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Pradhan R, Ghiasi A, Weech-Maldonado R. Leadership Matters: Investigating the Association Between Nursing Home Administrator Turnover and Quality. THE GERONTOLOGIST 2024; 64:gnae066. [PMID: 38835216 DOI: 10.1093/geront/gnae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Existing research has associated nursing home (NH) staff turnover with poor performance, yet the impact of nursing home administrator (NHA) turnover remains relatively understudied. This study aimed to explore the relationship between NHA turnover and NH quality, and to determine if this relationship was mediated by registered nurse (RN) turnover. RESEARCH DESIGN AND METHODS Utilizing data from multiple secondary sources, including the Care Compare: Skilled Nursing Facility Quality Reporting Program (SNF QRP) and LTCFocus.org, this study employed a longitudinal analysis covering the period 2021-2022 (n = 19,645). The dependent variable was quality star ratings from SNF QRP, whereas the independent variable was NHA turnover, reflecting the number of administrators who left each facility annually. We used Baron and Kenny's mediation testing method, incorporating 2-way fixed effects (state and year level) with appropriate organizational and market level control variables. RESULTS The results affirmed that NHA turnover negatively affected quality, decreasing the likelihood of a higher star rating by 14% with one departure and 25% with multiple departures (p = .001). Additionally, NHA turnover correlated with an increase in RN turnover by 7% and 11%, respectively, for one and multiple departures (p = .001). RN turnover fully mediated the impact of NHA turnover on quality, nullifying the direct effect of NHA turnover. DISCUSSION AND IMPLICATIONS The results of this study highlight the synergistic relationship between administrators and caregivers in NHs. To enhance NHA retention, NHs should improve compensation and benefits. Nonetheless, broader governmental support and interventions might be necessary to sustain these improvements.
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Affiliation(s)
- Rohit Pradhan
- School of Health Administration, Texas State University, San Marcos, Texas, USA
| | - Akbar Ghiasi
- Healthcare Administration Department, University of the Incarnate Word, San Antonio, Texas, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kiljunen O, Savela RM, Välimäki T, Kankkunen P. Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review. Res Nurs Health 2024; 47:397-408. [PMID: 38522016 DOI: 10.1002/nur.22382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.
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Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Kuusi T, Kulvik M, Härmä M, Ropponen A. Workload and short sickness absences in a cohort of Finnish hospital employees. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01698-8. [PMID: 38780861 DOI: 10.1007/s10198-024-01698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
This article used register data on day-to-day working hours of hospital employees combined with patient characteristics at work unit (wards) level to measure workload and its implications for short, self-certified sickness absences. We measured statistically the average nursing treatment burden of different patient mixes in hospital wards, and then analyzed the overall workload (intensity) of working days by comparing it to the actual available nursing workforce. We found that a significant part of the workload variation occurred between working days, and it was related to unexpected changes in the number of employees. In atypical situations a long work shift was associated with caring for patients with fewer resources. The high workload of a day increased the risk of short sickness absences along the following 3-week period. The results show that managing short-term workload variability should be a key aim from the perspective of well-being at work, and that combining different data sources can provide novel, important insights to the measurement of workload.
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Affiliation(s)
- Tero Kuusi
- Etla Economic Research, Helsinki, Finland.
| | - Martti Kulvik
- Etla Economic Research, Helsinki, Finland
- Etlatieto Oy, Helsinki, Finland
| | - Mikko Härmä
- The Finnish Institute of Occupational Health, Helsinki, Finland
| | - Annina Ropponen
- The Finnish Institute of Occupational Health, Helsinki, Finland
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Burfeindt C, Darmann-Finck I, Stammann C, Stegbauer C, Stolle-Wahl C, Zündel M, Rothgang H. Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes. BMC Nurs 2024; 23:201. [PMID: 38528537 DOI: 10.1186/s12912-024-01883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Staffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm 1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm 1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development. METHODS The mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm 1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm 1.0 into Algorithm 2.0 will be derived. DISCUSSION In Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023).
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Affiliation(s)
- Corinna Burfeindt
- SOCIUM Research Center On Inequality and Social Policy Mary-Somerville-Straße 3, University of Bremen, 28359, Bremen, Germany.
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Ingrid Darmann-Finck
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Carina Stammann
- Department of Evaluation and Implementation Research, aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Constance Stegbauer
- Department of Evaluation and Implementation Research, aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Claudia Stolle-Wahl
- Centre for Nursing Research and Counselling, Hochschule Bremen City University of Applied Sciences, Am Brill 2-4, 28195, Bremen, Germany
| | - Matthias Zündel
- Centre for Nursing Research and Counselling, Hochschule Bremen City University of Applied Sciences, Am Brill 2-4, 28195, Bremen, Germany
| | - Heinz Rothgang
- SOCIUM Research Center On Inequality and Social Policy Mary-Somerville-Straße 3, University of Bremen, 28359, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
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Palmers EE, De Almeida Mello J, Janssens L, De Visschere L, Declerck D, Duyck J. Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track. Gerodontology 2024; 41:149-158. [PMID: 37254273 DOI: 10.1111/ger.12693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults. MATERIALS AND METHODS An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme. RESULTS Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches. CONCLUSION By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.
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Affiliation(s)
- Ellen E Palmers
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Johanna De Almeida Mello
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- ELOHA (Equal Lifelong Oral Health for All) research group, Gerodontology, Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Lynn Janssens
- Gezonde Mond, Flemish Institute for Oral Health, Flemish Agency for Care and Health, Ghent, Belgium
| | - Luc De Visschere
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Gezonde Mond, Flemish Institute for Oral Health, Flemish Agency for Care and Health, Ghent, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
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Pradhan R, Ghiasi A, Davlyatov G, Orewa GN, Weech-Maldonado R. Beyond the Balance Sheet: Investigating the Association Between NHA Turnover and Nursing Home Financial Performance. Risk Manag Healthc Policy 2024; 17:249-260. [PMID: 38317855 PMCID: PMC10840411 DOI: 10.2147/rmhp.s421889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/02/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Nursing homes (NHs) serve as a safety net for vulnerable populations such as older adults and people with disabilities. Nursing Home Administrators (NHAs) play a crucial role in managing the daily operations of NHs, including overseeing direct care staff and establishing the facility's strategic direction. Unfortunately, NHs have consistently faced high NHA turnover rates, which have been linked to poor organizational performance. This study aims to investigate the relationship between NHA turnover and financial performance in NHs. Methods Using an integrated perspective based on the upper echelons theory and the resource-based view of the firm, we investigated the association between NHA turnover and financial peformance using multiple secondary data sources, such as the Care Compare: Skilled Nursing Facility Quality Reporting Program and Brown University's Long Term Care Focus. We conducted a cross-sectional study using a multivariate linear regression model, measuring financial performance using operating margin while NHA turnover represents the number of administrators that left the organization. Results Our findings indicate that NHs with higher NHA turnover rates have lower operating margins. Specifically, compared to facilities with no turnover, one NHA turnover is associated with a 1.14% decrease in operating margin, and two or more turnovers are associated with a 2.25% decrease. Discussion This study contributes to the existing literature by demonstrating the financial impact of NHA turnover and provides further evidence of the need for targeted organizational and policy interventions to improve NHA retention.
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Affiliation(s)
- Rohit Pradhan
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Akbar Ghiasi
- Healthcare Administration Department, University of the Incarnate Word, San Antonio, TX, USA
| | - Ganisher Davlyatov
- Health Administration & Policy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gregory N Orewa
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
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Estabrooks CA, Duan Y, Cummings GG, Doupe M, Hoben M, Keefe J, Poss JW, Song Y, Squires JE, Wagg A, Norton PG. Changes in Health and Well-Being of Nursing Home Managers from a Prepandemic Baseline in February 2020 to December 2021. J Am Med Dir Assoc 2023; 24:148-155. [PMID: 36584970 DOI: 10.1016/j.jamda.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. DESIGN Repeated cross-sectional survey. SETTING AND PARTICIPANTS A random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month. METHODS We measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory-exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form-8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity. RESULTS The final sample included 181 care managers (87 in the pre-COVID survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference -0.26, 95% CI -0.47 to -0.06; P = .011), cynicism (mean difference 0.43, 95% CI 0.02-0.84; P = .041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27; P < .001), and SF-8 mental health (mean difference -6.49, 95% CI -9.60 to -3.39; P < .001). CONCLUSIONS AND IMPLICATIONS Mental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed.
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Affiliation(s)
- Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Malcolm Doupe
- Max Rady College of Medicine, Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Janice Keefe
- Department of Family Studies & Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian Wagg
- Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Carnahan JL, Unroe KT. Prioritizing nursing home staff and leadership consistency to improve quality. J Am Geriatr Soc 2022; 70:2472-2473. [PMID: 35770904 PMCID: PMC9489602 DOI: 10.1111/jgs.17938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
This Editorial comments on the article by Zheng et al. in this issue.
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Affiliation(s)
- Jennifer L Carnahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kathleen T Unroe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
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