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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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

1. Did providers increase management practices and processes?

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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

2. Was there a difference between states by BJBC intervention?

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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

Appendix:

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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