Journal of Gerontological Nursing

CE Article 

Predictors of Staff-Supportive Organizational Culture in Assisted Living

Elzbieta Sikorska-Simmons, PhD

Abstract

This study examined predictors of staff-supportive organizational culture in assisted living settings. The sample included 294 staff members in 52 facilities. Organizational culture was assessed according to staff perceptions of teamwork, morale, information flow, involvement, supervision, and meetings. Hierarchical linear modeling was used to examine the effects of organizational factors (i.e., facility size, chain membership, ownership, level of care, level of residents’ disability) on staff-supportive organizational culture. More staff-supportive culture was associated with smaller facility size, chain membership, and a higher level of care. These findings point to the importance of organizational factors in shaping a staff-supportive organizational culture.

Abstract

This study examined predictors of staff-supportive organizational culture in assisted living settings. The sample included 294 staff members in 52 facilities. Organizational culture was assessed according to staff perceptions of teamwork, morale, information flow, involvement, supervision, and meetings. Hierarchical linear modeling was used to examine the effects of organizational factors (i.e., facility size, chain membership, ownership, level of care, level of residents’ disability) on staff-supportive organizational culture. More staff-supportive culture was associated with smaller facility size, chain membership, and a higher level of care. These findings point to the importance of organizational factors in shaping a staff-supportive organizational culture.

Dr. Sikorska-Simmons is Assistant Professor, Department of Sociology, University of Central Florida, Orlando, Florida.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity.

This research was funded by grant #1 RO3 AG-22100-01 from the National Institute on Aging. The author thanks Dr. Ann Christine Frankowski and Ms. Loren Butler for their excellent research assistance, as well as all administrators, residents, and staff members whose participation and cooperation made this research possible. The paper on which this article is based was presented at the 60th Annual Scientific Meeting of the Gerontological Society of America in San Francisco, California, November 20, 2007.

Address correspondence to Elzbieta Sikorska-Simmons, PhD, Assistant Professor, Department of Sociology, University of Central Florida, 4000 Central Florida Boulevard, PH 403P, Orlando, FL 32816-1360; e-mail: esikorsk@mail.ucf.edu.

Organizational culture refers to a system of values, beliefs, norms, and assumptions that guide the behavior of people in organizations (Schein, 1992). There is a growing recognition that organizational culture shapes work-related attitudes and the quality of services in long-term care environments (e.g., nursing homes, assisted living facilities). In particular, staff-supportive cultures that value staff empowerment, teamwork, and participation in decision making have been linked to higher staff job satisfaction, greater organizational commitment, lower staff turnover, improved quality of care, and positive resident outcomes (Eaton, 2000; Gifford, 2002; Hollinger-Smith & Ortigara, 2004; Laschinger, Finegan, Shamian, & Casier, 2000; Sikorska-Simmons, 2006). Despite this recognition, little is known about factors that foster staff-supportive organizational culture in long-term care facilities. The purpose of this study was to identify organizational predictors of staff-supportive organizational culture in assisted living settings.

Background

Staff-supportive organizational culture can be seen as being influenced by the facility’s internal structural conditions and external environmental context (Scott, 2003). Research suggests that facility structural conditions, such as size and resident case mix, are predictive of culture formation (Moos & Lemke, 1992a). For example, smaller facility size has been linked to more staff-supportive organizational culture. This might be because smaller facilities tend to be less bureaucratic and are more likely to foster socially cohesive relationships among workers (Moos & Lemke, 1992a).

Some evidence also suggests that residents’ disability level influences culture formation in long-term care facilities. Staff members in facilities with residents who are less disabled tend to perceive their organizations as more supportive than do staff members in facilities with residents who are highly impaired (Konetzka, Stearns, Konrad, Magaziner, & Zimmerman, 2005; Schaefer & Moos, 1996). This has been attributed to the fact that residents who are more disabled create a greater workload for staff, which in turn produces a less socially cohesive work environment.

In addition, organizational factors linked to facility environmental conditions can influence staff-supportive organizational culture. According to the resource dependence perspective, environmental conditions (e.g., ownership status, interorganizational connectedness) determine facility access to resources, which in turn fosters the development of organizational values, norms, and assumptions, which constitute the core elements of organizational culture (Gordon, 1991). Research consistently indicates that more resource-secure human service organizations tend to attract higher quality staff and are better able to meet their staff needs. For example, interconnected organizations with greater access to financial resources tend to have higher staffing levels, better division of labor, and better working conditions (Ermann & Gabel, 1986; Greenley & Schoenherr, 1981).

In the context of long-term care, facility ownership, chain membership, and regulatory status can be considered organizational variables that foster or impede facility access to resources. Research suggests that nonprofit facilities tend to be more resource secure than are for-profit facilities (Harrington, Woolhandler, Mullan, Carillo, & Himmelstein, 2002; Moos & Lemke, 1992a). This is because they attract residents from more privileged socioeconomic backgrounds (e.g., private-pay residents) and are more likely to draw on philanthropic sources for financial support (Harrington et al., 2002). In addition, facilities that are part of a chain have greater resources than do facilities that are not part of a chain, presumably because interconnected facilities have greater access to capital and, consequently, are more resource secure (Ermann & Gabel, 1986; Lavie, 2006).

Facility regulatory status (e.g., licensed level of care) also greatly determines resources. For example, facilities that are licensed to provide higher levels of care tend to have greater staff resources (e.g., more diversified staff in terms of occupational backgrounds, higher staff-to-resident ratios) than do facilities licensed for lower levels of care (Moos & Lemke, 1992a; Zimmerman, Sloane, & Eckert, 2001). Because organizational factors such as facility size, ownership, chain membership, regulatory status, and level of residents’ disability can influence culture formation, this study examined these factors as potential predictors of staff-supportive organizational culture.

There is a growing recognition that organizational culture exerts a strong influence on staff behavior and work-related attitudes in long-term care facilities. In particular, cultures that promote team-work and supportive relationships among staff have been linked to greater staff job satisfaction and stronger organizational commitment, which in turn are predictive of lower staff turnover and greater organizational effectiveness (e.g., better quality of services). Despite this recognition, little is known about factors that foster development of staff-supportive culture in long-term care facilities.

Therefore, the purpose of this study was to examine the effects of organizational factors on staff-supportive organizational culture in assisted living settings. Consistent with the literature, it was hypothesized that facility size, ownership, chain membership, regulatory status, and level of residents’ disability would be predictive of staff-supportive organizational culture. Greater understanding of how organizational factors affect organizational culture could help in designing strategies to improve the quality of the work environment for staff, and consequently, could contribute to the provision of better quality care.

Method

Design

Data used in this analysis came from 294 staff members in 52 assisted living facilities, which participated in a study that examined organizational determinants of resident autonomy. In total, 317 staff members and 61 assisted living facilities participated in the study, but 23 staff members and 9 facilities were excluded from this multilevel analysis because of missing data.

Sample

Assisted living was defined as a residential care program that provides housing and supportive services to older adults who need assistance with activities of daily living (Hawes & Phillips, 2000). An organizationally diverse sample of assisted living facilities was selected from licensed assisted living programs in Maryland, using an assisted living typology developed by Zimmerman et al. (2001).

According to this typology, assisted living facilities can be grouped into three categories: small, new model, and traditional homes. Small facilities are defined as housing 16 or fewer residents. New-model facilities house 16 or more residents, are purpose built after 1986, and fulfill at least one of four criteria (different private-pay monthly rates, at least 20% of resident population requiring assistance with transfer, at least 25% of residents incontinent daily, an RN or licensed practical nurse on duty 24 hours per day). Traditional facilities represent homes with 16 or more beds that could not be classified as new model.

Of the 52 participating facilities with complete data, 19 (37%) were new model, 17 (33%) were traditional, and 16 (31%) were small. The facilities ranged in size from 7 to 164 licensed beds. The number of occupied beds per facility varied from 6 to 129, with a mean of 35 beds (SD = 24). The majority of the 52 facilities were located in suburban areas (n = 39, 75%) and were licensed to provide three levels of care (i.e., were able to accommodate some residents whose functional status would otherwise qualify them for a nursing home) (n = 43, 83%). More than half (n = 30, 58%) of the 52 facilities were run as for-profit corporations, and nearly one third (n = 15, 29%) were part of an assisted living chain. The characteristics of the 52 facilities are presented in Table 1.

Facility Characteristics (N = 52)

Table 1: Facility Characteristics (N = 52)

In each facility, all staff members who were hired on a contract and who had daily contact with residents were invited to participate in the study. Research assistants distributed staff questionnaires during visits to each facility. The number of distributed staff questionnaires per facility varied from 1 to 25, with a mean of 9 questionnaires per facility.

Of the 574 staff questionnaires distributed, 317 were completed, for a response rate of 55%. Because of some missing data, 23 questionnaires were excluded from this analysis, resulting in 294 staff members. Their characteristics are presented in Table 2.

Staff Characteristics (N = 294)

Table 2: Staff Characteristics (N = 294)

Certified nursing assistants constituted the largest group of staff (n = 135, 46%). Almost all staff were women (90%), almost half were married (48%), and the majority were White (58%). The mean age was 43 (SD = 14 years). More than half (55%) of the staff had a 12th grade or lower educational level; only 16 (5%) were college graduates.

Instruments

The effects of organizational factors on staff-supportive organizational culture were assessed at two levels: the individual level (Level 1) and the facility level (Level 2). Organizational culture was measured at the individual level (Level 1), whereas organizational factors (i.e., facility size, ownership, chain membership, level of care, level of residents’ disability) were assessed at the facility level (Level 2). Data concerning organizational culture were collected from staff using self-administered questionnaires. Data concerning organizational factors were collected in interviews with administrators. Descriptive statistics and reliability estimates for the measures used in the study are presented in Table 3.

Descriptive Statistics and Reliability Estimates for Level 1 and Level 2 Variables

Table 3: Descriptive Statistics and Reliability Estimates for Level 1 and Level 2 Variables

Organizational Culture. Organizational culture (Level 1 dependent variable) was measured with the 36-item Organizational Culture Survey (OCS) developed by Glaser, Zamanou, and Hacker (1987). The OCS assesses organizational culture according to dimensions relevant to long-term care organizations (Scott, Mannion, Davies, & Marshall, 2003). These dimensions include employees’ perceptions of teamwork, morale, information flow, involvement, supervision, and quality of meetings. The authors established validity using observations and 45-minute critical incident interviews.

The Teamwork scale measures staff perceptions of coordination, honesty, support, and concern for each other (e.g., “People I work with function as a team.”). The Morale scale assesses staff perceptions of the quality of their working relationships and organizational character (e.g., “This organization respects its workers.”). The Information Flow scale refers to the quality of communication between staff and their supervisors (e.g., “I get the information I need to do my job well.”). The Involvement scale measures the extent to which staff members are involved in decision making (e.g., “I have a say in decisions that affect my work.”). The Supervision scale refers to staff perceptions of their supervisors (e.g., “When I do a good job, my supervisor tells me.”). The Meetings scale assesses staff perceptions of meetings (e.g., “Decisions made at meetings get put into action.”).

Each OCS item is scored on a 5-point scale (1 = to a very little extent to 5 = to a very great extent) and summed across items. Higher cumulative scores reflect more positive staff views of organizational culture. In this study, the Cronbach’s alpha coefficient for the entire OCS was 0.98, and the reliability estimates for the separate subscales (0.92 to 0.95) were higher than the estimates (0.63 to 0.91) reported in the original research (Glaser et al., 1987).

Predictors of Staff-Supportive Organizational Culture. Potential predictors of staff-supportive organizational culture (Level 2 independent variables) included facility size, chain membership, ownership status, level of care, and level of residents’ disability. Facility size was assessed with one item reporting the number of residents in the facility.

Chain membership was determined by facility ties to other assisted living organizations. Facilities that were part of a corporation that owned or operated more than two assisted living facilities were coded as 1, and facilities that were not part of a larger organization were coded as 0.

Facility ownership was measured using two categories: 1 = nonprofit and 0 = for profit. Facilities operated by voluntary organizations and run not for profit were coded as nonprofit. Facilities that were run for profit were coded as for profit.

Level of care was measured according to three categories: 1 = low, 2 = moderate, and 3 = high, as determined by Maryland assisted living regulations (i.e., based on the scope, frequency, and complexity of treatments and services required) (Department of Health and Mental Hygiene, 2001). Because no facilities provided only one level of care, level of care was subsequently recoded into two categories: 0 = moderate level of care and 1 = high level of care.

Level of residents’ disability was measured with a modified version of the Multiphasic Environmental Assessment Procedure Functional Ability scale (15 items, Cronbach’s alpha coefficient = 0.81) (Moos & Lemke, 1992b). The scale assesses an aggregate level of residents’ functional independence in performing activities of daily living, such as taking care of their own appearance, walking, getting in and out of bed, and handling money. The scale score reflects the percentage of residents who are completely independent in performing daily activities out of the total number of activities assessed. Higher percentage scores reflect greater aggregate levels of residents’ functional independence.

Data Analysis

Prior to the multilevel analysis, the relationships between organizational factors were examined using zero-order correlations. Subsequently, the effects of organizational factors on staff-supportive organizational culture were assessed using two-level hierarchical linear modeling (HLM), which takes into account the nested (hierarchical) structure of the data (i.e., staff nested within facilities) (Raudenbush & Bryk, 2002). Organizational culture (Level 1 dependent variable) was regressed on organizational factors (Level 2 independent variables) using HLM 5 software (Raudenbush, Bryk, Cheong, & Congdon, 2001).

First, a one-way analysis of variance (ANOVA) (Level 1 hierarchical regression model) with random effects was calculated to assess the amount of variation in organizational culture within and across facilities. The Level 1 regression model was specified as follows: Yij = Boj + rij.

Yij depicts the organizational culture score for staff member i in the facility j (j = 1 through 52 facilities) and rij is a random error associated with the unique effect of the staff member i in the facility j. Boj is the intercept for the jth facility and represents the adjusted mean organizational culture score for staff members in facility j. The model was specified as random, and the error term rij was assumed to be normally distributed with a mean of zero and a constant Level 1 variance.

Second, a Level 2 intercept-as-outcome hierarchical regression model was used to assess the effects of organizational factors (i.e., facility size, chain membership, ownership status, level of care, level of residents’ disability) on organizational culture. The Level 2 model was specified as follows: Boj = γ00 + γ01 (size) + γ02 (chain) + γ03 (ownership) + γ04 (level of care) + γ05 (level of residents’ disability) + μoj.

In the intercept-as-outcome regression (Level 2) model, the adjusted mean score of organizational culture in the facility j (i.e., the intercept Boj) was expressed as a function of the grand mean (γ00) and the Level 2 independent variables, including facility size (γ01), chain membership (γ02), ownership (γ03), level of care (γ04), level of residents’ disability (γ05), and a unique facility effect (error term μoj).

Subsequently, a multilevel model of the relationship between organizational factors and staff-supportive organizational culture was specified as follows: Yij = Boj + γ00 + γ01 (size) + γ02 (chain) + γ03 (ownership) + γ04 (level of care) + γ05 (level of residents’ disability) + μoj + rij.

In the two-level model, Yij staff member i organizational culture score in the facility j (j = 1 through 52 facilities) was expressed as a function of the grand mean of organizational culture, Level 2 variables, a random error (μoj) associated with the unique effect of the facility j and a random error (rij) associated with the unique effect of staff member i in the facility j. The coefficients γ01 through γ05 indicate the degree to which organizational factors (Level 2) influence staff-supportive organizational culture (Level 1).

Results

Zero-order correlations were used to examine relationships between organizational factors. These correlations are presented in Table 4. Zero-order correlations indicated that chain membership was related to facility size, level of residents’ disability, and level of care. Facilities that were part of a chain were larger, housed more functionally independent residents, and provided lower levels of care than did facilities that were not part of a chain. In addition, ownership status was associated with level of residents’ disability and level of care. Residents in nonprofit facilities were more functionally independent than were residents in for-profit facilities, and nonprofit facilities were licensed for lower levels of care than were for-profit facilities.

Zero-Order Correlations Organizational Factors (N = 52)

Table 4: Zero-Order Correlations Organizational Factors (N = 52)

The amount of variation in organizational culture within and across facilities was assessed using one-way ANOVA with random effects. The results are presented in Table 5.

Results of One-Way Analysis of Variance (ANOVA) Model with Random Effects

Table 5: Results of One-Way Analysis of Variance (ANOVA) Model with Random Effects

The grand-mean culture score across 52 facilities was 132.67 with a standard error of 2.68. The 95% confidence interval for the mean culture score across 52 facilities was 132.67 ± (1.96 × √2.68) = 132.67 × 3.2 = (129.47; 135.87), indicating a small amount of variation in organizational culture across facilities. The variance of the facility mean culture score (Boj) around the average (grand) mean (γ00) was 0.207 (χ2 = 129, df = 51, p < 0.001). The portion of total variance in organizational culture scores, attributed to between-facility variation, was 21% (207/207 + 773 = 0.21) (i.e., the intraclass correlation). Approximately one fifth of the variance in organizational culture could be explained by between-facility variation. The overall reliability of the sample mean (as an indicator of the true facility mean) was 0.541.

The effects of organizational factors on staff-supportive culture were examined using an intercept-as-outcome hierarchical regression model. All Level 2 independent variables were entered in one step into the regression equation (Table 6). The results indicated that more staff-supportive organizational culture was related to chain membership (t = 1.83, p = 0.074), facility size (t = −2.52, p = 0.016), and level of care (t = 3.79, p = 0.001). On the basis of the reported t ratios, level of care had the strongest effect on staff-supportive organizational culture. Staff members in facilities licensed to provide higher levels of care had more positive views of organizational culture than did staff in facilities licensed for lower levels of care. The estimated proportion of variance in staff-supportive organizational culture explained by organizational factors was 17% (207 – 172/207 = 0.17).

Results of the Intercept-As-Outcome Regression Model of Organizational Culture on Organizational Factors (Level 2)

Table 6: Results of the Intercept-As-Outcome Regression Model of Organizational Culture on Organizational Factors (Level 2)

Discussion

This study using HLM examined the effects of organizational factors (Level 2) on staff-supportive organizational culture (Level 1) in assisted living settings. Organizational factors (i.e., facility size, chain membership, level of care) had a significant effect on staff-supportive organizational culture, accounting for 17% of the between-facility (Level 2) variation in the dependent variable. These findings are consistent with previous research, which suggests that organizational factors influence culture formation in health care organizations (Gordon, 1991; Pfeffer & Salancik, 1978).

From the examined organizational factors, facility regulatory status (i.e., licensed level of care) had the strongest effect on staff-supportive organizational culture (t = 3.79, p = 0.001). Staff in facilities licensed to provide higher levels of care rated their organizational culture as more supportive than did staff in facilities licensed for lower levels of care. Provision of higher levels of care requires greater staff resources (i.e., quality and quantity of staff). Better staff resources, in turn, have been linked to more staff-supportive organizational culture (e.g., greater teamwork, staff participation in decision making) (Moos & Lemke, 1992a; Schaefer & Moos, 1996; Zimmerman et al., 2001). More positive staff views of culture in facilities that provided higher levels of care might have been because these facilities were better staffed.

Facility size emerged as the second strongest predictor of staff-supportive organizational culture (t = −2.52, p = 0.016). Consistent with the literature, smaller facility size was predictive of more staff-supportive organizational culture (Schaefer & Moos, 1996). The majority of small facilities were former “board-and-care homes” in which the owner was also the manager. Compared with larger facilities, smaller facilities were characterized by a simpler organizational structure (e.g., low work specialization, low departmentalization); their staff was more demographically homogeneous (i.e., similar in terms of minority group background); and they were less structurally segregated (e.g., African American employees were more likely to occupy professional positions) than staff in larger facilities. Organizational researchers have pointed out that employees who are demographically homogeneous and less structurally segregated are more likely to cooperate and create a socially cohesive work environment (Bacharach, Bamberger, & Vashdi, 2005). In particular, organizations in which “the balance of power and status is less skewed in favor of the dominant demographic group” (Joshi, 2006, p. 585) are more likely to foster cooperation and intergroup support. Future studies should examine how organizational demography and structural segregation shape staff-supportive organizational culture in long-term care facilities.

Facility chain membership was also related to staff-supportive organizational culture (t = 1.83, p = 0.074). Staff members in chain-affiliated facilities reported more positive views of organizational culture than did their counterparts in facilities that were not part of a chain. This finding is also consistent with research that suggests chain-affiliated facilities are better able to create a good quality work environment for staff because they have greater access to resources (Ermann & Gabel, 1986; Lavie, 2006). Future studies should examine the mechanism by which chain membership influences staff working conditions and organizational culture formation.

Limitations

The key limitations of this study are related to its cross-sectional design, small nonrepresentative sample, and lack of attention to the mechanism by which organizational factors shape organizational culture. Because the study was based on a cross-sectional design, the causal nature of the hypothesized relationships cannot be confirmed. To establish causal links between variables, future longitudinal studies should examine how organizational factors influence culture formation over time. The sample of facilities was selected from one state (Maryland) and is not representative of assisted living facilities in other states. In addition, the selection of facilities that operated under the same set of assisted living regulations restricted the magnitude of variation in facility characteristics and might have limited the study’s ability to detect significant relationships between Level 1 and Level 2 variables. In addition, the staff sample was biased in favor of those individuals who were willing to participate in the study. Perceptions of those staff may be different from staff members who chose not to participate. Future studies should include representative samples of facilities and staff to enable greater generalizability of the study findings.

Another limitation is related to the study’s simplified conceptual framework, which did not address the complex mechanism (i.e., causal pathways) by which organizational factors influence staff-supportive organizational culture. Research suggests that organizational structure (e.g., work organization) mediates the effects of environmental conditions on organizational culture (Stevenson, 2001). In this study, no data were collected on the key elements of organizational structure, such as work specialization, departmentalization, span of control, chain of command, centralization, formalization, and structural segregation (Joshi, 2006; Robbins, 1997). Consequently, it is unknown to what extent structural working conditions influenced staff-supportive organizational culture. Future studies should include a more comprehensive theoretical framework that would delineate “culture-relevant” elements of organizational structure and address the casual pathways through which organizational factors influence culture formation.

Conclusion and Nursing Implications

The practical implications of this study stem from its findings about the importance of organizational factors in facilitating staff-supportive organizational culture. In particular, because higher levels of care, which are indicative of greater staff resources, had the strongest influence on staff-supportive culture, nursing administrators who want to promote staff-supportive culture in their facilities should recognize the key role of staff resources in culture formation. Efforts to ensure adequate staff resources (in terms of number and mix of staff) might be most effective in facilitating staff-supportive organizational culture.

More research is needed to identify the key determinants of staff supportive-organizational culture. Greater understanding of these factors could guide efforts to improve the quality of the work environment for staff and, consequently, improve the quality of care in long-term care facilities.

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Facility Characteristics (N = 52)

Variable n (%)
Number of residents
  19 or fewer 19 (37)
  20 to 29 5 (10)
  30 to 59 20 (38)
  60 or more 8 (15)
Ownership
  Nonprofit 22 (42)
  For profit 30 (58)
Chain membership
  Yes 15 (29)
  No 37 (71)
Location
  Urban 9 (17)
  Suburban 39 (75)
  Rural 4 (8)
Level of care
  One 0 (0)
  Two 9 (17)
  Three 43 (83)

Staff Characteristics (N = 294)

Variable n (%)
Age
  16 to 29 58 (20)
  30 to 44 81 (28)
  45 to 59 100 (34)
  60 and older 35 (12)
Gender
  Women 266 (90)
  Men 28 (10)
Race
  White 169 (58)
  African American 98 (33)
  Other 27 (9)
Marital status
  Married 142 (48)
  Single 86 (29)
  Separated or divorced 39 (13)
  Widowed 21 (7)
Educational level
  8th grade or less 34 (13)
  9th to 12th grade 127 (43)
  Post-high school 66 (22)
  Some college 46 (16)
  College graduate 16 (5)
Position
  Certified nursing assistant 135 (46)
  Administrative staff 40 (14)
  Activity staff 31 (11)
  Dietary service staff 22 (7)
  RN or licensed practical nurse 16 (5)
  Director of nursing 15 (5)
  Housekeeping staff 11 (4)
  Social worker 9 (3)

Descriptive Statistics and Reliability Estimates for Level 1 and Level 2 Variables

Variables Mean (SD) Range Cronbach’s Alpha Coefficient
Level 1 (N= 294)
  Organizational culture 132.80 (31.26) 36 to 180 0.98
Level 2 (N= 52)
  Size 35 (24) 6 to 129
  Chain membership 0.29 (0.46) 0 to 1
  Ownership 0.42 (0.50) 0 to 1
  Level of care 0.83 (0.38) 0 to 1
  Level of residents’ disability 53 (13) 26 to 77 0.81

Zero-Order Correlations Organizational Factors (N = 52)

Factor 1 2 3 4
1. Size
2. Ownership −0.05
3. Chain membership 0.33*** −0.03
4. Level of residents’ disability 0.09 0.57*** 0.23*
5. Level of care 0.12 −0.33** −0.27* −0.25*

Results of One-Way Analysis of Variance (ANOVA) Model with Random Effects

Fixed Effect Coefficient Standard Error T ratio p Value
Average facility mean (γ00) 132.67 2.68 49 <0.001
Random Effect Variance Component df Chi Square pValue
Facility mean (μoj) 207 51 129 <0.001
Level 1 effect (rij) 773

Results of the Intercept-As-Outcome Regression Model of Organizational Culture on Organizational Factors (Level 2)

Fixed Effect (γ01) Coefficient Standard Error T Ratio df p Value
Chain membership 9.85 5.39 1.83 46 0.074
Ownership (1 = nonprofit) 6.66 4.78 1.39 46 0.170
Facility size −0.21 0.08 −2.52 46 0.016
Level of residents’ disability −0.03 0.23 −0.15 46 0.885
Level of care 16.86 4.45 3.79 46 0.001
Random Effects (μoj and rij) Variance Component df Chi Square pValue
Facility mean (μoj) 172 46 101 <0.001
Level 1 effect (rij) 780

Staff-Supportive Cultures

Sikorska-Simmons, E. 2008. Predictors of Staff-Supportive Organizational Culture in Assisted Living. Journal of Gerontological Nursing, 343, 15–23.

  1. Staff-supportive cultures, which value staff empowerment, team-work, and participation in decision making, have been linked to higher staff job satisfaction, greater organizational commitment, lower staff turnover, improved quality of care, and positive resident outcomes.

  2. This research suggests that nursing administrators who want to promote staff-supportive culture in their facilities should recognize the key role of staff resources (number and mix of staff) in culture formation.

  3. Future studies should include a more comprehensive theoretical framework that would delineate culture-relevant elements of organizational structure and address the causal pathways through which organizational factors influence culture formation.

Authors

Dr. Sikorska-Simmons is Assistant Professor, Department of Sociology, University of Central Florida, Orlando, Florida.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity.

This research was funded by grant #1 RO3 AG-22100-01 from the National Institute on Aging. The author thanks Dr. Ann Christine Frankowski and Ms. Loren Butler for their excellent research assistance, as well as all administrators, residents, and staff members whose participation and cooperation made this research possible. The paper on which this article is based was presented at the 60th Annual Scientific Meeting of the Gerontological Society of America in San Francisco, California, November 20, 2007.

Address correspondence to Elzbieta Sikorska-Simmons, PhD, Assistant Professor, Department of Sociology, University of Central Florida, 4000 Central Florida Boulevard, PH 403P, Orlando, FL 32816-1360; e-mail: .esikorsk@mail.ucf.edu

10.3928/00989134-20080301-09

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