Nursing homes that cultivate a caring environment for workers—one in which employees feel like valued team members — results in better care for their residents, according to a study published in the journal Health Services Research.
“We know from other fields of medicine that teamwork — the relationship between coworkers that facilitates decision making and care coordination — plays an important role in the quality of care,” said Helena Temkin-Greener, Ph.D., lead author of the study and professor in the department of community and preventive medicine at the University of Rochester Medical Center (URMC).
“Our body of work in this area demonstrates that, while many nursing home managers may contend that they have teams in place to coordinate care, it is only when staff perceives that they are part of a cohesive unit that the quality of care is improved.”
Researchers looked over data from over 45,000 residents in 162 nursing home facilities across New York State. They measured the quality of care by keeping track of the frequency of incontinence and pressure ulcers, conditions that, while very common in nursing homes, often can be prevented from occurring.
In nursing homes, the frequency of these conditions may be aggravated by poor staff communication, inadequate handoffs during shift changes, and poor care coordination. For example, pressure ulcers can be prevented by routine monitoring, regular repositioning of the patient, and by passing on patient information when care is transferred to the next staff member.
Researchers surveyed 7,418 nursing home workers providing direct patient care at these facilities to measure how they viewed staff unity — if the staff felt they shared common goals, values, responsibility for care delivery, and group identity. Answers to survey questions were used to come up with a numerical score, ranging from 1 to 5, that represented “staff cohesion” at each nursing home.
The researchers then compared the association between the feeling of staff unity and the occurrence of pressure ulcers and incontinence in that facility, adjusting for other patient factors.
They found that less than 0.25 point improvement in a nursing home’s staff unity score was associated with a 4.5 percent decrease in the prevalence of pressure ulcers and a 7.6 percent decrease in incontinence, showing a major improvement in both these health conditions.
“This study empirically demonstrates that better work relationships between staff, as measured by staff cohesion, are associated with better outcomes for nursing home residents,” said Temkin-Greener.
“Nursing home managers have the tools to encourage good patient care but they have to work at it and encourage practices that promote better cohesion, communication, and teamwork in their facilities. If they do this, the quality of care will improve.”