Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study

Int J Nurs Stud. 2017 Jan;66:15-22. doi: 10.1016/j.ijnurstu.2016.12.001. Epub 2016 Dec 6.


Background: A lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes.

Objectives: To examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes.

Design: Cross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems.

Settings: Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands.

Participants: Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards.

Methods: Ward rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward. Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards.

Results: In general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement 'In the event that a family member had to be admitted to a nursing home now, I would recommend this ward'. A better team climate was related to better perceived quality of care in both ward types (p≤0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p=0.028). In psychogeriatric wards, a lower score on market culture (p=0.019), better communication/coordination (p=0.018) and a higher rating for multidisciplinary collaboration (p=0.003) were significantly associated with a higher grade for overall quality of care. Total direct care staffing, adhocracy culture, hierarchy culture, as well as role model availability were not significantly related to quality of care.

Conclusions: Our findings suggest that team climate may be an important factor to consider when trying to improve quality of care. Generating more evidence on which work environment characteristics actually lead to better quality of care is needed.

Keywords: Nursing homes; Quality; Staffing; Team work; Work environment.

MeSH terms

  • Cross-Sectional Studies
  • Humans
  • Netherlands
  • Nursing Homes / organization & administration*
  • Nursing Homes / standards
  • Quality of Health Care*
  • Workplace*