Norwegian social research (NOVA), Norway.
BMC Health Serv Res. 2011 Nov 28;11:327. doi: 10.1186/1472-6963-11-327.
Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care.
A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively.
Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r=0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff.
Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care.
领导力和人员配备被认为是护理质量的重要因素。本研究考察了病房领导的任务导向和关系导向领导风格、人员配备水平、注册护士比例和无执照员工比例对护理质量的三个独立衡量标准的影响。
利用挪威 40 家养老院的横断面调查收集数据。利用了五个数据来源：444 名员工的自我报告问卷、13 名养老院主任和 40 名病房经理的访谈及问卷、378 名家属的电话访谈和 900 小时的现场观察。分别对家属、员工和现场观察评估的护理质量进行了单独的多层次分析。
任务导向的领导风格与三个护理质量指标中的两个呈显著正相关。相比之下，关系导向的领导风格与任何指标都没有显著的关系。关系导向的领导风格没有显著影响的原因是两种领导风格之间存在很强的相关性（r=0.78）。人员配备水平和注册护士比例与任何护理质量指标都没有显著关系。然而，无执照员工的比例与家属和现场观察评估的护理质量呈显著负相关，但与员工评估的护理质量无关。
养老院的领导应该注重积极的领导，特别是注重任务的行为，如结构、协调、明确员工角色和监督运营，以提高护理质量。此外，养老院应尽量减少使用无执照员工，并解决与无执照员工比例高相关的因素，如员工稳定性低。然而，该研究表明，人员配备水平、注册护士比例与护理质量之间的关系是复杂的。仅增加人员配备水平或注册护士比例可能不足以提高护理质量。
