Transcript JobTalk Presentation, Dissertation data

Examining a Relationship-based
Quality of Care in Organizations
with Different Ownership Types
Daphne P. Berry
PhD Candidate
University of Massachusetts Amherst
Jan. 25, 2011
01/2011
p.1
Agenda
• Background and description of my
•
•
•
01/2011
exploratory dissertation study
Research methods and data
Some preliminary findings
Contributions and future research
p.2
This study is about…
• Ownership and participation in home health
•
•
aide agency sector
Home Health Aide (HHA) agency outcomes to
caregivers (job satisfaction, org. commitment)
and clients
Productivity and a specific conceptualization
of “Quality of Care”
01/2011
p.3
Home Health Organization Types
State (All)
Total
Home Health Poviders
7000
State NY
6000
5000
Total
4000
Drop Series Fields Here
Total
3000
Home Health Poviders
2000
120
1000
100
0
Government
Non Profit
Proprietary
80
Drop Series Fields Here
Ownership Type
60
Total
40
20
0
Government
Non Profit
Proprietary
Ownership Type
01/2011
http://leadingage.org/about.aspx
p.4
Concepts
• Defining quality in a
Quality system
► Medical setting
► Direct care (includes nursing homes) setting
► Home health care setting
►
(Deming, 1982; Parasuraman, Zeithaml and Berry, 1985; Donabedian, 2005; Mor, 2006;
Eaton, 2000)
p.5
Concepts
• Caring labor
Usually worker and recipient in close
contact.
► Involves “caring for” and “caring about” the
recipient.
► Depends on the relationship between a
caregiver and the person cared for.
► Often, it is done for low or no pay.
►
(Folbre, 2003, 2001; Badgett and Folbre, 1999; Himmelweit, 1999)
p.6
Home Health Aides
Assist people with disabilities, are chronically ill,
cognitively impaired and elderly to live in their
own homes.
• Must obtain and maintain certification from states, Knowledgeable about
•
•
•
•
host of medical conditions, medications.
Perform light housekeeping.
Assist clients in and out of bed, with bathing, dressing, toileting, grooming.
Provide basic health-related services: checking pulse rate, temperature, and
respiration rate; help with simple prescribed exercises; assist with
medications administration; change simple dressings; give massages,
provide skin care; or assist with braces and artificial limbs; assist with
medical equipment such as ventilators.
Accompany to appointments.
p.7
Home Health Aide Agency Environment
federal and state programs
care coordinators
agencies
direct service
workers and clients
(*From
Scala, 2008) Home and Community Based Services: (Workforce
and Quality Outcomes)
p.8
Quality Care
•
Clinical aspects
► In home health environment, process measures are often
counts of
• How often home health team determined whether patients
had received a flu shot or
• Tasks to be completed by someone other than the HHA
(e.g. pain or depression assessment conducted)
► Heavy reliance on outcome indicators: improvement or
stabilization in
• Discharge to community, acute care hospitalization
• Patient ability to transfer to and from bed, groom, dress,
manage medications; Home care team checked or cared
for ulcers, wounds, UTIs, etc.
www.medicare.gov/HomeHealthCompare/Data/Measures/List.aspx
p.9
Quality Care
• Relationship between caregivers and clients is
important
Respect
► Security
► Caring
► Reliability
►
(Mor, 2006; Eaton, 2000)
p.10
Multi-method data collection
• Qualitative
Interviews – with home health aides, coordinators
and other agency management (24)
► Observations – during internal meetings, training
sessions (approx. 30)
► Documents – internal agency and publiclyavailable (50+)
►
• Quantitative
►
Survey (628 respondents total from 3 agencies)
p.11
Research Process
•
•
Interviews and observation for data on organizational
processes, for use with survey regarding quality of
care items.
Use items from pre-validated measure*, items from
interviews, home health aides and staff participated in
validation of final survey**
*survey instrument from “Shared Capitalism” research (Kruse, Freeman, Blasi, 2010)
** survey provided in English and Spanish
p.12
Initial propositions
How workers with or without an ownership stake
in the business and involved in organizational
decision-making would respond related to:
►
►
►
quality of care to clients
levels of job satisfaction
relations with management
p.13
Some preliminary results
p.14
Multiple comparisons, ANOVA means plots,
organizations not significantly different
OrgType- 1: For Profit, 2: Non Profit, 3: Worker Cooperative
p.15
Multiple comparisons, ANOVA means plots,
Worker Coop different from others
OrgType- 1: For Profit, 2: Non Profit, 3: Worker Cooperative
p.16
Multiple comparisons, ANOVA means plots,
All organizations different
OrgType- 1: For Profit, 2: Non Profit, 3: Worker Cooperative
p.17
Qualitative data
From caregivers at the cooperative:
► “The cooperative is a great place to work.”
► “Providing quality care is having the right training, caring
about patients.”
► “Taking care of patients is a hard job. I believe we should
make $10 an hour for the work we have to do in a patient’s
home. We aides go through a lot...”
From the for-profit:
► “Hell no I don't get paid fairly for what I do.”
► “We need more pay… we work like slaves for little pay.”
► “HHAs are not treated with any respect by the coordinator
and others in the office. They speak in a condescending
manner, very impatient and don't listen very well to HHAs but
they expect to be given respect… (Company) needs to be
investigated for abuse of labor and poor wages.”
p.18
Qualitative data
From the non-profit:
► “I enjoy caring for people. People in the administration
have always been kind but we should get paid more.”
► “Some of the HHAs receive bad treatment from the clients
or the client's family members -disrespect, cruel words, etc.
We can request to be removed but sometimes there might
not be a vacancy for a while. And even though the salary is
small, some of us stay because we are not sure if we will
get a worse case or an immediate vacancy. Of course, there
are wonderful clients and family members as well. I have a
college degree (associates). I was thinking to become a
nurse. I wanted a job and to see what it was like to work in
the home and help people. Soon, I will move on…”
p.19
Preliminary findings
• For quality of care – participation related to
•
•
HHA decision-making is important.
For job satisfaction – organization type not
most important, participation related to HHA
decision-making, inclusion and sharing are
important.
For management-employee relations –
organization type and participation related to
decision-making, inclusion and sharing are
important.
p.20
Conclusion
• Even in an industry with such challenging
staffing and other problems as home care,
employee participation in workplace
decisions is associated with positive
outcomes for workers, businesses and
clients.
p.21
Contributions
• Under-researched industry: home care and the
work environment of a critically-needed segment
of workers
• Adding to the initial studies related to quality of
care: focus on caregiver – client relationship,
intertwined outcomes to clients and caregivers
• Attention to democratic workplaces in the form
of worker-owned organizations, associated
participatory decision making
p.22
Future research
•
In the home health aide industry
►
►
►
►
Further development of relationship-based quality of care
measure
Study of how structural environment - including extensive
monitoring - may affect quality of care provided
Expanded study of quality of care concept including
perspectives of clients
Study of how participation in decision-making impacts
more comprehensive set of outcomes for the caregivers
p.23
Thank you.
Questions?
01/2011
p.24