June 15, 2001 UNT Inhouse publications: Sociologist studies use of self-managed work teams in nursing homes

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Sociologist studies use of self-managed work teams in nursing homes

Nursing home employees can provide a better life for the elderly residents in their care if they know each resident's favorite foods, routines and activities.

But elderly residents often have to adjust to newly hired staff members who don't know this information. Nursing home staffs have historically had high turnover rates, particularly among certified nurse's aides, who provide 80 to 90 percent of direct care to nursing home residents. Researchers have reported turnover rates of nursing home staffs averaging 100 percent a year, with some staffs having a 400 percent rate.

Use of self-managed work teams, or SMWTs, in nursing homes could increase employee morale, leading to less staff turnover and better work performance and care for residents, says a UNT sociologist.

"When the continuity of care is not maintained due to constant turnover, it is less likely that the staff members are aware of the many needs and preferences of the nursing home residents. This negatively affects the residents' health care," says Dale Yeatts, chair of UNT's Department of Sociology. "At the same time, high turnover rates result in increased costs for recruitment and training. One study found that facilities can pay more than $2,200 to replace one certified nurse's aide."

Self-managed work teams, originally introduced into manufacturing companies, are groups of three to 15 employees who are responsible not only for the technical aspects of their jobs, but also for management issues. Management responsibilities for SMWTs may include planning how the work will be accomplished each day, scheduling who will do what and monitoring the team's performance. SMWTs are now used in public agencies and health-care settings as well as in corporations.

Yeatts, who combines his research of workplace issues with research in gerontology, studied three SMWTs in a mid-sized nursing home in Wisconsin.

Two teams consisted of three certified nurse's aides, supervised by registered nurses. Both teams were responsible for caring for approximately 30 residents and were expected to decide who would serve which residents, the procedures that would be followed in serving the residents, and who would work during major holidays.

Yeatts observed the teams multiple times and sat in on team meetings. He also interviewed each team member and each team supervisor.

One of the teams of certified nurse's aides was judged by the nursing home administrator and director of nursing to be performing at a particularly high level, based on the care that residents were receiving. The other team was judged to be performing at a particularly low level.

Yeatts says members of the highest-performing team were making decisions about resident care based not only on input from their supervisors, but also on their own experiences working with the residents.

"On the other hand, members of the low-performing team were given much less opportunity to make such decisions," he says. "The supervising RN was found to make decisions for the team without consulting team members and subsequently without taking advantage of the added knowledge the certified nurse's aides could bring to the decision-making process. Case studies have shown that the decisions made by SMWTs can be extremely effective because those making the decisions – the team members – are the people most knowledgeable about the work."

Yeatts says members of the high-performing team made decisions usually at the beginning of their shift, but also at impromptu meetings during the day when a decision had to be made.

"Observations of these meetings showed that team members held a high level of respect for one another and one another's viewpoints. They listened to each other and did not appear afraid to disagree when they held different views," he says.

Although previous studies have shown that SMWT meetings are too time consuming, Yeatts says this did not appear to be the case with the high-performing team.

Most impromptu meetings lasted only five minutes, and if more time was needed, the team did not make a decision until the issue could be discussed again during a slower part of the workday, he says.

"If a consensus could not be reached, the supervisor attempted to help the team achieve consensus and, failing this, made the decision for the team. This process appeared to work well," he says.

Yeatts says members of the high-performing team had more job satisfaction than those in the low-performing team. This satisfaction, in turn, appeared to be related to reduced turnover, with the turnover rate of the high-performing team much lower than that of the low-performing team, he says.

"The annual turnover for the whole nursing home was roughly 20 percent," he says. "The nursing home administrator attributed this low rate in part to the higher overall job satisfaction that had been achieved through the use of work teams."

The third team at the nursing home Yeatts studied was an eight-member management team. Members included the nursing home administrator; the directors of nursing, social work and mental health; the assistant directors of nursing and social work; and the grounds and dietary managers.

Unlike the high-performing SMWT of certified nurse's aides, the management team devoted much more time to reaching decisions, Yeatts says.

Like the members of the high-performing team of certified nurse's aides, members of this team expressed respect for others even when they disagreed with opinions. However, the administrator always sought consensus on an issue and would set aside an issue rather than make a decision some team members would disagree with, Yeatts says.

"Several members were concerned that decisions were never reached and actions were never taken, and they believed this had negative consequences for the nursing home," he says.

Yeatts' research was published in The Gerontologist. He plans to examine work teams at three additional nursing homes in three different states to compare the nursing homes' efficiency with nursing homes that do not use SMWTs.


BY NANCY KOLSTI nkolsti@unt.edu

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