The Impact of Chain Standardization on Nursing Home Staffing.
The Impact of Chain Standardization on Nursing Home Staffing.
复制标题
连锁标准化对疗养院人员配置的影响。
DOI：
10.1097/mlr.0000000000000998
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发表时间：
2018
期刊：
影响因子：
3
通讯作者：
Hirth,RichardA
中科院分区：
文献类型：
--
作者：
Banaszak-Holl,Jane;Intrator,Orna;Li,Jiejin;Zheng,Qing;Stevenson,DavidG;Grabowski,DavidC;Hirth,RichardA
背景：生产标准化在多实体连锁组织中很常见。虽然连锁店在养老院部门很突出，但尚未研究护理标准化。一种方法护理院连锁店可能标准化是通过控制水平和混合的人员配备在member homes.Objectives：检查标准化的程度发生在人员配备，其相对存在于不同类型的链，以及是否设施变得更加标准化收购后的chain.Research Design：我们估计预测的差异设施和链人员配备使用广义估计方程与2000-2010年的数据Subjects：本研究包括全国范围内的护理院，不包括医院为基础的家庭和家庭在阿拉斯加，夏威夷，和哥伦比亚特区。措施：链的所有权是从识别链名称的文本中编码的。两个护士的人员配置措施：工作人员每住院日和员工mix.Results小时：非常大的营利性连锁养老院和大型非营利组织有较少的变化，工作人员每住院日的时间（P< 0.001），但更大的变化在人员配置（P< 0.001）相比，全国连锁平均水平。大型营利性连锁店和中型非营利连锁店在每居民日的工作时间上有更大的分散性（P< 0.001），而大型非营利连锁店在人员配置上有更大的分散性（P< 0.001）。设施和连锁店的人员配置之间的差异随着时间的推移而下降。结论：最大的连锁店（营利性和非营利组织）的人员配置变化与国家标准相比，这表明他们是最好的实施企业的做法。在所有权变更后，随着时间的推移，人员配置逐渐向连锁平均水平靠拢，这表明标准化需要时间来实施。
Background:Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes.Objectives:To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether facilities became more standardized following acquisition by a chain.Research Design:We estimated predictors of the difference between facility and chain staffing using Generalized Estimating Equations with 2000–2010 data.Subjects:This study included nursing homes nationally, excluding hospital-based homes and homes in Alaska, Hawaii, and the District of Columbia.Measures:Chain ownership was coded from text identifying chain names. Two nurse staffing measures were used: staff hours per resident day and staff mix.Results:Very large for-profit chain nursing homes and large nonprofits had less variation in staff hours per resident day (P< 0.001) but greater variation in staffing mix (P< 0.001) compared with the chain average nationally. Large for-profit chains and medium nonprofit chains had greater dispersion on staff hours per resident day (P< 0.001), while large nonprofit chains had greater dispersion in staffing mix (P< 0.001). The difference between facility and chain staffing decreased over time.Conclusions:The largest chains (for-profit and nonprofit) had less staffing variation compared with national standards, suggesting they were best at implementing corporate practices. Following ownership changes, staffing converged towards chain averages over time, suggesting standardization takes time to implement.