Improving long-term care management practices and direct care worker organizational commitment
Open Access
- Author:
- Stott, Amy Lynne
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 19, 2009
- Committee Members:
- Susan Diane Brannon, Dissertation Advisor/Co-Advisor
Susan Diane Brannon, Committee Chair/Co-Chair
Joseph J Vasey, Committee Member
Kathryn H Dansky, Committee Member
Melissa Hardy, Committee Member - Keywords:
- nursing homes
nursing supervisors
management practices
long-term care
direct care worker
training and development
work design
assisted-living
home care
organizational commitment - Abstract:
- High turnover of direct care workers is one of the biggest challenges in the long-term care industry today. Several types of management practices, such as staff training, professional development, career advancement opportunities, and work redesign, have been linked to employee organizational commitment. Previous studies show organizational commitment is associated with lower employee turnover. This study provides several contributions to the existing literature by filling gaps in previous research and resolving same-source bias. Testing relationships between direct care worker organizational commitment and management practices will expand on the existing long-term care organizational literature, which is primarily descriptive. Further, investigating the impact of each type of setting on this relationship is a new contribution to this body of literature. Methodologically, the use of separate respondents for organizational and direct care worker-level data reduces same-source bias between the organizational-level predictor variables and the direct care worker-level outcome variables (Fedor, Caldwell, & Herold, 2006). This analysis contains data from a panel of 76 clinical managers and 911 direct care workers who completed both waves of the Clinical Manager and Direct Care Worker Surveys used in the evaluation of the Better Jobs Better Care (BJBC) demonstration. The Clinical Manager Survey measures the work design, direct care worker training and development, and supervisor training management practice variables. The Direct Care Worker Survey contains items used to measure organizational commitment and demographics. Two types of research designs are used in this study. First, cross-sectional analyses, using baseline responses, investigate the relationship between baseline management practices and organizational commitment. Then, a one-group pretest-posttest design, examines whether changes in management practices change organizational commitment. Several types of linear regression techniques including ordinary least squares (OLS) and logistic regression with robust estimation are used to analyze the data. In the cross-sectional analysis, greater use of feedback is associated with direct care workers recommending the organization for a job and thinking about quitting less often. Supervisor participation in a greater number of training programs and having direct care workers participation in career ladder programs is also related to direct care workers recommending the organization for a job. Staff participation in a greater number of staff training programs is also related to direct care workers being less likely to leave their job in the next year. Being a nursing facility and having staff development and training programs is also linked with direct care worker organizational commitment. However, including interactions only improved the models marginally. The only consistent relationship in the cross-sectional and longitudinal analyses is the association of supervisor training with direct care workers recommending the organization for a job. Findings suggest aspects of both work design and staff training and development practices are related to direct care worker organizational commitment. For long-term care policy makers and administrators, who are concerned about increasing direct care worker retention, this study offers empirical evidence to formulate policies that improve management practices in these areas.