Nursing Home Work Environment and Organizational Performance: Association with Deficiency Citations

Work environment attributes - job design, teamwork, work effectiveness - are thought to influence nursing home (NH) quality of care. However, few studies tested these relationships empirically. We investigate the effect of these work environment attributes on quality of care measured by facility-level regulatory deficiencies.

Data on work environment are derived from survey responses obtained (in 2006-2007) from 7,418 direct care workers in 162 NHs in NYS. Data on facility deficiencies and characteristics come from the OSCAR database. The analysis is based on facility-level data.

The dependent variables are: number of health-related (HR) deficiencies; number of quality of care (QC) deficiencies; and presence/absence of high severity QC deficiencies (causing actual harm/immediate jeopardy). Independent variables of primary interest include: work effectiveness (a 5-point Likert scale score); percent staff in interdisciplinary teams and with primary assignment. The work effectiveness measure has been demonstrated to be psychometrically reliable and valid. Other variables include staffing, occupancy, facility case-mix, and ownership. Multivariate linear and logistic regression models with random effects and probability weights are employed.

Consistent with our hypotheses we find significantly fewer HR deficiencies in NHs with higher work effectiveness (p<0.001) and greater penetration of teams (p=0.013). Controlling for other factors, one standard deviation (0.216) increase in work effectiveness results in 1.73 decrease in HR deficiencies. Similar relationships hold for QC deficiencies.

Work environment attributes and organizational performance impact quality of care in NHs. These findings provide important insights for NH administrators and regulators in their efforts to improve quality of care for residents.