(APPLICATION ABSTRACT): Unlike many other domains of health care, the provision of high-quality nursing home care depends on relatively untrained workers executing the same basic tasks each day, without many of the high stakes, unexpected, confusing situations that are often associated with omissions and errors in health care. In nursing home care, quality is compromised when workers as a group consistently neglect elements of good basic care; for example, when failure to regularly reposition immobile residents leads to the development of pressure ulcers. The likelihood of such occurrences is heightened by the problems of worker recruitment and retention in the low-skill, low-paying jobs that are central to the provision of such care. Research across many industries has found that several characteristics of how jobs are designed can be changed in ways that influence work motivation: creating conditions that make jobs more motivating, eliciting improved performance, and reducing turnover. Task design features are important at both the level of individual jobs and at the level of jobs performed by groups or teams. We hypothesize that variation in job design, at both the individual and group levels, is associated with differences in staff satisfaction and with differences in care quality indicators. We will study 25 nursing homes, collecting data from several sources. We will administer the Job Diagnostic Survey to nursing home employees to collect data on the design of individual jobs, and on employee job satisfaction, across multiple job categories, primarily nurse aides and licensed practical nurses. Data about group task design will be collected through structured observation and interviewing of a sample of managers and employees in each nursing home. Commonly accepted quality indicators derived from the Minimum Data Set (MDS) will be used to assess care quality. Analyses will relate job design characteristics to employee job satisfaction and to care quality. This study will provide important information regarding the variation among nursing homes in the task design of nursing care jobs, and about how such variation is related to differences in worker outcomes and differences in care quality indicators. This information will fill an important gap in current knowledge, which has largely focused on higher-level structural variables, such as nursing home size and ownership, or on individual employee variation in adherence to required elements of care. Findings may suggest approaches to task design that are likely to be associated with better worker and quality outcomes. The connections between task design, worker satisfaction, and care quality are of interest in care settings beyond nursing homes, particularly in other settings where care is increasingly provided by health care workers without extensive professional training.
| Tyler, Denise A; Parker, Victoria A (2011) Staff teamwork in long-term care facilities: the influence of management style, training, and feedback. Res Gerontol Nurs 4:135-46 |
