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How Does Leadership Influence Quality of Care? Towards a Model of Leadership and the Organization of Work in Nursing Homes

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Abstract

Research has shown that certain styles of leadership and the use of work groups are related to higher nursing home quality, but few studies have described how these factors influence quality of care. This study examines how, or through which processes or mechanisms, the: (1) use of work groups, and (2) active leadership are associated with high quality of care in Norwegian nursing home wards. In addition, with our findings, we propose a Model of Leadership and the Organization of Work in Nursing Homes. Qualitative data from field observations and interviews were used to answer the research questions. The analysis was conducted by comparing two groups of nursing home wards. Group 1 consists of the eight (20%) highest quality wards and group 2 of the eight (20%) lowest quality wards out of a sample of 40 wards. In the analysis, we listed similarities within each group and differences between the two groups in order to isolate characteristic, or mediator variables, that distinguish the high from the low quality wards. The analysis suggests that work groups influenced three, and leadership four, mediators, which in turn may influence nursing home quality. These seven mediators could help explain how work groups and leadership effect quality of care. We found that the use of work groups seemed to foster the development of psychological ownership, perceived insider status and shared mental models among care workers, while active leadership seemed to foster the development of a strong work ethic, positive work environment, professionalism, and an organizational vision. A Model of Leadership and the Organization of Work in Nursing Homes may be useful for nursing home owners, administrators, ward leaders, and policy makers interested in improving the quality of care in nursing homes. With knowledge of how the use of work groups and leadership influence quality of care, such processes can be cultivated and facilitated to achieve higher nursing home quality. Our findings imply that policies that encourage smaller work groups, enhance leadership skills of ward leaders, and minimize ward leader’s administrative tasks may lead to higher quality of care in nursing homes.

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Abbreviations

MDS:

Minimum Data Set

FTE:

Full Time Equivalent

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Acknowledgements

The authors wish to express their gratitude to the nursing homes and their employees that participated in this study, and to the Research Council of Norway (Reference number: 187986/V50) for financing the study.

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Authors and Affiliations

  1. Centre for Care Research, Gjøvik University College, Teknologiveien 22, N-2815, Gjøvik, Norway

    Anders Kvale Havig

  2. Norway & Social and Behavioral Sciences, UCSF School of Nursing, San Francisco, CA, USA

    Anders Kvale Havig

  3. Institute for Health Aging, UCSF School of Nursing, San Francisco, CA, USA

    Brooke Hollister

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Havig, A.K., Hollister, B. How Does Leadership Influence Quality of Care? Towards a Model of Leadership and the Organization of Work in Nursing Homes. Ageing Int 43, 366–389 (2018). https://doi.org/10.1007/s12126-017-9304-8

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