Relationship between coworkers plays an important role in the quality of care

University of Rochester Medical CenterJun 8 2012

Nursing homes that foster an environment in which workers feel they are valued contributors to a team of caregivers provide better care to their residents. That is the conclusion of a study out this month in the journal Health Services Research.

"We know from other fields of medicine that teamwork - the relationship between coworkers that facilitates decision making and care coordination - plays an important role in the quality of care," said Helena Temkin-Greener, Ph.D., lead author of the study and professor in the Department of Community and Preventive Medicine at the University of Rochester Medical Center (URMC). "Our body of work in this area demonstrates that, while many nursing home managers may contend that they have teams in place to coordinate care, it is only when staff perceives that they are part of a cohesive unit that the quality of care is improved."

The study's authors used data on over 45,000 residents in 162 nursing home facilities across New York State. They measured the quality of care by examining the incidence of incontinence and pressure ulcers, conditions that, while highly prevalent in nursing homes, can frequently be prevented from occurring. In nursing homes, the prevalence of these two conditions may be exacerbated by poor staff communication, inadequate hand-offs during shift changes , and inefficient coordination of care. For example, pressure ulcers can be avoided by taking simple steps such as routine monitoring, regular repositioning of the patient, and the relay of this information when care of a patient is transferred between nursing home staff.

The authors surveyed 7,418 nursing home staff providing direct patient care at these facilities to measure perceived staff cohesion, defined by the extent to which staff share common goals, values, responsibility for care delivery, and group identity. Answers to survey questions were used to construct a numerical score (ranging from 1 to 5) that represented "staff cohesion" at a given nursing home.

The authors then examined the association between staff cohesion and prevalence of pressure ulcers and incontinence in that facility, adjusting for other patient characteristics. They found that less than 0.25 point improvement in a facility's staff cohesion score was associated with a 4.5 percent decrease in the prevalence of pressure ulcers and a 7.6 percent decrease in incontinence, representing a significant improvement in both these health outcomes.

"This study empirically demonstrates that better work relationships between staff, as measured by staff cohesion, are associated with better outcomes for nursing home residents," said Temkin-Greener. "Nursing home managers have the tools to encourage good patient care but they have to work at it and encourage practices that promote better cohesion, communication, and teamwork in their facilities. If they do this, the quality of care will improve."