Leadership, staffing and quality of care in nursing homes

Abstract

BackgroundLeadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care.MethodsA cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively.ResultsTask-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff.ConclusionsLeaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care.

Process Evaluation of a Quality Improvement Project to Decrease Hospital Readmissions From Skilled Nursing Facilities

“…This is not surprising as leadership has been documented as a critical success factor in QI initiatives in SNFs. 11,12 A final observation on the recruitment process was the nonparticipation of SNF Medical Directors in the QIO recruitment visits. This may have resulted from their limited availability as parttime staff in these institutions, but, given the importance of SNF Medical Directors in influencing quality of care, 13 their input may have resulted in a higher participation rate.…”

The Lock Point of Patient Care Outcomes: Leader of Nursing Service Management: Review

“…Bu tarzda astlar veya çalışanlar yönetimin dışında tutulmuş olup amaçların, planların belirlenmesinde astlara söz hakkı tanınmamaktadır. 7 Lider, emirlerine kayıtsız şartsız uyulmasını ve kendine güven duyulmasını istemektedir. Demokratik-katılımcı liderlik stilinde karar alınmadan önce çalışanların düşünceleri araştırılmaktadır.…”

“…Genel olarak hemşirelik hizmetleri yönetiminde kullanılan liderlik stilleri arasında otokratik, demokratik-katı-lımcı ve tam-serbesti tanıyan liderlik stillerinin yanı sıra görev odaklı liderlik yaklaşımlarından biri olan etkileşimci liderlik stili de yer almaktadır. 3,6,7,[20][21][22][23] Ayşe AKBIYIK ve ark.…”

“…tarafından bahsedilen ve liderlik stili ile hasta sonuçları arasındaki ilişkiyi tanımla-yan bu teorinin geçerliliğini inceleyen çalışmalar mevcuttur. 3,7,[20][21][22][23] Yaşlı bakım evi, evde bakım hizmetleri ve hastaneler gibi çeşitli sağlık kurumlarında kesitsel, deneysel ve yarı deneysel araştırmalarda dönüşümcü liderlik stilinin hasta bakım kalitesini ve hasta güvenliğini dolaylı yoldan artırarak, hasta sonuçlarına pozitif yönden katkı sağladığı saptanmıştır. 2,21,[26][27][28][29][30][31] İlişki odaklı liderlik yaklaşımları ile yönetilen kliniklerde sağlık hizmeti ile ilişkili enfeksiyonlarda ve hasta mortalite oranlarında belirgin düzeyde azalma, hasta memnuniyetinde artış olduğu belirlenmiştir.…”

Care on demand in nursing homes: a queueing theoretic approach

“…Unfortunately, in most nursing homes this type of information is not available. Even basic staffing information as information about actual staffing hours is often of poor quality [18] or not available at all [17]. Our experience is that the lack of reliable data is a common problem in healthcare facilities.…”