Managers Shaping the Service Triangle: Navigating Resident and Worker Interests Through Work Design in Nursing Homes

Abstract

Managers play a key role in shaping the service triangle and navigating stakeholder interests within this. In health care, labor shortages are prompting consideration of the consequences of care delivery for service users and staff. Here, the authors consider how senior nursing home managers tasked with balancing resident and worker interests manage tensions using work design. The findings identify a five-cluster typology, reflecting variations in how managers from 20 Flemish nursing homes operationalize the same resident-centered care model. Managers purposively shape a different service triangle in each operationalization, variously prioritizing benefits for residents, seeking the golden mean, or attempting to suppress tensions.

Über-Alienated: Powerless and Alone in the Gig Economy

“…Platform firms also rely on customer evaluations to track and shape worker behavior. The importance of such evaluations is not unique to platform work, with a growing body of 'service triangle' scholarship documenting employers' use of customers as an indirect mechanism to control front-line service workers (Korczynski, 2009;Lopez, 2010;Subramanian & Suquet, 2018;Vermeerbergen et al, 2021). Nonetheless, the impact of customer evaluations is intensified by online labor platforms, since worker ratings are analyzed and used by an algorithmic control system to make decisions involving the allocation of future assignments as well as employee retention (Griesbach et al, 2019).…”

Creating “Risky” New Roles in Healthcare: Identities, Boundary-Making, and Skilling Under Rationalization and Consumer Demand

“…Our findings may not be applicable in settings where workers in the new role do not work as a team, are not asked to help shape the role, or do not work within a bureaucratic, hierarchical organization. Future research may benefit from a focus on the perspectives of managers and professionals, who likely view the creation of the new roles quite differently (Vermeerbergen et al, 2021). Additionally, we use interview data to understand the experiences of working within this new role.…”

“…Research on the "service triangle" between workers, customers, and management often centers on more transient encounters, finding that there are several different configurations of power within those encounters (Lopez, 2010;Subramanian & Suquet, 2018). In caring work, the long-term connections between workers and care recipients may shift the power dynamic to produce resistance against management, especially if management is seen to stand in the way of meaningful connections (Brown & Korczynski, 2010;DiCicco-Bloom & DiCicco-Bloom, 2019;Dodson & Zincavage, 2007;Vermeerbergen et al, 2021).…”

Working Hard for the Ones You Love and Care for Under Covid-19 Physical Distancing

“…Realising this model in an era of liberalisation and privatisation creates conflicts between cost reduction practices and customer-oriented behaviour, which induces debatable consequences for care workers. While Clarke (2015) emphasised that elderly care workers 'loved the work because they were able to "make a difference"', there is a constant danger in this model of workers becoming emotionally over-involved due to the close relationship with residents (Vermeerbergen et al, 2021) in a financial constraining care setting. Moreover, they are supposed to provide customised 'high-quality' care, an obligation which translates into broader care and personal tasks (Vermeerbergen et al, 2021).…”

“…In nursing homes, the latter has led to the introduction of a customer-centred organisational model (Lopez, 2006;Verbeek et al, 2009), a 'caring' model increasingly present in private and public nursing homes, where a 'homelike' care environment allows residents to live a life closely resembling their previous everyday life (Vermeerbergen et al, 2017). Although the benefits for residents are often sketched (Verbeek et al, 2009), whether a customer-centred model also improves working conditions in nursing homes is debatable (Lopez, 2006), especially as the new 'caring' model means that care workers become physically and emotionally more attached to residents (Vermeerbergen et al, 2021). The worker-customer relationship is a special one, consisting of a mix of worker 'duties' covering both the job and the 'moral' responsibilities involved in catering to residents' physical and emotional needs (Verbeek et al, 2009).…”