Organizational Structure, Human Resources & Employee Retention in Long-Term Care

Job satisfaction and intent to leave on the part of direct care nursing staff are both important contributors to care quality and staffing. How might human resources (HR) practices, like communication from management and staff training, affect staff attitudes toward their jobs? A forthcoming study in Health Care Management Review examines the effect of the combination of HR practices and organizational structure on job satisfaction and intent to stay among 1,303 direct care employees in 58 long-term care communities across five US states.

The researchers grouped each of the 58 facilities into one of three categories, based on organizational structure and HR practices. Organic workplaces were relatively decentralized, with less of an emphasis on formal guidelines for care practices, and a greater emphasis on training and communication. Mechanistic workplaces had a higher degree of centralization and formalization of caregiving practice, and a moderate degree of communication and training. Finally, minimalist organizations had some formal structures, very centralized decision-making, and were low on staff training and communication. The surveys also collected a range of demographic and other relevant individual data on employees, so that the researchers could control for the effects of related variables in their analysis.

Organizations classified as organic had the highest overall job satisfaction, while minimalist organizations were associated with lower job satisfaction. Similarly, working at an organic workplace was associated with lower intent to leave, while workers in minimalist work environments were more likely to intend to leave. However, the differences between minimalist and mechanistic environments on job satisfaction were no longer significant when controlling for individual characteristics. The authors acknowledge that other factors not included in the study, such as organizational financial characteristics and staffing levels, may also have a significant impact on job satisfaction.



Kim J, Wehbu N, DelliFraine JL, et al. The joint relationship between organizational design factors and HR practice factors on direct care workers’ job satisfaction and turnover intent. Health Care Management Review (2013). DOI: 10.1097/HMR.0b013e31828c8b8f


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