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Nursing home working conditions are linked to care performance

Despite years of escalating regulatory oversight, the quality of nursing home care remains a national concern. A new study of 32 Colorado nursing homes found that better-performing nursing homes emphasized the importance of staff, quality communication, teamwork, and clear standards and expectations. Supported by the Agency for Healthcare Research and Quality (HS12028), Jill Scott-Cawiezell, Ph.D., of the University of Missouri-Columbia, and colleagues interviewed staff from nursing homes with higher care performance scores and noted how their leaders explicitly focused on, recognized, and expressed appreciation for staff. Leaders and staff more frequently mentioned feeling involved, empowered, and appreciated. Leaders from homes with lower scores did not emphasize staff and staff informants said that they felt underappreciated and unheard.

Staff working in low-scoring homes discussed a lack of good systems for learning about what is going on and said they did not receive clear communication about their roles or expectations. Conversely, those working in high-scoring homes discussed good communication and described strategies or tools used to enhance it. While staff from low-scoring homes expressed a lack of cohesion or team, staff at high-scoring homes were more likely to use the word teamwork and were able to clearly describe its impact on morale and care of the residents.

Finally, leaders at low-scoring homes were more likely to emphasize the nursing home's census and financial markers to define how well they were doing their work, while leaders at high-scoring homes emphasized an internal commitment to standards of care. These findings were based on staff surveys, secondary data such as State-cited deficiencies, and interviews with nursing home leadership and staff.

The study explained noteworthy points from which high- and low- scoring nursing homes diverged. These points of divergence share a key element: leadership.

See "Linking nursing home working conditions to organizational performance," by Dr. Scott-Cawiezell, Deborah S. Main, Ph.D., Carol P. Vojir, Ph.D., and others in the October 2005 Health Care Management Review 30(4), pp. 372-380.

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