Top managers affect acceptance of innovations in nursing homes

Innovations in care and management can make or break a nursing home. A new study of 473 administrators examines what qualities in managers make them more likely to accept innovations.

CINCINNATI -- Managers with time, talent and outside ties help nursing homes and their residents.

A study of 473 administrators at 248 nursing homes suggests that managers with more time on the job and higher levels of education and professional involvement are the most likely to adopt innovations that benefit residents. The study also shows that adoption of innovations is strongly affected by whether a nursing home belongs to a chain.

Innovations in care and management can make or break a nursing facility. This study of nursing homes looks at the attributes of managers who are more likely to innovate.

"Nursing home managers with increased tenure and education may provide the legitimacy and talent to prompt innovation," says Nicholas Castle, a postdoctoral researcher in the Community Health-Gerontology Center at Brown University and the study's lead author. "Increasing professional involvement may expose managers to a greater variety of ideas on how to manage and can lead to increased engagement in the exchange of ideas."

Some research on innovation suggests that managers play little or no role in the adoption of innovations, Castle says. But the study indicates that the attributes and differences between managers do affect whether nursing homes adopt an innovation, he says.

Castle and co-researcher Jane Banaszak-Holl, an assistant professor at the University of Michigan, examined how the attributes of managers affect whether they adopt the innovation of computerizing a detailed set of data about residents. This data set, called MDS, helps nursing homes better assess the health of residents. Although its adoption can lead to improved care, computerizing the MDS is a concept still being introduced in nursing facilities.

The researchers also looked at the organizational structure of nursing homes. They found that among chain-affiliated facilities, corporate directives have the strongest effect on whether homes computerize the MDS.

"One way that chains make a difference is by providing greater resources and more upper management who think about making their nursing homes better," Castle says. "Managers at some non-chain homes may be too tied up in routine administrative duties to be innovative." A growing number of nursing homes belong to chains. About 55 percent of the facilities in the study were chain-affiliated.

Most nursing homes have two managers - an administrator and a director of nursing. The researchers found that the more dissimilar the characteristics of a nonchain's managers, the more likely those managers are to engage in innovative behavior.

"Slight differences in education and experience among managers may cause conflict that is good for innovation," Castle says. "The extra disagreements and discussions appear to lead to the adoption of innovation."

However, differences in education and experience among top managers do not affect the likelihood that chain-affiliated homes decide to computerize the MDS, Castle says. This suggests that chains may impose daily pressures that affect interactions among top management team members, he says.

Castle presented the findings Aug. 9 at the annual meeting of the Academy of Management.

The average tenure of nursing home administrators is just 18 months in a top-management position, Castle says. This turnover may be too quick to promote good care practices, he says.

"Maybe nursing homes can offer their good managers ample pay raises, yet keep them longer in management positions," Castle says. Although examining nursing home administrators is an emerging research topic, more research is needed before substantive conclusions can be drawn, he says.