1 Did Better Jobs Better Care Change Management Practices and Processes? Amy Stott June 8, 2008 Presented at the 25 th AcademyHealth annual meeting. The.
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1
Did Better Jobs Better Care Change Management Practices
and Processes?Amy Stott
June 8, 2008
Presented at the 25th AcademyHealth annual meeting. The authors are grateful for supported from The Atlantic Philanthropies, The Robert Wood Johnson Foundation, and the National Institute on Aging Training Grant, Interdisciplinary Training in Gerontology, #T32 AG00048
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Data Source:Clinical Manager Survey
• Designed by the BJBC Evaluation Team at Penn State• Questions measuring the level of use
of management practices and processes• Respondents: Clinical Managers
Participating States by Provider Type
StateNursing Facilities
Assisted Living
Home Care Total:
Iowa 8 -- 4 12North Carolina 13 18 15 46
Oregon 4 5 1 10
Pennsylvania 11 4 7 22
Vermont 2 3 3 8Total: 38 30 30 98Note. Excluded adult day
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Top Management Training
Supervisor Training
Team Building
DCW Career Development
Caregiving Skill Development
BJBC Interventions
Clinical Manager’s Survey
Before During After
Design
Clinical Manager’s Survey
Demonstration Timeline
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Top Management Training
Supervisor Training
Team Building
DCW Career Development
Caregiving Skill Development
Surveyed Management Practices• Scales• Items
Clinical Manager’s SurveyBJBC Interventions
Matched Practices to Interventions
Not Related to Interventions
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Methods
• Calculated change
Time 2 – Time 1 = Difference Score
• Compared practices related to interventions with practices not related to interventions
Results:Supervisor Training Intervention
Management Practices & Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Supervisor training ( = 0.89) 2.47 2.04 0.43*** 0.004
Participation in care planning ( = 0.71) 2.71 2.59 0.12 0.206
Feedback ( = 0.66) 2.35 2.24 0.11 0.137
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***p<0.01
Other Interventions
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Interventions Significant ChangeTop Management Training NoneTeam Building +DCW Career Development +Caregiving Skill Development +Note. Positive change in: self-managed work groups related to team building; cross training, peer mentor, and opportunities to become a higher-level DCW or a Licensed Practical Nurse (LPN) related to DCW career development; DCW training related to caregiving skill development.
Not Related to Interventions
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Management Practices & Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Training linked to compensation 0.53 0.60 -0.07 0.264
Hiring strategy 0.31 0.37 -0.06 0.449Recruitment strategy 1.07 1.21 -0.14 0.159DCW write in charts 2.04 2.19 -0.15 0.432Resident/client satisfaction surveys 1.54 1.79 -0.25 0.125
Training linked to performance appraisal 0.68 0.67 0.01 0.854
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Methods• Calculated change
Time 2 – Time 1 = Difference Score
• Difference-in-difference for state that did intervention compared to states that did not
Intervention IA NC OR PA VTSupervisor Training √ √ √
Management Practice & Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Supervisor training ( = 0.89) -- -- -- --
Intervention 2.57 2.00 0.57*** 0.005
Non-Intervention 2.05 2.19 -0.14 0.750
Difference-in-difference -- -- 0.71** 0.045
Results:Comparison of States with and without
Supervisor Training Intervention
**p<0.05***p<0.01
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Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Participation in care planning ( = 0.71) -- -- -- --
Intervention 2.72 2.62 0.10 0.460
Non-Intervention 2.65 2.48 0.17 0.479
Difference-in-difference -- -- -0.07 0.653
Feedback ( = 0.66) -- -- -- --
Intervention 2.40 2.26 0.14 0.198
Non-Intervention 2.18 2.15 0.03 0.890
Difference-in-difference -- -- 0.11 0.560
Comparison of States with and without Supervisor Training Intervention
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State Comparison of Other Interventions
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Interventions Significant DifferenceTop Management Training No
Team Building +
DCW Career Development No
Caregiving Skill Development
Note. Positive difference in management communication between states that did team building and states that did not. Negative difference in permanent assignment between states that did caregiving skill development and states that did not.
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Summary• Modest increase in management practices
and processes• Greater increase related to BJBC
interventions• Positive differences between state that had
top management and supervisor training interventions compared to states without these interventions
Management Practices and ProcessesMeanTime 2
Mean Time 1
Mean Difference p-value
Self managed work groups 1.30 0.98 0.32** 0.025
Cross training 1.73 1.49 0.24* 0.053
Higher-Level DCW 0.87 0.63 0.24** 0.030
Become a Licensed Practical Nurse 0.51 0.37 0.14* 0.052
Designated peer mentor 1.09 0.81 0.28* 0.056
DCW Training ( = 0.72) 1.95 1.66 0.29*** 0.006
Organization Readiness for Change ( = 0.65) 2.72 2.60 0.12 0.108
Communication about tasks ( = 0.70) 3.01 2.90 0.11 0.196
Flex time for DCW 1.80 1.55 0.25 0.102
Permanent Assignment 2.66 2.49 0.17 0.285
Management Communication ( = 0.83) 2.46 2.45 0.01 0.948
Mean Difference of Management Practices and Processes
*p<0.10**p<0.05***p<0.01 18
Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Organizational Readiness for Change ( = 0.65) -- -- -- --
Intervention 2.70 2.59 0.11 0.485
Non-Intervention 2.73 2.61 0.12 0.346
Difference-in-difference -- -- -0.01 0.996
Management Communication ( = 0.83) -- -- -- --
Intervention 2.51 2.34 0.17 0.356
Non-Intervention 2.43 2.51 -0.08 0.623
Difference-in-difference -- -- 0.25 0.235
Comparison of States with and without Top Management Training
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Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Communication about task ( = 0.65) -- -- -- --
Intervention 3.00 2.90 0.10 0.373
Non-Intervention 3.02 2.91 0.11 0.461
Difference-in-difference -- -- -0.01 0.848
Management Communication ( = 0.83) -- -- -- --
Intervention 2.51 2.33 0.18 0.262
Non-Intervention 2.40 2.59 -0.19 0.329
Difference-in-difference -- -- 0.38* 0.066
Comparison of States with and withoutTeam Building Intervention
*p<0.10 20
Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Self-managed work group -- -- -- --
Intervention 1.43 0.90 0.53** 0.023
Non-Intervention 1.16 1.07 0.09 0.729
Difference-in-difference -- -- 0.47 0.164
Comparison of States with and withoutTeam Building Intervention
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**p<0.05
Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Cross Training -- -- -- --
Intervention 1.84 1.64 0.20 0.282
Non-Intervention 1.36 1.00 0.36 0.155
Difference-in-difference -- -- -0.16 0.525
Higher-level DCW -- -- -- --
Intervention 0.93 0.68 0.25 0.083
Non-Intervention 0.64 0.45 0.19 0.497
Difference-in-difference -- -- 0.06 0.806
Comparison of States with and withoutDCW Career Development
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Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
Become a Licensed Practical Nurse (LPN) -- -- -- --
Intervention 0.55 0.38 0.17 0.127
Non-Intervention 0.36 0.32 0.04 0.757
Difference-in-difference -- -- 0.13 0.473
Peer Mentoring -- -- -- --
Intervention 1.17 0.84 0.33 0.113
Non-Intervention 0.82 0.73 0.09 0.752
Difference-in-difference -- -- 0.24 0.425
Comparison of States with and withoutDCW Career Development
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Comparison of States with and without Caregiving Skill Development
Management Practice and Processes
MeanTime 2
Mean Time 1
Mean Difference p-value
DCW training ( = 0.72) -- -- -- --
Intervention 1.92 1.63 0.29 0.038
Non-Intervention 2.00 1.72 0.28 0.257
Difference-in-difference -- -- 0.01 0.938
Participation in care planning ( = 0.71) -- -- -- --
Intervention 2.71 2.59 0.12 0.416
Non-Intervention 2.69 2.60 0.09 0.597
Difference-in-difference -- -- 0.03 0.894
Permanent Assignment -- -- -- --
Intervention 2.60 2.61 -0.01 0.977
Non-Intervention 2.76 2.26 0.50 0.087
Difference-in-difference -0.49** 0.051
24*p<0.10
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