Organizational Culture's Impact Across the Nursing Home Industry

描述（由申请人提供）：该提案评估了在养老院部门观察到的组织文化的范围，以及文化与设施结构特征和结果（如员工流动率和护理质量）的密切联系。虽然文化变革运动促进了组织文化的发展，作为提高养老院质量的一种手段，但我们没有关于设施的一般人群在多大程度上坚持文化变革运动中突出的文化价值观或倾向于组织变革的设施的信息。 我们使用一个竞争的价值观框架（CVF），研究了一系列的文化价值观，在设施水平，我们使用管理人员和护理主任（DON）的关键线人，在确定组织文化。组织文化的大量定量研究经常将联合收割机的结构、行为和价值因素结合在文化量表中。我们使用专门的CVF价值导向的文化框架，以检查文化变革模型的一个关键要素，使我们可以明确的价值观和组织结构之间的关系模型。我们将使用两个受访者的一致性来评估设施级文化的可靠性和强度。 这项研究包括对六个州的1,305个设施的调查，这些设施最初是在2005-2006年调查的。根据原始回复率，预期调查回报率约为65%，这将导致对800多个设施的分析文件。本研究确定的国家，如果有高员工流动率的设施，目前在国家，使我们可以确保代表高质量和低质量的设施。质量成果和设施结构特点的措施将从现有的数据集。养老院文化将通过四个规模变量来确定，这些变量测量CVF定义的四种类型的价值观的强度：市场，等级，氏族和adhocratic价值观，其中氏族导向的价值观是与文化变革运动最密切相关的价值观。 多变量分析将确定管理员和DON文化报告之间的通信，并将用于创建组织级文化量表。随后，广义线性模型与国家内的分组方差校正将被用来估计组织结构对文化的影响，随后，结构，文化，成果在以前的时间，和国家的位置上的利益-工作人员的流动和聚集居民的成果措施的同时影响。作为其中的一部分，我们将确定营业额是否介导文化和结构对质量的影响。结果将导致更好的规范模型如何护理之家的环境影响提供临床服务和发展的组织层面的变化，以提高服务提供的模型。公共卫生相关问题：价值观是高层管理者建立组织文化的基础，可以用来推动组织变革和提高质量。我们调查管理人员和护理主任在六个州的养老院随机抽样，以探讨什么类型的文化价值观是在整个行业的设施。我们还将这些数据与二级数据联系起来，以评估文化价值观是否与设施的持久结构特征以及员工流动率和质量结果相关。

DESCRIPTION (provided by applicant): This proposal evaluates the range of organizational cultures observed within the nursing home sector and how closely culture is linked to facility structural characteristics and outcomes such as staff turnover and quality of care measures. While the culture change movement promotes the development of organizational culture as a means to improve nursing home quality, we have no information on the extent to which the general population of facilities adheres to the cultural values that are prominent in the culture change movement or that predispose facilities to organizational change. We use a competing values framework (CVF) for studying a comprehensive range of cultural values at the facility level and we use administrators and directors of nursing (DONs) as key informants in identifying organizational culture. Large quantitative studies of organizational culture frequently combine structural, behavioral and value element in cultural scales. We use specifically a CVF value-oriented frame for culture in order to examine a key element of the culture change model and so that we can explicitly model the relationship between values and organizational structure. We will use consistency across the two respondents to evaluate reliability and strength of facility level culture. This study includes a survey of 1,305 facilities across six states that were originally surveyed in 2005-2006 regarding their turnover rates. The expected survey return is approximately 65% based on original response rates, which will lead to an analytic file on slightly over 800 facilities. States were identified for this study if there were facilities with high staff turnover rates present in the state so that we could insure representation of both high and low quality facilities. Measures of quality outcomes and facility structural characteristics will be taken from existing data sets. Nursing home culture will be identified by four scale variables that measure the intensity of four types of values defined by the CVF: market, hierarchical, clan and adhocratic values, where clan- oriented values are those most strongly associated with the culture change movement. Multivariate analyses will identify correspondence across administrator and DON reports of culture and will be used to create organizational level culture scales. Subsequently, generalized linear models with corrections for grouped variance within states will be used to estimate the effects of organizational structure on culture and subsequently, the simultaneous effects of structure, culture, outcomes at prior time, and state location on the outcomes of interest---staff turnover and aggregated resident outcome measures. As part of this, we will determine whether turnover mediates the effects of culture and structure on quality. Results will lead to better specification of models for how nursing home environments affect the delivery of clinical services and to the development of a model for organizational level change to enhance service delivery. PUBLIC HEALTH RELEVANEC: Values are the basis on which top managers build organizational culture and can be used to drive organizational change and improve quality. We survey administrators and directors of nursing in a random sample of nursing homes across six states to explore what types of cultural values are used in facilities throughout the industry. We also link these data to secondary data in order to evaluate whether cultural values are related to enduring structural characteristics of facilities and to employee turnover and quality outcomes.