Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

Elderly/Long-term Care

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Nursing homes that emphasize team effort and staff flexibility are more likely to sustain improvements in quality of care

Nursing home organizational cultures that emphasize a team or group approach and staff flexibility are more likely to implement and sustain quality improvement programs, suggests a survey supported by the Agency for Healthcare Research and Quality (HS12028). Jill Scott-Cawiezell, Ph.D., R.N., of the University of Missouri, and colleagues surveyed the leaders and staff of 31 U.S. nursing homes about their dominant organizational culture: group, developmental, hierarchy, or market.

Staff responses from 84 percent of the nursing homes reflected a dominant group culture, indicating a family and team orientation that provides an optimal context for working conditions that sustain quality improvement efforts. However, the strength of the overall group culture was weak in 55 percent of the homes, suggesting competing values, perhaps from nursing home administrators, who more often reflected a hierarchy value orientation. These facilities emphasized efficiency of operations and the importance of following rules and procedures. Organizational flexibility scores ranged from 46 to 64, with a mean flexibility score of 53.4. Nursing homes with scores lower than 53 more often reported issues with staff morale, team work, and ability to move from crisis management to continuous quality improvement.

See "Nursing home culture: A critical component in sustained improvement," by Dr. Scott-Cawiezell, Katherine Jones, Ph.D., R.N., F.A.A.N., Laurie Moore, M.P.H., and Carol Vojir, Ph.D., in the October 2005 Journal of Nursing Care Quality 20(4), p. 341-348.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care