Organizational Culture's Impact Across the Nursing Home Industry

描述(由申请者提供)：本建议评估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措施)的密切联系。虽然文化变革运动促进了组织文化的发展，以此作为提高养老院质量的一种手段，但我们没有关于普通设施人口在多大程度上坚持文化变革运动中突出的文化价值观或使设施容易受到组织变革影响的信息。 我们使用竞争价值观框架(CVF)在设施层面研究全面的文化价值观，并使用护理管理人员和主管(DON)作为确定组织文化的关键信息者。对组织文化的大规模定量研究往往将文化尺度中的结构、行为和价值因素结合在一起。我们特别使用了CVF价值导向的文化框架，以检查文化变革模型的关键要素，以便我们能够明确地建模价值观和组织结构之间的关系。我们将使用两个受访者的一致性来评估设施级别文化的可靠性和强度。 这项研究包括对六个州的1,305家机构的调查，这些机构最初是在2005-2006年间进行的人员流失率调查。根据原始回复率，预期调查回报率约为65%，这将导致对略高于800个设施的分析文件。这项研究确定了该州是否存在工作人员更替率较高的设施，以便我们能够确保高质量和低质量设施的代表性。将从现有数据集中衡量质量成果和设施结构特征。养老院文化将由四个尺度变量来确定，这些变量衡量CVF定义的四种价值观的强度：市场价值观、等级价值观、氏族价值观和世俗价值观，其中以氏族为导向的价值观是那些与文化变革运动联系最紧密的价值观。 多变量分析将确定管理员和DON的文化报告之间的对应关系，并将用于创建组织级别的文化量表。随后，将使用对州内分组方差进行校正的广义线性模型来估计组织结构对文化的影响，以及随后结构、文化、先前的结果和州位置对利益的结果-工作人员流动率和聚合的居民结果衡量标准的同时影响。作为这一点的一部分，我们将确定营业额是否会调节文化和结构对质量的影响。结果将导致更好地规范疗养院环境如何影响临床服务提供的模型，并开发组织级别变化的模型以提高服务提供。公共卫生RELEVANEC：价值观是高层管理人员建立组织文化的基础，可以用来推动组织变革和提高质量。我们在六个州的疗养院随机抽样调查护理管理人员和主管，以探索在整个行业的设施中使用哪些类型的文化价值观。我们还将这些数据与次要数据联系起来，以评估文化价值是否与设施的持久结构特征以及员工流动率和质量结果有关。

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.