The influence of nursing home structures on the quality of work among nursing home workers: a systematic review
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2022-06-23
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en
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Abstract
The purpose of this research is to improve the quality of work among nursing home workers, by enhancing the understanding of the effect that structures have on the quality of work of nursing home workers. More specifically, in this research a systematic review has been conducted, which was used to explore the relation between two specific types of structures and elements of quality of work: the bureaucratic- and the flexible nursing home structure.
Nursing homes are not able to create a high quality of work when they implement a bureaucratic nursing home structure. The bureaucratic nursing home scores a high degree on the degree of functional concentration, the degree of operational differentiation, the degree of operational specialization, and the degree of separation between operational and regulatory activities. The high value of the parameters results in a structure in which nursing home workers have small and narrow operational tasks, without regulatory potential, and focused on multiple types of patients. Furthermore, nursing home workers perform all their tasks on their own, and thus perform their tasks in isolation. These bureaucratic structures negatively influence quality of work, due to several reasons. Bureaucratic nursing home structures: (1) increase job demands, as they increase the workload and time-pressures, (2) decrease job control, as they disable decision authority and intellectual discretion, (3) decrease social support, as they disable structural- and functional support, and (4) increase absenteeism and turnover, as they limit learning- and development opportunities, and limit the possibility to control stress conditions. As a result, a low psychological well-being and therefore a low quality of work will be created.
In contrast, nursing homes can create a high quality of work when they implement a flexible nursing home structure. The flexible nursing home structure scores low on the degree of functional concentration, the degree of operational differentiation, the degree of operational specialization, and the degree of separation between operational and regulatory activities. The low value of the parameters results in a structure in which nursing home workers have broad and complete tasks, contain full regulatory potential, and which focus on a specific number of patients instead of all patients. Furthermore, nursing home workers in a flexible nursing home structure do operate in teams, providing them with the opportunity to be part of the nursing home network. These flexible structures positively influence quality of work, due to several reasons. Flexible nursing home structures: (1) decrease job demands, as they decrease the workload and time-pressures, (2) increase job control, as they enable decision authority and intellectual discretion, (3) increase social support, as they enable structural- and functional support, and (4) decrease absenteeism and turnover, as they provide learning- and development opportunities, and enable the possibility to control stress conditions. As a result, a high psychological well-being and therefore a high quality of work will be created.
This model extends the literature on organization structures and healthcare, by providing insight in how a structure should be designed in such a way, that a high quality of work is created among nursing home workers. Moreover, this research integrates the influence of several structural characteristics on multiple quality of work elements. Besides the literature contributions that this research provides, practical contributions are also provided. More specifically, by enhancing the understanding of the influence of the nursing home structure on quality of work among nursing home workers, this research will contribute to the government, civil society organizations, managers of nursing homes, and individual nursing home workers.
A recommended direction of future research is that future research should conduct research on the influence of nursing home structures on quality of work among nursing home workers in other countries, future research should try and focus on the influence of all structural characteristics (parameter) on the quality of work among nursing home workers, and future research should try and focus on determining the best process for building a flexible structure in nursing homes.
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Faculteit der Managementwetenschappen