The proposed project relies upon a combination of primary and secondary data sources at the facility level, employee level and resident level to examine the use and impact of quality improvement activities in nursing facilities. The research will be conducted based on an on-going partnership between a research team from the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin-Madison and the Wisconsin Association of Homes and Services for the Aging (WAHSA). A conceptual framework is proposed by which the degree of institutionalization of quality improvement (QI) principles is a function of the implementation process, the organizational structure and the organizational culture. In turn, the degree of institutionalization is believed to influence the perceptions and objective measures of the impact of QI. In order to test the hypothesized relationships among these constructs, two types of data will be collected. Employee level data will focus on employee development, leadership, use of information to support QI activities, job characteristics, work environment, organizational commitment, perceptions of the quality of working life, and perceived quality of care delivered. Facility level data will include organizational characteristics as well as a set of reliable and valid quality indicators constructed from resident-level assessment data (MDS2.0) to provide objective measures of the impact of QI on resident care. To gather these data, two types of data collection procedures will be used: (1) surveying all employees in a sample 100 nursing facilities, members of the Wisconsin Association of Homes and Services for the Aging (WAHSA), and (2) gathering routinely collected resident- level information using the Resident Assessment Instrument (RAI). These data will be collected simultaneously in two different years to study changes over a period of one year. The data will be merged and two types of analyses will be undertaken with the employee as the unit of analysis in one set of analyses and the facility as the unit of analysis in the other. We will ascertain whether the data are consistent with our hypotheses that implementation processes, structural and cultural variables influence the institutionalization of QI activities which in turn impacts both the quality of working life and the quality of care delivered in nursing homes. The knowledge resulting from these analyses will be of direct use to nursing homes throughout the U.S. who are seeking to implement a quality improvement philosophy within their facilities.
