Daily practice teams in nursing homes: What is the evidence from NYS?

Most healthcare organizations, including nursing homes (NH), report having teams. However, little is known about presence/absence of everyday practice teams in NHs. We assess perceptions of teamwork among NH managers and validate them by examining their association with facility attributes hypothesized to relate to teams.

A mail survey of nursing home managers (n=338) was conducted in 188 NYS facilities. We posited staff working in: formal teams with defined membership and process; self-managing teams, or no teams. Other survey items addressed: perceived importance of teamwork in NH operations; nurse aides' participation on teams; management style (autocratic, custodial, supportive or collegial); job characteristics; and facility characteristics (from OSCAR database).

We estimated multinomial logistic regression models with random effects to assess the association between team type (dependent variable) and facility characteristics.

Respondents characterized everyday work practice as: formal teams - 35.2%, self-managing teams - 39.6%, or no teams - 25.2%. Their observations are validated by strong associations with other facility attributes expected when teams are present. We find formal (OR=3.396) and self-managing (OR=2.547) teams to be more likely in facilities characterized by collegial management style. Formal teams are more likely when: management views teamwork as very important for staff turnover/retention (OR=3.053), and when LPN (OR=3.900) and CNA (OR=3.148) hours per resident per day are higher.

Study findings are based on managers' perceptions and may be overly optimistic. Further empirical assessment by direct care staff is needed. We discuss the implications of our findings for developing and sustaining team practice in nursing homes.