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Updated: May 3, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

High-performance workplace practices in nursing homes: an economic perspective.

Christine E Bishop¹

¹Address correspondence to Christine E. Bishop, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02254-9110.

The Gerontologist

|January 21, 2014

Summary

Nursing home culture change initiatives share similarities with high-performance work systems but lack essential elements like intensive training and competitive compensation. Implementing these would improve care quality and worker commitment.

Keywords:

Culture change Nursing home Resident-centered care Work system Workforce

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Last Updated: May 3, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Area of Science:

Health Services Research
Human Resources Management
Organizational Behavior

Background:

Nursing home culture change aims to improve care quality and resident experience.
High-performance work systems (HPWS) in other industries are linked to enhanced productivity and quality.
A comparison is needed to identify gaps and opportunities in nursing home employment practices.

Purpose of the Study:

To compare nursing home culture change work practices with HPWS.
To identify essential elements missing in nursing home culture change initiatives.
To propose policy and practice implications for improving the nursing home sector.

Main Methods:

Literature review of economics and human resources management research.
Comparative analysis of nursing home culture change and HPWS.
Identification of commonalities and discrepancies between the two systems.

Main Results:

Nursing home culture change shares features with HPWS, including worker autonomy and self-managed teams.
HPWS necessitate intensive recruitment, screening, ongoing training, and supportive compensation, which are often absent in nursing homes.
Culture change in nursing homes lacks critical elements that require higher compensation.

Conclusions:

Nursing home culture change systems are incomplete compared to successful HPWS.
Higher compensation, supported by purchasers like public payers, is crucial for implementing essential HPWS elements.
Shifting to a 'high-road' employment system in nursing homes could enhance care and worker commitment.