Task Design, Motivation, and Nursing Home Care Quality Final rept. (Sept. 30, 2001-Sept. 29, 2004)

摘要

The purpose of the study was to determine if variation among nursing homes in the task design of nursing care jobs was present, and how such variation is related to differences in worker outcomes and differences in care quality indicators. This study fills an important gap in current knowledge of factors influencing job satisfaction of long-term care workers, which has largely focused on higher-level structural variables such as nursing home size and ownership, or on individual employee variation in adherence to required elements of care. Primary data were collected from 1146 nurses and nursing assistants in 20 Massachusetts nursing facilities. Minimum Data Set (MDS) data were obtained from the Center for Medicare and Medicaid Services (CMS) to assess three resident outcomes for residents in the 20 facilities during the study period. Employee perceived elements of task design and work outcomes were assessed via the Job Diagnostic Survey (JDS). Logistic regressions were used to develop risk-adjustment models. Linear models were applied to examine the relationship between risk-adjusted resident outcomes and individual task design characteristics. We found significant inter-facility variation in aspects of nursing care job design, and in employee outcomes related to that variation. While some aspects of job design were positively linked with lower rates of problematic resident outcomes, others were not. The positive linkages, with the job characteristics of task identity, intrinsic feedback, and autonomy, are suggestive, however. Neither job satisfaction nor motivation was significantly related to the resident outcomes investigated.