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Nursing homes as complex adaptive systems: relationship between management practice and resident outcomes
Ruth A Anderson1, L Michele Issel, Reuben R McDaniel
1Duke University School of Nursing, Durham, North Carolina 27710, USA. Ruth.Anderson@duke.edu
Nursing Research
|January 29, 2003
Summary
Effective nursing home management, focusing on communication and leadership, improves resident outcomes like reduced aggression and restraint use. Larger facilities and experienced directors also contribute to better care quality.
Area of Science:
- Gerontology
- Healthcare Management
- Complexity Science
Background:
- Persistent issues with nursing home quality of care necessitate exploring effective management strategies.
- Clinical and regulatory interventions have not fully resolved quality of care problems in nursing homes.
Purpose of the Study:
- To investigate the relationship between specific management practices and resident outcomes in nursing homes.
- To test complexity hypotheses linking management (communication openness, decision making, leadership, formalization) to resident outcomes (aggression, restraint use, immobility, fractures).
Main Methods:
- A cross-sectional correlational field study involving 164 Texas nursing homes.
- Data collected via onsite surveys from nursing directors and registered nurses.
- Linked primary survey data with secondary data from Medicaid Cost Reports and the Texas Minimum Data Set (MDS).
Main Results:
- All tested management practices were associated with at least one resident outcome.
- Increased nursing home size and longer director tenure/experience correlated with better resident outcomes.
- The predictors collectively explained 11% to 21% of the variance in resident outcomes.
Conclusions:
- Findings support complexity science hypotheses regarding nursing home management and resident well-being.
- Rethinking nursing home management practices is crucial for improving care quality.
- Management practices fostering communication and interaction are vital for enhancing resident outcomes.