This proposal evaluates the range of organizational cultures observed within the nursing home sector and how closely culture is linked to facility structural characteristics and outcomes such as staff turnover and quality of care measures. While the culture change movement promotes the development of organizational culture as a means to improve nursing home quality, we have no information on the extent to which the general population of facilities adheres to the cultural values that are prominent in the culture change movement or that predispose facilities to organizational change. ? ? We use a competing values framework (CVF) for studying a comprehensive range of cultural values at the facility level and we use administrators and directors of nursing (DONs) as key informants in identifying organizational culture. Large quantitative studies of organizational culture frequently combine structural, behavioral and value element in cultural scales. We use specifically a CVF value-oriented frame for culture in order to examine a key element of the culture change model and so that we can explicitly model the relationship between values and organizational structure. We will use consistency across the two respondents to evaluate reliability and strength of facility level culture. ? ? This study includes a survey of 1,305 facilities across six states that were originally surveyed in 2005-2006 regarding their turnover rates. The expected survey return is approximately 65% based on original response rates, which will lead to an analytic file on slightly over 800 facilities. States were identified for this study if there were facilities with high staff turnover rates present in the state so that we could insure representation of both high and low quality facilities. Measures of quality outcomes and facility structural characteristics will be taken from existing data sets. Nursing home culture will be identified by four scale variables that measure the intensity of four types of values defined by the CVF: market, hierarchical, clan and adhocratic values, where clan- oriented values are those most strongly associated with the culture change movement. ? ? Multivariate analyses will identify correspondence across administrator and DON reports of culture and will be used to create organizational level culture scales. Subsequently, generalized linear models with corrections for grouped variance within states will be used to estimate the effects of organizational structure on culture and subsequently, the simultaneous effects of structure, culture, outcomes at prior time, and state location on the outcomes of interest---staff turnover and aggregated resident outcome measures. As part of this, we will determine whether turnover mediates the effects of culture and structure on quality. Results will lead to better specification of models for how nursing home environments affect the delivery of clinical services and to the development of a model for organizational level change to enhance service delivery. PUBLIC HEALTH RELEVANEC: Values are the basis on which top managers build organizational culture and can be used to drive organizational change and improve quality. We survey administrators and directors of nursing in a random sample of nursing homes across six states to explore what types of cultural values are used in facilities throughout the industry. We also link these data to secondary data in order to evaluate whether cultural values are related to enduring structural characteristics of facilities and to employee turnover and quality outcomes. ? ? ?
| Banaszak-Holl, Jane; Castle, Nicholas G; Lin, Michael K et al. (2015) The role of organizational culture in retaining nursing workforce. Gerontologist 55:462-71 |
| Banaszak-Holl, Jane; Castle, Nicholas G; Lin, Michael et al. (2013) An assessment of cultural values and resident-centered culture change in U.S. nursing facilities. Health Care Manage Rev 38:295-305 |
