Staff Interaction Habits Holding Back Nursing Home Quality Improvement

Staff interaction habits are holding back nursing home quality improvement, researchers find.

Nursing homes can improve resident care and staff satisfaction by changing the usual way that workers interact with each other, suggests newly published research from investigators at a handful of academic institutions.

To understand worker interactions, researchers interviewed staff members and reviewed organizational charts, survey reports and other information sources at four nursing homes — two with high quality ratings and two with low quality ratings. The researchers identified a “common pattern of interaction” and a “positive pattern of interaction.”

The common pattern was the “default” behavior for many workers at all levels, according to the researchers. In the common pattern, “people blamed others, avoided collaboration, decided ‘not to bother the nurse,' ignored others, said ‘it's not my job,' scolded others, or ‘passed the buck,'” they wrote.

Punitive managers and overreliance on rules fostered these bad patterns of interaction, the researchers stated. One example was a manager who “scolded” a nurse aide for leaving a shampoo bottle in a clean linen cart. The manager did not talk to the aide to learn that she had bought the shampoo using her own money, after observing that a resident did not respond well to the facility's shampoo.

The positive model consisted of 20 strategies that created more productive staff interactions and better resident outcomes. These strategies included being approachable, pitching in, listening carefully, and paying attention to surroundings. They led to better connections among workers, improved their satisfaction and promoted the exchange of information. They also led to “cognitive diversity,” in which workers from various parts of the facility came together to solve problems.

It was not as widespread as the common pattern in any setting, but the positive interaction pattern was seen in all four nursing homes, the researchers noted. Although their findings stem from only these four facilities in the southeastern United States, they have confidence that all nursing homes can improve by identifying and expanding on the “pockets of excellence” created by positive interactions, they wrote.

New job performance measures could encourage staff members to engage in positive interactions, the researchers suggested. Frontline nurses and aides likely are the best people to engage first, as the benefits of positive interactions were “most apparent” among these caregivers, they stated.

The findings appear in BMC Health Services Research. Study authors are affiliated with a variety of institutions, including the schools of nursing at Duke University, the University of North Carolina at Chapel Hill and The University of Texas at Austin.