Measuring work environment and performance in nursing homes

Abstract

Background: Qualitative studies of the nursing home work environment have long suggested that attributes such as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant.

Objectives: This study is designed to develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance.

Research design and methods: The analysis was based on survey responses provided by managers (N = 308) and direct care workers (N = 7418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Cronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness.

Results: The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness have been demonstrated. Several individual (eg, occupation, race) and facility characteristics (eg, management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified.

Conclusions: The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care.

Figure 1. Impact of Work Environment on Organizational Performance

Adapted from: Shortell et al and Temkin-Greener et al