scholarly journals THE RELATIONSHIP BETWEEN ORGANIZATIONAL CULTURE AND FINANCIAL PERFORMANCE AMONG HIGH-MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S698-S698
Author(s):  
Robert Weech-Maldonado ◽  
Akbar Ghiasi ◽  
Ganisher K Davlyatov ◽  
Justin C Lord ◽  
Jane Banaszak-Holl
Keyword(s):  
Organizational Culture ◽  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Working Environment ◽  
Future Research ◽  
Market Culture ◽  
Operating Margin ◽  
Clan Culture ◽  
The Relationship

Abstract This study examines the relationship between organizational culture and financial performance of high Medicaid census (70% or higher) nursing homes (NHs). Based on the Competing Values Framework, there are four types of organizational culture: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the operating margin, while the independent variable comprised type of organizational culture. Control variables were organizational (ownership, chain affiliation, size, occupancy rate, and payer mix), and county-level factors (Medicare Advantage penetration, income, education, unemployment rate, poverty, and competition). Multivariable regression was used to model the relationship between organizational culture type and financial performance. Regression results show that compared to a market culture, a hierarchy culture was associated with an 11.8 % lower operating margin, a clan culture with a 10.6% lower operating margin, and a non-dominant culture with 11.4% lower operating margin. Organizational culture is associated with financial performance among high Medicaid facilities, with market cultures outperforming other organizational cultures. Given increasing competition in the nursing home market and declining resources for high Medicaid nursing homes, facilities with a more external orientation and focus on results may be able to perform better financially. Future research should examine the effect of organizational culture on quality of care.

scholarly journals ORGANIZATIONAL AND COMMUNITY FACTORS ASSOCIATED WITH NURSING HOME ORGANIZATIONAL CULTURE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S510-S510
Author(s):  
Akbar Ghiasi ◽  
Ganisher K Davlyatov ◽  
Justin C Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Organizational Culture ◽  
Nursing Home ◽  
Working Environment ◽  
Occupancy Rate ◽  
Community Factors ◽  
Lower Odds ◽  
Skill Mix ◽  
Market Culture ◽  
Clan Culture ◽  
Hierarchical Cultures

Abstract This study examines how organizational and community factors are associated with organizational culture among high Medicaid nursing homes (70% or higher Medicaid census). According to the Competing Values, Framework, there are four types of organizational culture: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). Survey data from 324 nursing home administrators (30% response rate) from 2017- 2018 were merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of organizational culture type. The independent variables comprised organizational factors (facility has nurse practitioner/physician assistant (NP/PA), RN/LPN/CNA hours per resident day, RN skill mix, ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix) and community factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multinomial regression results showed that, compared to facilities with hierarchical cultures, those with a market culture have greater odds of having an NP/PA and higher RN skill mix and LPN intensity, but lower odds for RN intensity, Medicaid payer mix, occupancy rate, and Black residents. Also compared to facilities with hierarchical cultures, those with a clan culture have lower odds for having an NP/PA, beds and occupancy rate, but higher odds of being located in communities with lower unemployment and higher Medicare managed care. In conclusion, different organizational cultures are associated with different staffing patterns, as well as organizational and community factors.

Organizational culture as moderator in the relationship between organizational reward on knowledge sharing and employee performance

2019 ◽  
Vol 38 (7) ◽  
pp. 538-560 ◽  
Author(s):  
Abdul Rohim ◽  
I Gede Sujana Budhiasa
Keyword(s):  
Organizational Culture ◽  
Knowledge Sharing ◽  
Municipal Government ◽  
Employee Performance ◽  
Content Type ◽  
Local Agency ◽  
Market Culture ◽  
Clan Culture ◽  
Organizational Rewards ◽  
The Relationship

Purpose The purpose of this paper is to examine whether organizational rewards are able to improve knowledge sharing and have an impact on employee performance moderated by organizational culture type in Ternate Municipal Government. Design/methodology/approach The design for data collection a uses survey approach, that is a form of research conducted to obtain facts about the phenomena that exist in regional government organizations to seek more factual and systematic information. The research was conducted in Ternate Municipal Government area of North Maluku Province, Indonesia. The organizations of regional apparatus are public sector agencies responsible for providing services to the public. The population in this study is echelon IIb‒IVb officials in regional apparatus organizations and certain structural officials. The units of analysis that are focused on in this research are the head of local agency, body, and office; the secretary of local agency, body and office; the head of board, the head of division, the head of the sub-board and the head of sub-division. Findings Organizational rewards in the form of giving economic rewards as remuneration, such as employee performance allowance, significantly affect individual attitudes in knowledge sharing. The interaction between the variable of remuneration with clan culture has a significant effect on knowledge sharing; these findings suggest that clan culture is a pure moderation variable that strengthens the relationship between remuneration and knowledge sharing. The result of this research proves that the interaction between the variable of remuneration with adhocracy culture has no significant effect on knowledge sharing. The interaction between the variable of remuneration with hierarchical culture has a significant negative effect on knowledge sharing. Market culture is not proven to moderate the relationship between remuneration and knowledge sharing. However, market culture variables directly and significantly affect knowledge sharing. Originality/value This research is the development of a research model conducted by Durmusoglu et al. (2014). The previous model uses organizational culture with a knowledge-sharing culture instrument, whereas this research develops organizational culture by using the type of organizational culture by Cameron and Quinn (1999), namely clan culture, adhocratic culture, hierarchical culture, and market culture. This type of organizational culture as a moderating variable can be expected to play a role in strengthening organizational rewards toward sharing knowledge and also impacting employee performance. Howell et al. (1986) revealed that organizational culture can strengthen the relationship between organizational rewards and disseminated knowledge. Hence, organizational culture moderates the relationship between organizational rewards for knowledge sharing to build upon Durmusoglu et al. (2014).

scholarly journals THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S156-S156
Author(s):  
Justin C Lord ◽  
Ganisher K Davlyatov ◽  
Akbar Ghiasi ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Culture Change ◽  
Market Competition ◽  
Profit Margin ◽  
Organizational Level ◽  
Poverty Level ◽  
The Impact ◽  
The Relationship

Abstract This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p < 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.

scholarly journals Organizational culture types and individual readiness for change: evidence from Indonesia

2019 ◽  
Vol 2 (2) ◽  
pp. 86
Author(s):  
Aktsar Hamdi Tsalits ◽  
Gugup Kismono
Keyword(s):  
Organizational Culture ◽  
Stock Market ◽  
Readiness For Change ◽  
Future Research ◽  
Test Results ◽  
Market Culture ◽  
Clan Culture ◽  
Market Test ◽  
Positive Effect ◽  
Simple Regression

This study aims to examine the effect of organizational culture types on individual readiness for change in Indonesia as a country with high collectivism. Specifically, this study examines the effect of four types of culture namely clan, adhocracy, market, and hierarchy on individual readiness for change. The sample of this study was 264 employees of XYZ Company, a family company in Indonesia that made changes by releasing part of its shares into the stock market. Test results using simple regression support the hypothesis that clan culture and adhocracy have a positive effect on individual readiness for change. However, the influence of market culture and hierarchy on individual readiness for change was also found to be positive instead of negative as hypothesized. Discussions and suggestions for future research are presented.

scholarly journals HUMAN RESOURCE MANAGEMENT PRACTICES, ORGANIZATIONAL CULTURE, AND NURSE STAFFING TURNOVER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S743-S744
Author(s):  
Robert Weech-Maldonado ◽  
Akbar Ghiasi ◽  
Ganisher K Davlyatov ◽  
Justin C Lord ◽  
Kent Rondeau
Keyword(s):  
Organizational Culture ◽  
Resource Management ◽  
Nursing Homes ◽  
Human Resource Management ◽  
Human Resource ◽  
Nurse Staffing ◽  
Working Environment ◽  
Turnover Rates ◽  
Hrm Practices ◽  
Clan Culture

Abstract This study examines whether nursing homes’ (NHs) human resource management (HRM) practices and organizational culture are associated with nursing staff turnover. HRM practices are classified into traditional (employment selection tests, formal performance appraisal systems, and realistic job previews); employee-centered (flexible work hours and job sharing); and high involvement (incentive based/merit pay and self-managing teams). Organizational culture consists of four types: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). This study used facility survey data from approximately 324 NH administrators (30% response rate) from 2017- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variables consisted of RN, LPN, and CNA turnover rates (% voluntarily quit), while the independent variables comprised HRM practices and type of organizational culture. Control variables consisted of organizational (ownership, chain affiliation, size, occupancy rate, and payer mix) and county-level factors (Medicare Advantage penetration, income, education, unemployment rate, poverty, and competition). Generalized linear model results show that every unit increase in high-involvement HRM practices is associated with a reduction of 6%, 4%, and 2% in RN, LPN, and CNA turnover rates, respectively. Also compared to hierarchical cultures, nursing homes with a clan culture are associated with a reduction of 62%, 49%, and 33% in RN, LPN, and CNA turnover rates, respectively. HRM practices and organizational cultures that promote employee participation, engagement, and empowerment have the potential to reduce nurse staffing turnover rates among underresourced nursing homes.

scholarly journals The Role of Assisted Living Capacity on Nursing Home Financial Performance

2018 ◽  
Vol 55 ◽  
pp. 004695801879328 ◽  
Author(s):  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Kali S. Thomas ◽  
Kathryn Hyer ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Assisted Living ◽  
Repeated Measures ◽  
Fixed Effects ◽  
Negative Impact ◽  
Secondary Data ◽  
The Relationship

The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupancy. This research utilized publicly available secondary data, for the state of Florida from 2003 through 2015. General descriptive statistics were used to assess the relationships among financial performance, assisted living capacity, and occupancy. To explore the relationships among financial performance, assisted living capacity and occupancy, and test potential mediation of occupancy, we followed Baron and Kenny’s approach and estimated 3 models examining the relationships between (1) assisted living capacity and nursing home financial performance, (2) assisted living capacity and nursing home occupancy, and (3) nursing home occupancy and financial performance after assisted living capacity is included in the model. We used generalized estimating equations, to adjust for repeated measures and to model the above relationships. Year fixed effects control for time trend. The independent variable, assisted living beds, was lagged for 1 year to account for the potential influence on financial performance. The final analytic sample consisted of 7688 nursing home-year observations from 657 unique nursing homes. Our findings suggest that assisted living capacity does have a negative impact on nursing homes’ financial performance. Even though, assisted living capacity seems not to significantly decrease nursing home occupancy. The relationship between assisted living capacity and financial performance was not mediated through occupancy. These findings suggest that assisted living communities may not be able to significantly reduce nursing home occupancy; however, the presence of assisted living communities may create additional financial/competitive pressures that result in decreased nursing home financial performance.

scholarly journals Nursing Home Quality and Financial Performance: Is There a Business Case for Quality?

2019 ◽  
Vol 56 ◽  
pp. 004695801882519
Author(s):  
Robert Weech-Maldonado ◽  
Rohit Pradhan ◽  
Neeraj Dayama ◽  
Justin Lord ◽  
Shivani Gupta
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Business Case ◽  
Pressure Ulcer Prevention ◽  
Skill Mix ◽  
Nursing Home Quality ◽  
Operating Margin

This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian’s structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.

scholarly journals Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 82-83
Author(s):  
Kallol Kumar Bhattacharyya ◽  
Lindsay Peterson ◽  
John Bowblis ◽  
Kathryn Hyer
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Staff Training ◽  
Policy And Practice ◽  
Abuse And Neglect ◽  
The Relationship ◽  
Investigation Process

Abstract Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

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