TY - JOUR
T1 - Supporting employees' work-family needs improves health care quality
T2 - Longitudinal evidence from long-term care
AU - Okechukwu, Cassandra A.
AU - Kelly, Erin L.
AU - Bacic, Janine
AU - DePasquale, Nicole
AU - Hurtado, David
AU - Kossek, Ellen
AU - Sembajwe, Grace
N1 - Funding Information:
Research conducted as part of Work, Family and Health Network, which is funded by cooperative agreement through National Institutes of Health and Centers for Disease Control and Prevention: Eunice Kennedy Shriver National Institute of Child Health and Human Development ( U01HD051217 , U01HD051218 , U01HD051256 , U01HD051276 ), National Institute on Aging ( U01AG027669 ), the National Heart, Lung and Blood Institute ( R01HL107240 ), Office of Behavioral and Social Sciences Research , and National Institute for Occupational Safety and Health ( U01OH008788 , U01HD059773 ). Phase one interview transcription and analysis was funded by the University of California, San Francisco Health Disparities Working Group Pilot grant. CAO & JB were funded by Harvard Chan School Career Incubator Funds and NIOSH ( U19OH008861 ); ND funded by NIA ( F31AG050385 ). We gratefully acknowledge the contributions of project staff and thank the facilities' owners, managers, and workers for their participation.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59-0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality.
AB - We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59-0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality.
KW - Long-term care
KW - Low-wage workers
KW - Multi-method design
KW - Occupational health
KW - Organizational climate
KW - USA
KW - Work-family conflict
KW - Work-family support
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U2 - 10.1016/j.socscimed.2016.03.031
DO - 10.1016/j.socscimed.2016.03.031
M3 - Article
C2 - 27082022
AN - SCOPUS:84962865420
VL - 157
SP - 111
EP - 119
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
ER -