Home health care quality improvement: Its relationship to organizational culture and its effect on employee satisfaction and organizational performance, as measured by patient outcomes

Escalating costs and concerns about accessibility and patient safety have generated continued interest in health care quality. Researchers have examined quality improvement (QI) in various settings, but scarce research has been conducted in home health care.;Prior research in other health care settings had shown the importance of an organization's culture to its QI implementation, and the degree of QI to performance outcomes, including employee satisfaction. Findings relating QI to patient outcomes were inconclusive. Given the unique aspects of home health care (i.e., its community setting), this study tested several hypotheses, including: H1. Home health agencies (HHAs) were equal in the extent to which they implement QI activities. H 2. There was no relationship between the degree to which HHAs possessed a group/development culture and their degree of QI implementation. H3. There was no relationship between the implementation of QI practices and HHA employee satisfaction. H 4. There was no relationship between QI implementation in HHAs and organizational performance as measured by risk-adjusted patient outcomes.;Results, based on an HHA employee survey, indicated that there were significant differences in the level of HHA QI implementation; differences in QI implementation were significantly related to the degree to which the agency possessed a group/developmental organizational culture. The extent of an agency's QI implementation was significantly related to employee satisfaction. These results had implications for managers implementing QI and recruiting and retaining staff.;Results examining the link between HHA QI and patient outcomes were weak for the sample HHAs. The weak findings may have been caused by factors related to the patient outcome data used, including a lack of congruence between the prior years' patient outcomes and current QI efforts.;Analyses of the age and education level of respondents indicated that a large majority of survey respondents were over 40 years of age. This finding comported with national HHA worker demographic data.;Education levels reported by survey respondents, however, indicated that, although the HHA work force is composed mostly of paraprofessionals, survey respondents were predominantly professional employees, suggesting that the study data may reflect primarily the perspectives of the professional segment of the work force.