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The purpose of this paper is to explore the attitudes of nursing home administrators and key managerial staff toward health information technology (health IT).

This research is exploratory in nature, and applies qualitative case-study methodology to further understand health IT adoption by nursing homes through multiple in-depth semi-structured interviews of management, and direct observations of employee behavior at each participating facility. A modified Technology Acceptance Model is used to examine the attitudes and perceptions of administrators.

This study finds that there are differences in the level of health IT adoption by nursing homes. While some administrators are aware of health IT and are implementing or updating their IT systems in a gradual but haphazard manner, others exhibited a lack of interest in implementing change. Overall, there is a lack of systematic planning and decision-making toward health IT adoption. Adoption is not evidence-based, instead driven primarily by real and perceived regulatory requirements combined with a lack of information about, or consideration of, the real costs and benefits of implementing health IT.

Including six in-depth case studies, the sample for this study is small for generalizing the findings. Yet, it contributes to the literature on the slow process of health IT adoption by nursing homes. Moreover, the findings provide guidelines for future research.

This study demonstrates that nursing home administrators must systematically plan the adoption of health IT, and such decision making should be evidenced-based and participatory so that employees can voice their opinions that could prevent future resistance.

This study is original and advances knowledge on the reasons for the slow adoption of health IT in nursing homes. It finds that lack of adequate information regarding the utility and benefits of health IT in management adoption decisions can result in haphazard implementation or no adoption at all. This finding has significant value for policy makers’ practitioners for improving accessibility of information regarding the use of health IT in nursing homes that could address the health IT adoption challenge in this industry.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

Providing health care services requires collaboration between several occupations. This study aimed to reveal how three occupational groups (nurses, physicians, and administrators) perceive human resources management practices (HRMP) and whether these practices are differently associated with trust in the clinic manager.

The study included 290 employees from 29 primary care clinics, all affiliated with a health care organisation that operates in the public sector. Self-reporting questionnaires measured participants’ perceptions of six HRMP across occupations and their association with trust in the clinic manager. Variation between occupational groups was analysed through one-way analysis of variance (for groups’ perceptions of HRMP and trust in manager) and t-tests (for the association between perceived HRMP and trust in manager).

The results indicate some differences in perceived HRMP and trust across groups. Also, some differences were found across occupations regarding the relationship between HRMP and trust in the clinic manager: Nurses’ perceptions significantly differed from those of physicians and administrators, yet there was no significant difference between the two latter groups.

Health care organisations should expand their human resources architecture and customise their HRMP for each occupational group based on that group’s perceptions of the workplace. This can nurture trust in managers and create a climate for trust as a mechanism that encourages employees from distinct occupational groups to work together for the benefit of their clinic, organisation, and patients.

This study contributes to the discussion about the contextualisation of HRMP, providing insights regarding perceptions of HRMP as an enabler of an organisation’s strategy.

This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These organizations were part of an EMR demonstration project cosponsored by the for-profit segment of the nursing home industry in the region and 1199SEIU United Health Care Workers East, the union that represented frontline staff in these organizations. We report central lessons from our evaluation, which took place over the course of four years and included multiple data sources. The primary purpose of our research was to examine the effects of EMR adoption on employment and labor relations in the participating organizations. Findings are based on a longitudinal study of EMR adoption in 15 of the 20 organizations that received the EMR technology and five “control” organizations, which did not receive the technology, employing a mixed methodological design with both quantitative and qualitative data collection methods. Results from our research inform the existing EMR adoption discussion in two ways. First, we find mixed evidence associated with EMR implementation. The adoption of this new technology enhances certain organizational outcomes, but it seems to hinder others. Second, findings from our research highlight the importance of preexisting organizational factors as predictors of EMR-associated outcomes. EMR-associated outcomes, positive or negative, are likely to be contingent on key organizational characteristics and on managerial adoption strategies. Our study's findings imply that the meaningful use of EMR needs to take into account not only the technical specifications of EMR but also the organizational characteristics of the physician practices and healthcare facilities adopting the technology. Healthcare organizations vary in their capacity and ability to make optimal use of health information technology, which should be incorporated into public policy and organizational practices designed to increase adoption.

The purpose of this study is to establish a set of measurable criteria for elderly nursing homes (ENHs) in Lebanon. Donabedian's model known by structure/process/outcome was used as the driving conceptual framework for the study.

The study reports on a panel discussion where administrators, caregivers and specialists, separately established and exchanged key information on best practice approach. The work was carried out in the summer of 2008, using the consensus panel method. A group of expert opinions (Dalkey) made up of elderly home administrators and caregivers, policy makers, and academics discussed specific key issues related to elderly health and quality of life.

A total of 40 criteria were retained along seven main dimensions: types of elderly homes; funding; health services; boarding services; activities; structures; and elderly rights.

A major limitation in this study is that elderly were not part of the consensus making process. Thus, including elderly in the process would have substantiated and added validity to the established criteria.

The criteria developed in this study can be turned into key performance standards for elderly homes in Lebanon, other Mediterranean and Arab countries. These criteria would greatly benefit elderly homes if validated and used as guidelines for quality care.

The study is original in the sense that it seeks to establish measures for criteria, a blueprint, and benchmarks for ENH standards.

The balanced scorecard (BSC) has been a popular management innovation in health care. Implementing an innovation like the BSC can change the professional subcultures of a hospital. The purpose of this paper is to measure subcultures to establish the level of change during the implementation of a management innovation in a single Chinese public hospital.

Four surveys were administered to the staff of a single hospital, and a 100,000-word research diary was compiled from observation of the research process. A longitudinal case study design was administered from 2006 to 2009. The competing values tool was administered twice to assess organizational cultural change.

There was a change in the culture of different professional groups. The group with the strongest dominating culture type, which relies on cohesion, morale and employee participation in decision-making, shows the most positive change in cultural types during the BSC implementation process. Management innovations such as the BSC can create more balance in each professional group.

The successful implementation of a management innovation in a hospital requires the managers to consider meeting the demand of medical professional groups and achieve desired culture type change, which in turn may help to achieve the expected results.

This paper provides support to the finding that groups with a dominant group culture are more receptive to change and implementing a management innovation can influence professional group’s culture. It also provides evidence that the implementation of BSC can create more balance in each professional group’s culture. Although these findings come from health care, it may have relevance to other contexts in China.

The purpose of this article is to critique extant nursing research on nursing practice environments by juxtaposing it with critical sociological perspectives on nurses' work and to propose an alternative paradigm for future research based on these perspectives.

The extant nursing/health services research on nursing practice environments is reviewed. Sociological concepts are introduced, expanded on, and linked to the variables measured in the nursing literature.

The substantial body of nursing research about nurses' job satisfaction has been targeted to management concerns and has taken the positivistic perspective that is traditional in organizational research. However, attempts to address nurses' working situations using expedient solutions obscure any consideration of underlying influencers. Several well‐developed sociological concepts pertaining to gender, knowledge, professionalization, and organizations have direct relevance for the study of nurses' work and can provide new perspectives for deeper questioning about nurses' work experiences.

Unprecedented organizational restructuring in health care has had a profound impact on the practice of nursing, prompting health system administrators and nursing researchers to study the consequences of system change and devise solutions. This paper presents a discussion of typically disconnected perspectives in the study of work (management and sociological) in order to reframe what is known about the factors influencing the quality of nurses' working lives and to provide a conceptual foundation for deeper and more critical research about nurses' work.

Working to improve organizations is the mainstay of organization development (OD) practice and includes figuring out the sources of workplace disruptions and dysfunctions. Casting aside the focus of most change-management initiatives, the organization, organizing intelligence (OQ) relies on paying attention to what people actually do, making meaning of complex, messy human-social organizing activities, in the interests of fostering productive workplaces. Resting on dialog with and among participants “feeling their way” as they organize their work, OQ is an exercise in synthesis rather than analysis. A holistic understanding of organizing activities is helped by exploring the roles of a triad of closely interwoven factors – organizing structures, work-practices, and relationships – in how people get things done, while understanding how these are interconnected. This chapter examines why the capacity for OQ matters, why and how OQ differs from widely practiced, technically framed, organizational analysis, and what distinguishes people with OQ from those with a more conventional interest in organizational change. A case study of the Dutch home-nursing organization, Buurtzorg, illustrates OQ in practice. With small groups of nurses who self-organize, this is a structure that changes both the way people work and their relationships, to the benefit of nurses and the quality of life and care of their patients, while reducing costs; clearly an example of a more productive workplace.

Dyadic leadership models, in which two professionals jointly lead and share unit responsibilities, exemplifies a recent trend in health care. Nonetheless, much remains unknown about their benefits and drawbacks. In order to understand their potential impact, we conducted a review of literature evaluating dyad leadership models in health systems.

Our narrative review began with a search of PubMed, CINAHL, Web of Science and Scopus using key terms related to dyads and leadership. The search yielded 307 articles. We screened titles/abstracts according to these criteria: (1) focus on dyadic leadership model, i.e. physician–nurse or clinician–administrator, (2) set in health care environment and (3) peer-reviewed with an evaluative component of dyadic model. This yielded 22 articles for full evaluation, of which six were relevant for this review.

These six articles contribute an assessment of (1) teamwork and communication perceptions and their changes through dyad implementation, (2) dyad model functionality within the health system, (3) lessons learned from dyad model implementation and (4) dyad model adoption and model fidelity.

Research in this area remains nascent, and most articles focused on implementation over evaluation. It is possible that some articles were excluded due to our methodology, which excluded nonEnglish articles.

Findings provide guidance for health care organizations seeking to implement dyadic leadership models. Rigorous studies are needed to establish the impact of dyadic leadership models on quality and patient outcomes.

This review consolidates evidence surrounding the implementation and evaluation of a leadership model gaining prominence in health care.

The purpose of this study is to investigate the relations between emotion regulation (reappraisal and suppression), discrete emotions and emotional exhaustion among nurses.

A cross-sectional design was used with 168 nurses in South Korea. Structural equation modeling and path analysis were conducted for analysis.

Reappraisal correlated positively with enjoyment and pride and negatively with anxiety, anger and frustration, whereas suppression correlated negatively with enjoyment and positively with anxiety and frustration. Moreover, reappraisal was negatively associated with emotional exhaustion, whereas suppression was positively associated with it. Enjoyment was negatively related to emotional exhaustion, and anger and frustration were positively related to it. Enjoyment and frustration mediated the relation between emotion regulation and emotional exhaustion. Findings demonstrate the potentially beneficial influences of reappraisal as well as harmful impacts of suppression in the nursing context.

This paper expands research on nurses’ emotion management by applying Gross’s emotion regulation framework rather than Hochschild’s emotional labor framework. The mediating result suggests that not only nurses but also hospital administrators and nurse managers should pay attention to nurses’ emotional experiences to improve nurses’ well-being and ultimately better nursing practice. This research can provide the basis for developing practical interventions to efficiently regulate nurses’ emotions.

This is the first study exploring the mediating role of emotions in the link between nurses’ emotion regulation and emotional exhaustion. It contributes to interdisciplinary research by integrating perspectives from psychological emotion and emotion regulation research into the nursing field.