:47. [PMID: 25638047 PMCID: PMC4332719 DOI: 10.1186/s12913-015-0707-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While research on individual health literacy is steadily increasing, less attention has been paid to the context of care that may help to increase the patient's ability to navigate health care or to compensate for their limited health literacy. In 2012, Brach et al. introduced the concept of health literate health care organizations (HLHOs) to describe the organizational context of care. This paper presents our effort in developing and validating an HLHO instrument. METHOD Ten items were developed to represent the ten attributes of HLHO (HLHO-10) based on a literature review, an expert workshop, a focus group discussion, and qualitative interviews. The instrument was applied in a key informant survey in 51 German hospitals as part of a larger study on patient information and training needs (PIAT-study). Item properties were analyzed and a confirmatory factor analysis (CFA) was conducted to test the instrument's unidimensionality. To investigate the instrument's predictive validity, a multilevel analysis was performed that used the HLHO-10 score to predict the adequacy of information provided to 1,224 newly-diagnosed breast cancer patients treated at the sample hospitals. RESULTS Cronbach's α of the resulting scale was 0.89. CFA verified the one-factor structure after allowing for the correlation for four pairs of error terms. In the multilevel model, HLHO-10 significantly predicted the adequacy of information as perceived by patients. CONCLUSION The instrument has satisfactory reliability and validity. It provides a useful tool to assess the degree to which health care organizations help patients to navigate, understand, and use information and services. Further validation should include participant observation in health care organizations and a sample that is not limited to breast cancer care.
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Affiliation(s)
- Christoph Kowalski
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne, Eupener Strasse 129, Cologne, 50933, Germany.
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | - Shoou-Yih D Lee
- Department of Health Management and Policy, The University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Anna Schmidt
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne, Eupener Strasse 129, Cologne, 50933, Germany.
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | - Markus A Wirtz
- University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne, Eupener Strasse 129, Cologne, 50933, Germany.
| | - Nicole Ernstmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne, Eupener Strasse 129, Cologne, 50933, Germany.
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Grabowski DC, Elliot A, Leitzell B, Cohen LW, Zimmerman S. Who are the innovators? Nursing homes implementing culture change. THE GERONTOLOGIST 2014; 54 Suppl 1:S65-75. [PMID: 24443608 DOI: 10.1093/geront/gnt144] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation. DESIGN AND METHODS Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011. RESULTS At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem. IMPLICATIONS To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.
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Affiliation(s)
- David C Grabowski
- *Address correspondence to David C. Grabowski, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899. E-mail:
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Abstract
ABSTRACTOrganisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the ‘right’ leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.
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Clark MA, Roman A, Rogers ML, Tyler DA, Mor V. Surveying multiple health professional team members within institutional settings: an example from the nursing home industry. Eval Health Prof 2014; 37:287-313. [PMID: 24500999 PMCID: PMC4380513 DOI: 10.1177/0163278714521633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality improvement and cost containment initiatives in health care increasingly involve interdisciplinary teams of providers. To understand organizational functioning, information is often needed from multiple members of a leadership team since no one person may have sufficient knowledge of all aspects of the organization. To minimize survey burden, it is ideal to ask unique questions of each member of the leadership team in areas of their expertise. However, this risks substantial missing data if all eligible members of the organization do not respond to the survey. Nursing home administrators (NHA) and directors of nursing (DoN) play important roles in the leadership of long-term care facilities. Surveys were administered to NHAs and DoNs from a random, nationally representative sample of U.S. nursing homes about the impact of state policies, market forces, and organizational factors that impact provider performance and residents' outcomes. Responses were obtained from a total of 2,686 facilities (response rate [RR] = 66.6%) in which at least one individual completed the questionnaire and 1,693 facilities (RR = 42.0%) in which both providers participated. No evidence of nonresponse bias was detected. A high-quality representative sample of two providers in a long-term care facility can be obtained. It is possible to optimize data collection by obtaining unique information about the organization from each provider while minimizing the number of items asked of each individual. However, sufficient resources must be available for follow-up to nonresponders with particular attention paid to lower resourced, lower quality facilities caring for higher acuity residents in highly competitive nursing home markets.
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Affiliation(s)
- Melissa A Clark
- School of Public Health, Brown University, Providence, RI, USA
| | - Anthony Roman
- Center for Survey Research, University of Massachusetts-Boston, Boston, MA, USA
| | | | - Denise A Tyler
- School of Public Health, Brown University, Providence, RI, USA
| | - Vincent Mor
- School of Public Health, Brown University, Providence, RI, USA
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Corazzini K, Twersky J, White HK, Buhr GT, McConnell ES, Weiner M, Colón-Emeric CS. Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework. THE GERONTOLOGIST 2014; 55:616-27. [PMID: 24451896 DOI: 10.1093/geront/gnt170] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 12/05/2013] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. DESIGN AND METHODS The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. RESULTS Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. IMPLICATIONS Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges.
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Affiliation(s)
- Kirsten Corazzini
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina. Duke University School of Nursing, Durham, North Carolina.
| | - Jack Twersky
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina. Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Heidi K White
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Gwendolen T Buhr
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Eleanor S McConnell
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Madeline Weiner
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Cathleen S Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina. Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Banaszak-Holl J, Castle NG, Lin MK, Shrivastwa N, Spreitzer G. The role of organizational culture in retaining nursing workforce. THE GERONTOLOGIST 2013; 55:462-71. [PMID: 24218146 DOI: 10.1093/geront/gnt129] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/24/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY We examined how organizational culture in nursing homes affects staff turnover, because culture is a first step to creating satisfactory work environments. DESIGN AND METHODS Nursing home administrators were asked in 2009 to report on facility culture and staff turnover. We received responses from 419 of 1,056 administrators contacted. Respondents reported the strength of cultural values using scales from a Competing Values Framework and percent of staff leaving annually for Registered Nurse (RN), Licensed Practice Nurse (LPN), and nursing aide (NA) staff. We estimated negative binomial models predicting turnover. RESULTS Turnover rates are lower than found in past but remain significantly higher among NAs than among RNs or LPNs. Facilities with stronger market values had increased turnover among RNs and LPNs, and among NAs when turnover was adjusted for facilities with few staff. Facilities emphasizing hierarchical internal processes had lower RN turnover. Group and developmental values focusing on staff and innovation only lowered LPN turnover. Finally, effects on NA turnover become insignificant when turnover was adjusted if voluntary turnover was reported. IMPLICATIONS Organizational culture had differential effects on the turnover of RN, LPN, and NA staff that should be addressed in developing culture-change strategies. More flexible organizational culture values were important for LPN staff only, whereas unexpectedly, greater emphasis on rigid internal rules helped facilities retain RNs. Facilities with a stronger focus on customer needs had higher turnover among all staff.
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Affiliation(s)
- Jane Banaszak-Holl
- Department of Health Management and Policy, University of Michigan School of Public Health, Institute of Gerontology, University of Michigan Medical School, Ann Arbor.
| | - Nicholas G Castle
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | | | - Nijika Shrivastwa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Gretchen Spreitzer
- Department of Management and Organizations, University of Michigan Ross Business School, Ann Arbor
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