The effects of integrated care on quality of work in nursing homes: A quasi-experiment

Background: In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. Objectives: The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). Design: A non-equivalent pre-test/post-test control group design was used in this study. Settings and participants: Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. Method: Data were selected by means of written questionnaires. Results: The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. Conclusions: The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric). (c) 2007 Elsevier Ltd. All rights reserved.