1. 1 Did Better Jobs Better Care Change Management Practices and Processes? Amy Stott June 8, 2008 Presented at the 25 th AcademyHealth annual meeting. The authors are grateful for supported from The Atlantic Philanthropies, The Robert Wood Johnson Foundation, and the National Institute on Aging Training Grant, Interdisciplinary Training in Gerontology, #T32 AG00048

2. 2 Data Source: Clinical Manager Survey Designed by the BJBC Evaluation Team at Penn State Questions measuring the level of use of management practices and processes Respondents: Clinical Managers

3. Participating States by Provider Type State Nursing Facilities Assisted Living Home CareTotal: Iowa8--412 North Carolina13181546 Oregon45110 Pennsylvania114722 Vermont2338 Total:3830 98 Note. Excluded adult day 3

4. 4 Top Management Training Supervisor Training Team Building DCW Career Development Caregiving Skill Development BJBC Interventions Clinical Manager’s Survey Before During After Design Clinical Manager’s Survey Demonstration Timeline

5. 5 Top Management Training Supervisor Training Team Building DCW Career Development Caregiving Skill Development Surveyed Management Practices Scales Items Clinical Manager’s Survey BJBC Interventions Matched Practices to Interventions Not Related to Interventions

6. 1.Did providers increase management practices and processes? 6

7. 7 Methods Calculated change Time 2 – Time 1 = Difference Score Compared practices related to interventions with practices not related to interventions

8. Results: Supervisor Training Intervention Management Practices & Processes Mean Time 2 Mean Time 1 Mean Differencep-value Supervisor training (  = 0.89) 2.472.040.43***0.004 Participation in care planning (  = 0.71) 2.712.590.120.206 Feedback (  = 0.66) 2.352.240.110.137 8 ***p<0.01

9. Other Interventions 9 InterventionsSignificant Change Top Management TrainingNone Team Building+ DCW Career Development+ Caregiving Skill Development+ Note. Positive change in: self-managed work groups related to team building; cross training, peer mentor, and opportunities to become a higher-level DCW or a Licensed Practical Nurse (LPN) related to DCW career development; DCW training related to caregiving skill development.

10. Not Related to Interventions 10 Management Practices & Processes Mean Time 2 Mean Time 1 Mean Difference p-value Training linked to compensation 0.530.60-0.070.264 Hiring strategy 0.310.37-0.060.449 Recruitment strategy 1.071.21-0.140.159 DCW write in charts 2.042.19-0.150.432 Resident/client satisfaction surveys 1.541.79-0.250.125 Training linked to performance appraisal 0.680.670.010.854

11. 2.Was there a difference between states by BJBC intervention? 11

12. 12 Methods Calculated change Time 2 – Time 1 = Difference Score Difference-in-difference for state that did intervention compared to states that did not InterventionIANCORPAVT Supervisor Training √√√

13. Management Practice & Processes Mean Time 2 Mean Time 1 Mean Differencep-value Supervisor training (  = 0.89) -- Intervention2.572.000.57***0.005 Non-Intervention2.052.19-0.140.750 Difference-in-difference-- 0.71**0.045 Results: Comparison of States with and without Supervisor Training Intervention **p<0.05 ***p<0.01 13

14. Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Participation in care planning (  = 0.71) -- Intervention2.722.620.100.460 Non-Intervention2.652.480.170.479 Difference-in-difference-- -0.070.653 Feedback (  = 0.66) -- Intervention2.402.260.140.198 Non-Intervention2.182.150.030.890 Difference-in-difference-- 0.110.560 Comparison of States with and without Supervisor Training Intervention 14

15. State Comparison of Other Interventions 15 InterventionsSignificant Difference Top Management TrainingNo Team Building+ DCW Career DevelopmentNo Caregiving Skill Development  Note. Positive difference in management communication between states that did team building and states that did not. Negative difference in permanent assignment between states that did caregiving skill development and states that did not.

16. 16 Summary Modest increase in management practices and processes Greater increase related to BJBC interventions Positive differences between state that had top management and supervisor training interventions compared to states without these interventions

17. Appendix: 17

18. Management Practices and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Self managed work groups 1.300.980.32**0.025 Cross training 1.731.490.24*0.053 Higher-Level DCW 0.870.630.24**0.030 Become a Licensed Practical Nurse 0.510.370.14*0.052 Designated peer mentor 1.090.810.28*0.056 DCW Training (  = 0.72) 1.951.660.29***0.006 Organization Readiness for Change (  = 0.65) 2.722.600.120.108 Communication about tasks (  = 0.70) 3.012.900.110.196 Flex time for DCW 1.801.550.250.102 Permanent Assignment 2.662.490.170.285 Management Communication (  = 0.83) 2.462.450.010.948 Mean Difference of Management Practices and Processes *p<0.10 **p<0.05 ***p<0.01 18

19. Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Organizational Readiness for Change (  = 0.65) -- Intervention2.702.590.110.485 Non-Intervention2.732.610.120.346 Difference-in-difference-- -0.010.996 Management Communication (  = 0.83) -- Intervention2.512.340.170.356 Non-Intervention2.432.51-0.080.623 Difference-in-difference-- 0.250.235 Comparison of States with and without Top Management Training 19

20. Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Communication about task (  = 0.65) -- Intervention 3.002.900.100.373 Non-Intervention 3.022.910.110.461 Difference-in-difference-- -0.010.848 Management Communication (  = 0.83) -- Intervention 2.512.330.180.262 Non-Intervention 2.402.59-0.190.329 Difference-in-difference-- 0.38*0.066 Comparison of States with and without Team Building Intervention *p<0.10 20

21. Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Self-managed work group-- Intervention 1.430.900.53**0.023 Non-Intervention 1.161.070.090.729 Difference-in-difference -- 0.470.164 Comparison of States with and without Team Building Intervention 21 **p<0.05

22. Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Cross Training-- Intervention 1.841.640.200.282 Non-Intervention 1.361.000.360.155 Difference-in-difference-- -0.160.525 Higher-level DCW-- Intervention 0.930.680.250.083 Non-Intervention 0.640.450.190.497 Difference-in-difference-- 0.060.806 Comparison of States with and without DCW Career Development 22

23. Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value Become a Licensed Practical Nurse (LPN) -- Intervention 0.550.380.170.127 Non-Intervention 0.360.320.040.757 Difference-in-difference-- 0.130.473 Peer Mentoring-- Intervention 1.170.840.330.113 Non-Intervention 0.820.730.090.752 Difference-in-difference-- 0.240.425 Comparison of States with and without DCW Career Development 23

24. Comparison of States with and without Caregiving Skill Development Management Practice and Processes Mean Time 2 Mean Time 1 Mean Differencep-value DCW training (  = 0.72) -- Intervention 1.921.630.290.038 Non-Intervention 2.001.720.280.257 Difference-in-difference-- 0.010.938 Participation in care planning (  = 0.71) -- Intervention 2.712.590.120.416 Non-Intervention 2.692.600.090.597 Difference-in-difference-- 0.030.894 Permanent Assignment-- Intervention 2.602.61-0.010.977 Non-Intervention 2.762.260.500.087 Difference-in-difference -0.49**0.051 24 *p<0.10