Nursing home environment and organizational performance: association with deficiency citations

Work environment attributes--job design, teamwork, and work effectiveness--are thought to influence nursing home (NH) quality of care. However, few studies tested these relationships empirically.

We investigated the relationship between these work environment attributes and quality of care measured by facility-level regulatory deficiencies.

Data on work environment were derived from survey responses obtained (in 2006-2007) from 7418 direct care workers in 162 NHs in New York State. Data on facility deficiencies and characteristics came from the Online Survey, Certification and Reporting database. We fit multivariate linear and logistic regressions, with random effects and probability weights, to models with the following dependent variables: presence/absence of quality of life deficiencies, number of quality of care (QC) deficiencies, and presence/absence of high severity G-L deficiencies (causing actual harm/immediate jeopardy). Key independent variables included work effectiveness (a 5-point Likert scale score); percent staff in daily care teams and primary assignment. The work effectiveness measure has been demonstrated to be psychometrically reliable and valid. Other variables included staffing, size, facility case-mix, and ownership.

In support of the proposed hypotheses, we found work effectiveness to be a statistically significant predictor of all 3 measures of deficiencies. Primary assignment of staff to residents was significantly associated with fewer QC and high severity deficiencies. Greater penetration of self-managed teams was associated with fewer QC deficiencies.

Work environment attributes 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.