Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care

Abstract

We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1,214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n=30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as Correspondence should be sent to Cassandra A. Okechukwu, Assistant Professor, Harvard T.H Chan School of Public Health, 677 Huntington Ave, Kresge 7th Floor, Boston, MA 02115 (cassandrao@post.harvard.edu). Phone: +01 617 432 4486; Fax: +01 617 432 3123.. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (−2.62%) and other injuries (−9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (−17.94%) and falls with injuries (−7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59-0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing workfamily support and ensuring hi...

Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods

“…DONs were initially invited to respond to the survey based on previous evidence indicating that nursing home directors are more knowledgeable about workplace policies, programmes and practices than any other managers in the organisation. 10 Their knowledge is due to their involvement in the development and implementation of nursing home policies and procedures 13 and exposure to the clinical operations of nursing homes. 14 However, DONs were instructed to seek input or pass the survey to an appropriate health and safety representative for their nursing home, if needed.…”

“…The nursing home industry is of interest as its main goal is to provide high-quality patient care to an increasing ageing population. However, in the USA, the industry is sustained by a low-wage labour force and under-represented minorities and is largely dependent on payments from Medicaid and Medicare, 10 11 which are federal health programmes for low-income individuals and individuals over age 65. Evidence from research on nursing home facilities shows that placing workers’ health as secondary to patient care may have deleterious effects on quality of patient care by increasing employee turnover.…”

“…Evidence from research on nursing home facilities shows that placing workers’ health as secondary to patient care may have deleterious effects on quality of patient care by increasing employee turnover. 10 12 Measuring the implementation of integrated approaches to protect and promote workers’ health, safety and well-being in a nursing home population could help us understand how TWH approaches are associated with workers’, patients’ and enterprise outcomes.…”

How to ask: Surveying nursing directors of nursing homes

“…3,4 In qualitative studies, DONs provided more detailed information about workplace policies, programs, and practices than executives or other managers. 5,6 They also recognized the need to invest in worker health, but viewed this need as disconnected from the need to improve quality of care. 5,6 Earlier research reported on data collection methods in nursing homes in which researchers sought responses from both the administrator and the DON.…”

“…5,6 They also recognized the need to invest in worker health, but viewed this need as disconnected from the need to improve quality of care. 5,6 Earlier research reported on data collection methods in nursing homes in which researchers sought responses from both the administrator and the DON. 7,8 These studies generally had response rates over 50%.…”