Een continue zorg : een studie naar het verband
tussen personeelswisselingen, organisatiekenmerken, teameffectiviteit en kwaliteit van begeleiding in
residentiele instellingen voor mensen met verstandelijke beperkingen
Citation for published version (APA):
Buntinx, W. H. E. (2004). Een continue zorg : een studie naar het verband tussen personeelswisselingen, organisatiekenmerken, teameffectiviteit en kwaliteit van begeleiding in residentiele instellingen voor mensen met verstandelijke beperkingen. Datawyse / Universitaire Pers Maastricht.
https://doi.org/10.26481/dis.20041222wb
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Published: 01/01/2004
DOI:
10.26481/dis.20041222wb
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envatting
D w . ~ studie behandelt het probiccm van frcc(ucnrc wisschiiscn y F * f i yroeprlcidcrr woongrcicprealns van Nederlandse r~cslcPcnaele i ~ l h t d h ~ i ~ e ~ ~ lmcnsrli, vcrstalldeLljke b c p e r h g e n . Met r.iarrze w ~ ~ r d i ondr.r;.ocht a t A r dc samCnllaiig is nlsserl enerzi~ds aard ornx-a~lg van p e z s o n e e ~ s \ x ï ~ ~ . r s s e l ~ ~ ~ ~ ~ n el1 lauzdei-j..rj~s, c j q p n n i i - cauekcnli.ierken, de tearneffecti~rtcit en1 de kwalineir van d e bsgclci~ifirir. Her \rCrshg van d c ~ c s t u d ~ e biestaat tiut rlcgen hnol&tukke12.
ld-~sojf!.sli4k 1 15 een inleldmng op het citudictcrrcirr en 013 de ctinrralc problemanck
.
En Nederlaiild ~iilakeru ongeveer 33.500 iulenscr~ ri.rc.o ï~er~ïaiiiirh~lie beperkli7gen g c b s u ~ k van 3 4 - ~ 1 ~ 1 r s zorg ln reslcle~ztiElc ~nstellingen. De \riocrnt~~~~crac-. 1s nagrnocg rollccllg gerealiseerd in xvoongruepeti. 4an een wtlongroep 1s ccn rciirn va11 ijra-c>fes- jionele groeps\exdess \.crbcpricPcrx: liet \r-oongrocprcanz. \iTenrek van gïocb3dg,,dcu~ L i l r
cie instelling (door l-iecinchgititlg varr arbctdsovcrec~ak~)rmst) Icrdt uii ie raar cl ~ 0 . i vcr-rek u t liet woongrocpream, cn xrianncet veiTangitig pl:i;~rsï.isidt, ttsi ~~ersnncclswissc- h n g c t ~ . blaar bit.inen wocrtlgroepteains ~rincfcn. fiai3~1~iili~Yi meer \visscl~ng*en pll~ans dan op grond van vcrloop kan wnrdei-i ~rcrklaard. Zo x11ii c ï tal van andcrc oriastair- dighcoden die kuaiiarn letdcn tui ~ i i t - of instl.ooi.i~ van groepsleiders: bij\rr>oi-beckci, docrri vertsek naar een andcr woongroepleam binlicri dczclfdc iilstcllnirg (job ciliat~oiii), doos vcrva~~gingen voor ziekte of voor ahve/ighcid otn andcuc r-cclciicir voor lan-es-c of kortcre Ojd, door tljdelijl?; versterking v'in Lret icai-ri, door nldclljk 'urrhe1l~ci1'1iri a~aclere teams, af door oplciclingsgebonden toeti-eci~ng.
I n de vaklatesaruur klagen professlonals bailraeii clc residciiuele zorg zcZf, magr [neet.
nag cliënten en hun hmlhc, over deze personcelsïv~ssel~ngen ciir volgcnc hcrr de gclevcrde kxvalateit van begcleiclir-ig neganef bci~ivloedcn. IJirt gcgc\,eii vcsrii-~t dc belcidsrnange aat~lel&ng van deze studie. Hocwel "verloop' van gm-ocjsslcucYi-r-c r i l de w-etencchappelijke hiteratuur nn en b u t e n Nederland vcel aandacliii l-~eeft gclr+egei-i,
1s &t nier ge\-,21 voor het verschijnsel pcr~xxsds\vissePit~ge~~. Dit gegcveii vormt dc wctcn-rsclrappeYijlrc aasiladiig voor deze studie. Ilet docl \-At1 dczc srudrc 1s:
inrrcllt refivcmcn In llct ~erscl-ii~nscl pel-soneclswiscel~ng~n in residcnuclc inslel- h1-ngc.n voor merisci-r rr-~et ver~iandelilkc L>eprr.kingcn.
I n het eerste lIoofdctuk wordcri de brlwngrijkstc begrippen gc~lcfii~icci-~i caz wi,rdt cel1 ovcrïlciit en Yecswrjzc.r gegeven, Dc siudlc I S c>p~;ellsc~~iwd {w-l: elclen.
[-lc( eerste deel bcrref[ eeil algernclle plaaisbci->alin# van de ~~roblrm~liiclc cloor iuu&cl ~lrcr:ituurïtuL~c. DCzc iaif;,rrilatac ~~~~~~t d c nchict-grimcl vcx)r een Cliilxrfis"h aiiderzocl;. P]ecl twee LJcircfi 11ct verslag \<nn hrrn ciiipiric~h c ) i i ~ k r ~ c ) ~ ~ .
Uc Iiictoriscli-ctrctalc scl-iet* mr /!on/~i?rlitk 2 is o p g e b e ~ ~ w d i-cjtld dc sicllui~g zS:1n tic structurejc coiiringcntle theonc ilai d ï ititirne srriicrririr een orgmisniic bcgrc- pen '-ent i e worden in ftinctie van lialr r>rngcxtlng. D r 'Cr' tussen <IC r x i i - ~ i c ixrige- f r ~ l g <:n. haar interne qlriiciuur bepaalt de cffcci~i~tteir van ceii S l>c externe omB\-ulg van res~dcnliele instcllingcn wi>rc!r b c ~ c l i i c ~ c i i i i i rii-ic pcn<)dcji:
(1) 5 an i 9. eruw de ,%%BZ, (2) van 1968 ior 1990 cn (3) rail 1990 i ( )i 211113
I)aar1~ii ~vordt tcEk-cns nuk de interne s m c m u r I~eschreven. Hec blilkt dar reir~lctqlicic 1i7\tcl!ln~;er1 tn d c eerste pernode relarlef eenvoudge orgariicarics waren mer qrerk autcsr.itirine werongrocptc:irns die zich in de m e e d e peinade nnhwikkeldcn Lot "j~rokss~c-r~rcle I3urcaucratjeenY mer als doel, het bieden van ecil a l r c n ~ a u c ~ e s a m e n l c ~ ' ~ ~ ~ p ~ ~ ~ « l . m voor mensen mei versrandel~jkc beg~erkir-igen. D e externe oizt-uvikkclirsgen in de ~ l c ï d c pcuiode zijn complex en dc aanpassingen van de ineerrie organisaue ziln zeker nog nier zi~tgcknscaihseerd. Onder it7wlocd van cleconcen- trariebclcld, n~eiii~ve regelgeving, nieuwe finariclenngsvormen en vcrioral ~ I I I G ~ S
017tstaarr grorcrc, geddwis~oi~eesdc ongamsaues maar ook rretwerkorgailisa~ etr virnielc orgamiisatie.;. C>p niveau van de wuongroepreams wordt de begeleiding Ineer gciihdividiualiseerd en wardr ir-ieer riandac1.i~ besteed aan methodisclii werken. Dit leidt tot verkleining van woongroepen, tot veraizdei-ia~geil in taken Cpersoorrli~ke begcleidcrs' doe in hun ina*cde 11-1 de wrrongrue~~teams) en ror inchtriducle zorg- plannen als coordlnatlctech~loBog~; het leidt niet tot veranderingeti vaal de basn.;- scructuizr van woongrrey,teaans. Door verklcinialg van dc woongrnepen onder handlntiw~ng y;zn een srulkic koppeling van woongroepen woongrrireptcarrr. v c r g o m cle lt.rvcwbaarlac~d vítn dczc tcanas voor personcelswrsselingen.
lJersciincelswlssc~lt~~gen lrorrneii eer) bron van x7ersroïmg van de rnterne ccrnsistenuc
V;ICY r~si41enuèlc organisaties en daarmee van hun effectiv~tcit. Dit gebeurt de meest Icïversbxre lplaals voor de realisering van hun irrissie: in de ~ o o d 1 ~ r o c p a l s rrracrface russen de ocgarilsatic cn ]-iet cliL.trtsjsreetir. Wet hoofclsmk eit-iciligt met con
»verzicht van kerrrnerlten x7ai1 Nederlandse residentiele ~n$~ellitzgcn.
H O O / ~ . S I Y I ~ 3 bcliairdclt di: waklicer:ahuur en de wctenschappehjki. hteraru~ar nlci lsctrclk~ng tor verlirop en personeclswlsselingen. klit de vakhttïahx~ir bllpkt clat
*(>wel clicntern relf, hun ouders en familie alsook professionals persot~cclswissc- l~rugcn i~aclelig acl-iteau voor dc Irwaliteit van bcgelcidiiig. Persoticclswrsselin~;eti worden gckaralsteriseerel als l~ejegeningsprobleiiaa~ek (bedreiging Iran wedezzilds verti-ouwen) m:liir ook als risicofactor 7jroor het opucden van gedsagsproblemen ei1 uitc~ndclijl; voor cle kwíiht-c-ir van be.s.aaan van rneinscn mer veusrai~delr~kc I,rpcr- kiilgcn.
I n clc inicrnauonalc wctcnschaj~pclqke Imtrratuur is trccl aandacl-ii bc3rccd íian rrltrop. I)aarl_lil overheerst - voci~al in de illil~cnkaanse six~dies -- het orgarnis:lile- pcrspc.c(~cf, gericht 012 betic)ud van mcdeïverkcrs. Ook wc-rrden problen~crr gcaigna- Iccrd in cle il~itltoinsten Iran 1~cgeleidl;llig (cloor ~~crconecls-cw~sseli~igct~ gc~riducccnic
~ c c l ï ~ g s ~ ~ r c i l ~ l c . ~ i r c ~ ~ ) en Ir1 dc eCfercivtrcit vati I-iet tca~rriFui~ct.rcpnere~~.
I'cii systcmansdie a~aalysc vati dc (slgrilficatrt gcblekcn) correlate1.i van vrrloop en p c f i ~ i ~ c ~ l s w i s s e l ~ ~ ~ ~ g e t ~ b ~ n n c n rt.stdci~tiele irïstcllingcn \-oor nicnscn met verstar-- clcliihc bcficrkitlgcru It,vc.rt $13 cei-stc instaiitlc &neraveïrng rclevatrtc kenmerken op.
Doc. uurknrn~icn blijken te cot-i\.ergerct~ in de volgciidc relevante c o r r e l ~ r e t ~ v;rti
I cilonp rcspccrievelijk \.ai] persoricclsw~ssclnilgcn: rnstelling; sociowoning of wo-
i-uing op lcrrciti; groorte van dc woongroep; zorgzwaarte van de wocingocp:
arbcidss,inshci~c; door gruclissleiders etTTaren píirsicipau'e in b e s l u ~ o n - ~ l / n ~ , s>ndet-- Iingc san~en.rwerkirng e11 iold~indelrjkl-ieid. Uit analyse van dcïelfde \vetencaihappclr)I\c 1ixcr:aixxur wordetr drie tjpen van niatcn '~~006: ] ~ c ~ ~ ~ n c e l ~ ~ ) u ~ s s c l ~ ~ k g e ~ ~ aigeleid: srnbl-
Iran hei team ( n p e 1); frrquenae waarmee Neu\lie t e a d e d e n IIisanrncli ( n p e
lq,
de ge11~ddelde d u 1~su1-r ~ het tea~~&dmaarschnp (type 111).I*old~hfk -I ~ e h n d e l r de bctoren trsinefiecn\iteir ei2 haliteir van bcRleidng.
Deze llarl$?cn nauw met elkaar samen: de kuvalitclt Lran het ~ e ~ m f U n c ~ o a l e r c r i cfl de:
daarbij horende gunstige coi-idatics, xrormen aspecten van de inteme effecti1~nrcit 1rar-a de o r p m s a u e . D e door het chënïsqrsacern cnrarcrr k\valttert, voïriïr eei-i aspccr linrz de eurerrie effccti~-itelt. Teameffrcclivite~t on door het cli&nrs)isteer-iu cl--aren k\valneir .r-orr-izen als laer ware twee kariteri van detelfcie meduue. Vocrr dc nadcsc bccriide- n17ig var] beide aspccren worden rcader~rmi.le instelhngciz bcschnutvd als t i i ~ c ~ ~ ~ r - verleiacnde oi-garusaaes mrt de daarbij horende kenii~erken. Dat wordt n~ltgewcrkt iiz de eerste p a r a g a a f x-an dl? hoofdsttlk.
Er woldit aandacht besteed aan cle brgnppen uraaggerichrheid, lilaritgc~-icl-ithcrd cn aan eeri ornschn)vi.rig ~ ; i i l 'de chP11c' in Imct grval van residentiele instell~iag~o~.n i ~ o r mensen mct verstandelijke bepcrlirngcr-r. Hlrru~t Iidtjki dat ouders en fan~iiltc 211s naastbe~rcakkcnc-i en vcelal ook als wetrelrjkc .i-cïicgen\vanrdigcr-s v a n de bewoners, belangïiik zijn voor ]-iet beooi-dele11 vati de lcw6ilitert dcior reizidctatlclc instel- hi~gerr gel~oderr begeleiding. Na. een nxdere onlrscliri~mng van dc begrlppeir 'markt"
en 'clii&ntrevredcnheud' wordt de re1cvan.a-r~ va11 de imarl~enaigdiscip1111c twor cic swdie van het wersch~j~nsel pcrsonccls\-vissellr~gcti onderzcichir.
E3
\~oIgï eet1 \ cskeii nlng víii~ dc relatie russen tearneffectrviteit e11 cgJEtittcvrcdei~lae~d i r i inrirkermi~g- ctcrdics. Hiercirc volgt de relevantie van het n1arlcetia-igconcep.t als tl~corrt~scli k:tdei- voor de studie van persoileels\visselif~gc"~l.Ir2 de t~veede paragraaf \-ai1 $1.1 I-ioofdsni'k woida ingcg;ia.ri o p kui:tl~~citszorg. Iieisl urcsrden de vele facetteil van 'kmY1teit' besprokeil. Vervolgerls wordil een iI>elínopr historiscll oveïzichit gegeven van de aandacht voor- kwaliteitszorg in de Nedcrlandsc residentiële zo- ve)or rJilensen met vcïstandehjke bcperhngetli. Na cc11 I J C F C ~ O U -
\xTng ovcr her k\vrrYiteitsaspect 'conun~iiterr\\xrordeil p e r x ~ x e l ~ ~ ~ s s c l n r ~ g c ~ a 01x1- schrcTcn belernmerendc factor \-oor de rclationelc conijricrircil i12 mc~dcwcr1ca.- cIriinr contacten en danrrizce .iTooï dc ervarmg van de kxvallteir van bcgclend~ii~ dotrr Eaia-ilil~c \7;ii-i clientcii.
J J ~ ~ ~5 \rat de ~ ~ ~ ~ ~ ~ L de E ve3crrafg;~ii'idc drie ho~~fdclsnukl.;cn ~ : s;iitaieil.
gccr&j ~tcra~xllIrst-C$le op grond tian Izet perstyrectrcf van t . 1 ~ k ~ ~ í l l 1 l ~ ' f i ~ - iL?arket,llg, a c r i-els\~aritc facrerrrn @2!\/, /j,
B,& c:)
~ C ~ L I C ~ ~ I I ' C W ' L I v(l(>J" dc? E ~van ~ persunec]sw~sse~~ngel~. ~ e De probleenistelling I~iidi: i5 LIG $ : 1 1 7 ~ l l h ~ l ~ # 2 ~ , s s ~ 1 7 cnerzilds aard (>invang \*art p c r s c i n ~ c l . ; ~ * . l s s ~ ~ l l l g c ~ ~
(j'w)
Cn ; ~ n d c r ~ i ~ ~ l ~ , org2~~ininsaiic~ciime.e.r~Cei~.) de tenmcffect~ritert en de I<walltrit i a 1 1 l~ej$rl<llngj 131ifac.lor dcclfactoren. ]Jrr lcverr de voìgcncie ult\iiiet.~clng VRil c l c i ~ l c ~ - i ~ ~ t ~
\*at1 de probleeinstrlling op:
- Orgaiiisaricfacroicn (op iiivenu van de ~nsiclliiig en dc woongsocp - .l):
m Im-isrelling als zodanig;
a Oliivang varm. het cluster waarloc de wncingsuep beli<zorr, Woongroep op hei terrein of buitcri lact tcrrclii (scrci<~wcinirug),
ir ($rc)orte van de woongroep;
e Lol-gzi,% aartc uvali de: be~voners 1-an de woongroep.
-- 1Jeir~(,~~c~l'i\-iisscl1~i~cn (maidaliteiten van rearnw~ssclingen - PW)
5 Silabrliteli van het tcasr?,
r I're~iucnt~el van nicuwe instsromcri in het team;
*
Clknuddclde iiijd clar dc teairdeden decl u~rmaken va31 laei woongroepteam ('Tijd op \voongrorcp').- 'Beainefkctiviiar (cernditics voor effecnv~telt van het teamfuncrlonercn - B)
a ~\rbc~dscariisfacric;
Rolduldclrjkhcid;
*
Vcrtruuwen i i r elgcn darelmatiglleid;o lirvarcïr auioaloime.
- Door familtc tiniaren Iiwali~eii van Ixgelerdlng
(C);
Q Edvarcil tnhcpudehjke l~~valitent;
a I ~ m a r c n relationele kwaliteit.
ilari her eind vat1 licjofdstuk 5 worclen aai1 de hand vaia dezr factoren e n clcclf:~':rciorcn dc ondcrzoeksvragcn srespecneveltlk de deelttagen vric~rlnpig gc foni~u1eem.d.
In lioojiidttk 6 \uord~ de probleci-izsrellir~~ nnet de \roorlopige ondetzoeksvragcil bniincn ccn ~heoïec~sch lradcr gep8aatsi. h a een enleaditig over Il-ict eco1og1~cl.i kaj-abier sr;rni d c bcgripper-i 'vcrsrandclijlrc beperkingen' cn 'onderstcunnng' volgr eeri ciilecn;Yelting vair de so,ciale ccc~log~e. Urt de soaaal-ecologische theofie van C.
lii-crtiiF(~iabrc~:a~~cr ~vtiordcai - vuor de bcgcleidingssntuane vala mensen mcl .i~crstamide- l~pkc bcperkingcii - vnoiwaardcri voor gulistige inceracnes afgeleid. D a t zijn x oc>r- xvíiarden dle Lcidcn tot o r r ~ ~ ~ k k e h r - i g cir tot beter fiinctionercn. 'liiln~ur een iiilio~iclcli~k 1>crspeci1c6 wor~li eciï i~l-ieoretrscla k* A cl er van ~nteracnes tuswri ivooi~- g i t r c p t e ; ~ n ' ~ , ouders c111 [;11111hc, C I I l ~ e t r j ~ ~ i e r s va1-1 iesrdcntikle iiastcllirigerr g e f o r ~ i ~ u - Iwrd. I r e t ~ ~ » l g ~ i ~ s worclt vnntiir ~i1:1rkctnn~~crs~3cctlef cle riiicraclies tusscti ~ v c ~ o n
g r o q ~ w z u ~ i en clrci~rsysiecni (\vrt;lrrrndcm oudcrs ci-u rarntkic) bc.scl?rclien ei1 nc~rdcii i.c>rir\iv,~ar~Xct~ voor guiz.;age 1rrrer;icties gefiiiinuleerd. Dat z~;ta toor-rvaraicieil clrc
Icnclcrl tcrt groirirc teamcFfcctiviccii cri 111 siiinenhang daiit-mee, rot grojtr'rc clriintiu~r-edclrlirid. IJaariioc \i.urdr gcbriuk gctiî;ialit mln eeiia cn-ipir~scla ilaociel .r :iri
I lal-tlmc ciil Cicrrcll. N:i ee11 Iattisc81e Iscschouwri~g over het mcteai v a n clierlr- ïc.vi~cdriilicic1, \r.orden de 111 11oofc~s~1Ii
5
g c s ~ I e c ~ e ~ r c i e fac7orc.n biilireil CC17 rheo- rcrisch 1iacilc.r gcpln:r~sr. Dir krtdcr is congruei-it met zowel de si~cníile-ecologie als CICniai l-.ceiiigthcoeic ct) IS claarrnec zi~wel inlics_udclijk ais organisa.toi.~scli relewanr. 'rrlï
$101 \\:O~CILYI zcs dlt~ii~liit~ve o ~ i d e ï ~ o ~ k ~ v ï n g e n ralet bijbehorende dcelvragcri $efc'6ir 1ii~i1ce.r-d 13e eerste cirtc o n d c ~ z o e k s ~ ~ í ~ g ~ t ~ bcr+cfÇen het vcrbaricrl tussen pe-~o- ricclï\~aa~eliizgc~i~ r.ti (l) \\~oongroepke1r1ner1cct1, (2) iearneficnlvlrci~ cn (3) tlot>r Sainzilic crvarerr l<\valttcii rnn Lliegclcidmg. C1nSerzoeks~-rdlag 4 bctreft ]let
nissen tearnrifectiviteit en door familie eiTareii kwaliteit van begclctding. OilUcr- zoekcvraag 5 betrek het effect van prrsoneelcwisseliiip op lier \-erband tussen tea~~~effectiimtelt en ervaren k ~ v ~ h t e ~ t van begeleiding. T o t slot \r,ordt i11 oirder-- zoeksvraag G gezocht naar een madel waarin de sainenhmg vm \~ro<rng-oep- kenmerk ei^, personeelsu-isseli~i~e~i en teameffecur-ireit als vours~iellers van cnrarrii kwaliteit wan begeleiding worden geb~vtkt.
Dr: dee1vragei-i bctïeffci~ telkens de hierboven genoemde deelfactoren van \rioon- goepkenmerken, teameffectiviteit en c i ~ - a r e r ~ kwaliteit.
In hoo/ii~-ttfk 7 waar de opzet van het onderzoek beschreven. Her gaar om een cross- secnonrel onderzoek met een exploratlef karakter \va:ttrbil gebr~iblk wordr gemaakt n n vt-agcnbjsten'k. H e i onderzoek v~ildt plaars bij vrjf resldent'isle iilstellirz-n voor menscm met l erstandelijkc beperhngen; het totaal aantal clienïcn r t l drxe groep is
srpresentaticf voor de populaue bewoners vala Nederlandse alget-iïenc residentiele imctclhngen. Het betxeft 111 oii7e onderzoeksgrr~cli, 1.813 bewoners. 111 &i lii~ofclstuli wmxdt de oper:uuonalisering van de ocidch-zocks\-rage11 en de deelvragen toegclrclzr.
Pelis~rieelsw1.;sc1jn~e11 worden gemeten 111cr drie maten dlt" elk een moclalircit van de teamwisselirigen meten: Stabiliteit, Insrroomfreq~ierriie en Tijd op wocii-groep.
D e tcati~effec~r].~~iteit wordt geoperatioi-ialtseerd door iniddel van vier x~ragenlm~srcrï (j611 voor elke deelfactor). De door fai11ihe ersaren kwalitcir van begelerc21ing \vordt geopcrauoi~aLiseerd aan de hand van twee \.ragenlijsten (éC-11 \-oor clkc declCacior).
De keuze voor de ~iriugenYi~ctetl, hun validlre~t en berrouiwbaarheitl worden verairt- wucrrci. Fier hoofdstuk sluilr af met íile forniulenizg van de gcoperaiionalisccrde - - ondcrzoeksdeclvragen.
In haqkt~-tz.rk 8 wordcn de resultíitcn gepi-escntee~d win hrt einpir-isch onderzoek waaraan 1 .l51 groepsle~derc en 1.021 farmheleden door terugsturen Tati hun .~ragenlijxen deelnainen. Dara werden verzameld over pcrs.ot~eels\vlsseJinge~~ cn
\n.c)oiigrnepke~~n~erke~~ van 188 woongroepen ei1 wootlgroeptcams. De oii.ivang van de personeels~rnsscl1tïge11 bedraagt in de gehele groep VCJOT de Stiiblliteit~maat gcnxd- deld 66,5 proccnt; \-oor de IrmïtroniniFr~~~~clt~tic-maar gein~ddeld 64,s procet-it; ria voor dc "*Tild CDFL) \ v o ~ ~ ~ ~ g r o e j - ~ ' - m ~ a t "C3,J maanclcn. Vervolgens wcsrclen per onclcr- zacksdeek.irraag afzc~ndedilk dc rnztk~xnsrct~ gepresei-iireem-d. 1Sij clkc ~ILcclvraag \vord~
eerst een Isesehrijving r a r i cle u~ilíomstei~ v;zn dc bcaefknde vínriabclci~ gcgcvctl.
Dan volgt het aiInvoord op de ondcirzoel<svïa;~g dcrnr het r;il~porrcrcïr va11 dc correlaties nrsscn dc vanabelen 111 elke declvraag (haar hei orn vcrbaradcrli gaai) < r f
d~ U l & o ~ m ~ ~ C n van een variantieanalyse (waar hct verschillet1 bctrcti). C ) r i l c J i ~ t cr drie mater1 r o o i pcrsoncelsw~ssehnge~~ wordcn gebiuikt, wor-dt bi) cllic. declvraixg laet of lael \?erschll gerapporteerd clwar elke Inaal afnioiiderll~k.
JJe rersclall]en nissen dc iilstel]inr;ei~ zijn alleen stgnificni-it voor dc ~ri4xsocrn.1i-
frequalnc en ''Tijd op a:oongi.ocp'-maal (deelvraa~; I l). rs ccn ticgnc~cv~
cor~c-latre msscn de gïnorle v221 clusters e11 dc rsmvnirg vari elc ~ns~ronznfr~t-ccl~1c~a111c cn *"jvild 013 woon,goep-'rnaat. E r IS cen poslurf rcrlraiid i-ci~~cn dc gnioiic if:ii3
clucrers en de Stabili~eit (declvraag 1
.z).
P-Iei anfivrii~rd op deel\rr;uag 1.3 luicli tl:itop her renein verSchllien rati sociowoningen op d i Srib~liicir maal
(rcn
vm de socioivoningeli) cn van de ''Tijd op woongrocl3-'maat (ten guiistevan de \woongroepc-n up her rerrc~ii). Vcrdcr \werd een positieve correlane geXron- dcni m\scn de ~voc'ingclepgroocte en de 'T~ijd op \x;oonguoep-'maat (declvraag 1.4).
IS c.11 ncgaucf verband tussctl zorgzwaarte en Incrroornhcquen~e (deelvraag
I .j>
I k bhijkt gcen verband tiassen arbr~dssatisfactte en personeeiswsselingcn: geen cnkellc maat lc~dt tor significanre correlaties (deielvraag 2.1). Gr Is een kleinc
3209mwc ë<irrelaae tcisscri rolduidelij~kheid en de Instïoornfrequenitne van nieuwe rearnleden en ook met de geiniddeldc Tijd op woongroep (deelvraag 2.2). Er wordt een posmcve corrc-iatïc- aangetroffen tuscerl de variabele 'vertrouwen in eigen doei- rnatiglreid' en de Stabiliteit maar respectrewelijk met de Tijd op woongroep'-maat (declvraag 2.5). Ook worden posirzewe carrela~cs gevoilden tussen dc vanabele 'crvarel~ autonome' en tie Statilll~eit respectievelijk de T~ijd op woon-oep7-maat (declwaag 2.4).
Bq onderzoekcvraiig 3 wordt het verband tussen personeclsw~ssehnp en de door fainrille rwaren liwalite~t vair Lcgelesding onderzocht. De ervaren inho~idchjk kwab- eelt vrrtoont cc11 kleine posinevc correlatie iner de 'Tijd o p woongroep"-maat. De a-varcn relaaonele kwahre~t vertoont ccn posinel-e correlatie met de Saahditcit maat cri met de 'Tiid op wotrnguocp7-maat (deelvragen 3.1 en 3.2).
111 a~ztwoord 013 oolnderzocksvraag 4 bhjkt er een positieve correlatx tc I~estaan tussen arbeidssausfactie en zowel dc emxren rn~houdelulke als relarmnelc kxvahrein van begeleicling (declvraag 4.13. Hetzelfde I3eeld gcPclir voor de variabele rolduide- hjklieid (cdcelvraag 4.2). l->e vanabele vertrouwera i11 eigen doelmatigheid corrcleïrï alleen n1c.t de ervaren relauotrele kwalitat (deelvraag 1.3). E r blijken kleiiie pos~rieve cnrrcllahies rtisscn de vanabele 'e~liarelr autonamie' en de erwaren inl-iouclclijke 2cnvcl als relanonele kwaliileit (dee1vra:ig 4.43.
13ij ondcrzoeksvraag 5 wouc&~ plieken naar hct effect van pel-so~~eels~wisselingen op de cosrelattes tussen dc tearneffccu~itent era de door fainihc ervaren kxvaittei~ van begeleiding. D e resultaten van de rcgressscanalyses naar interactie-cffcc~ laren
xieil dat de o m v a n g van de stabrlnrci~ 17ar.i liet oearm r e n elfcct hcrft op d r grooicc
vali CIC coi-sclanc tusxcli arbctdssausfac~lc rcspectici~elilk roldmdclijklacid. en dc cloor fjiiaril~<~ cï~rarcn I . C ~ I I I I O I ' ~ C ~ C Ic\wahtc~t van begclcldlrig. We raoen~eri dat een sensil3ili.;~-- iiiirg~effccr: bij ongunstige srabrlircrr is er cc11 hogere correlnt-ie russen ;arbc~dc.saas- Iacilc respcctirt~clijk roldriidelijllilzeid en door brnilia: ctTaren relatioriclc k~valr~enr vati begclciíiiiag.
131~ oiitler7richsvrarn~ 6 tvorch gezocht naar ecn rnodcl van samctlhang ciissci~ alle var~abclenz viin dc factorcil wonngrc~t~plccir~rnerken, persoì~eelsw~sselrngen~ tcxni- e i l ~ ~ c t ~ ~ ~ r i e i x als vuorspellc~rs vair door Sainilte ervaven relationele k~vahie~r van bccc- l c ~ d ~ i ~ g . I-Iic-rl~ij bhilicta directe srgi~ificairtc paclen tc ~iisouden gevrrnderi rilct arbcids- sansf;+ctic 'Tijd op \voomlgroep'. 'Tijd op woongroep' vertoont een sic~nikicant posiiuef tl~erliiia~d nner ;nrbeidssansfczcrïc. Woocigrocl-~goorte, zorgmvaartc rir cluster- grootte blijken voorspellers te zijn van 'Tijd op \v»ongroep'. E r woudi resi mrcu.;inaal significant rechrsrcecks p;ad aai~gecïoffcn van clustergrocitte naar e n aren rel>itloncle kxveihrac van bcgelcrding.
I n Izoofdsmk 13 worden de coriclusaes gdortnillecrd. Algernceru kuniaen gersoneels- mssehragen worden beschou~\v-d als belemmerende factoren ~r?i)ot zomiel tearrieffc~c- wxrireliï als door familie ervaren kw311teit van begeRr~&ng. Dat effect is eclitcr sterk a f i a d e h i k van de bcschuuwde imodaliteit van personeelr.\~~sselirrgei~ &die op liun beurt afl~ankehlk zijn van orgai~isaronische kenmerken.
h% een aantal krit~sche naetlioclol~~sche Piiaruttekenia~ge volgen drie iilhoudei~jkc besclioum-~ngen. 113 de eerste pla:tts tvondt - in het Lelatrg v u l tcameffcchmteit crï.
kxv&te~t var1 begele~hilg - het bclatlg onderstreepr van her ïsiica~~tai-en van dc
~eamstabnliteir en l ~ e r nemen van rizaatrc~elien wantices dexc bedreigd wordt: delie rnaamgeleri dieneri de vertxowtvensrela~e tusseri orgatilsatrc ern Çninihc te oïider- steunen. IPn de tweede plaars dleneri door dc argauusaue zelf geindzrcecn-de tvisse- hngen in rclatle tot njdelijke vensinging van tcamledcn Mern te wordet-i gehouden;
&t kat1 door veLT7anpng zo dicht rnogeliqk b31j het team te organjseren ïnct r~~edewcrkers d ~ e mer cli&nten, collega's en wcrll~\~ijzcn van Iicr team bekend ziin. 1x1 de derde plaats blijkt de "geanididelde tijd up wooi~ga-nep-Ie belangrijksre coria- nwtelzsmaat, en iii hei: kader wan doom: fa~ivhe cl-varen lcwal~te~t van zorg, cetr relevante kxvaliteitsund~cator te ztjtl.
Het E~crofcist~rk clmt af met aanbeveltngeni voor Tics kwalireitsR-3eleic2, voor d e belieersing van ailcrdenteri (&sconunuiteit) van woongocptearrzs cii voor l ~ c r strateg1sc1-r belelcl van residentikle rnsrellinigen.
Con 00 airy o f Care
-% smdl; o f rlw relations bemeen cbrecr senme staff connnun), orgarr~zat~ona?
cl~aractcnstics, team efficacy and far-ruly perce~ved sermcc quallqr ln Ilr~ncch res~dentral faclht~es for persons with ~ntellecmal cbsabl11n.y.
Chapter 1 introduces tllc central problemm of thc ]>rcsetlc resc;ncll project: tllr c o n t i n u ~ q of resrdcntial care for persons wmth 113 In the Nethc.rlarrds. l'l're restson for the project are the repearedly esprcsscd concerns and cor13pln111ts b!r cllencs, chents' farvllhes and professiot~als about frequcnr chamlgcs of cbrect scrxsicc ~ r ; ~ f f P S S ) rrr resldeazdal selvicc teams. it res~denlraal senlce team 1s a grollp of dlirrct care employees that offers practical and daily face-to-face suppost. to a group rrf cherats shaang thr same residential sernng (e.g. a group home or a h u n g uti~t). Tire srabdity and continmty oC these DSS teams arc pivotal to rhe qualrry of care that chcnts actually are rccciving.
r\llthough research projects 0 1 1 DSS tti;?rv-nowr tn resiclenrt~l facilities for persons \mtIl intellectual d~satsiliry (LEI) arc well documenrecl in the Y~teramre, rcmcarch on rhougrr
of D5.Y ~ ~ L I I P ? mt7mJiJtr~/lp tm tlin the primary eeslcZelli~al serlnce t cams 1s h ~ ~ r d l y avarlable. Althoug11 DSS rumover of course 1s retlecred in DSS tea111 rncrnbcrshlp changes, the latter are subject to acldiuonal pressures aiid slrovlld 2 3 ~ seen as thc res~vlt of the c o t ~ ~ b l n e d effects of turnover as well as of trat~sfers, ternlaorasy assignments, interilships, reluef s t a g wltllin the sal-sle conapany and challgrs lor reasons o f h~lmaiz resources rnanageliaenr. Swmc authors suLggest t-11a~ tlze ratcs of DSS changes at the level of cfirect semnce teams ~ i u g h t be substaniually l-i~ghcr than mu-mover rates at the level o f rhc argantzauon as a whole (tl-te usual lcvel for t w n o s e r studies). However, hardly any empirical evidence ~ ~ 1 s t ~ as ( O the size and emzlpact of these ream membershtp cl~anges (Baurneister ct al., 1987; IZraddc~ck c r a].,
1392).
T l z s study amas at clarifying the s17e and the ~ m p a c t o l IISS ( c a m nrenallrorsh~p changcs in Dutch rcsidonwal ~ ~ C I L I I I C S . ' r h c central C ~ L I C S ~ I C > ~ ~ I of 111~" S X I I I C I ~ 1s X B ~ C relanon Zlaenxree~z DSS tcarn mcml3crshlp ch;lngc ralcs 2nd (A) (11e orgai'r~~;itto~~al colatcwt o f t h e re';.ndci~ual l~ving gr(3~12,
03)
13% ream effic;rcj' 2nd((:I
c~ual1i3 of cartfrom the perspecuvc. To answer tlus contra1 tlucst101-1, a \[udy of clrc 1rxcr:itw.c
1s first conducted tcr descr~l3e tlze coclrext of the prnlrlem, to ~clcntify rrclcvant corrrla~es of DSS cllilt~g~s 111 r c s ~ d ~ n u a l SCITICC te;~ms mid t o explore rclc\iant tlaeorcrlcal frames for the study of tlzis problem (';ir~ 1). S c c o ~ ~ d , at1 ctm~3uncrz~ slt~c!)"
3s COlldCLCted to invcsrrgare rhc r e l a ~ ~ o n s bcrwoct~ DSS changes and thrcc grr>ul>s of yclrlables. organlznuorlal charxctensucs, tcarn sfiectrvcnoss and pcrcc~vcd ym;bl~ty of care @ a r t I[).
Chapter 2 offers an histoncd rcv~cw o l organtznrronal charactcrlst~cs ancl IISS
~XH-II~VCT. ~ t l r c s l d e n t ~ ~ j f a c ~ l ~ t ~ e s f a r persons with 1D. IIr ic; dumc~t~sarafoci rhar
turalovur I-has grc.o:l a prol-iiernatic fc-;l~llrc o f profes.c;lona! resadenzaal carc ever slnce
jrs orq:~j-r\ 117 thc hi;t 35 year5 of thc nlnercenth century. T h e organmanonall strwcrure of thcse fac~lines tn rEne Netherlands vanes as a funcuon of ~o the c k a r ~ g ~ r ~ g buseaucratac envucunrncnr mmnng from 'simple' orgal~lzatlons (1875 -
19511) t o f~lil \r3rofcssnonal bureaucr.aaesi (1350 - 1990) and recently shawmg a tcnc!cnc\~ rowards "netvdork urgin~zauons' (1330 - present). However, rhe baste:
an.rr:angemenc of tlae res~dcnual 's e ~ v ~ c e encounter' - dcsplre changes m group saze rcductloc~ and ream h n c u o n s (e.g. tlre antroducnon of case management bascd DSS i;tsks) - has always been the lnnkage of one speclhc DSS team t o one s p e a h c setung 05 clremts. When rn tnnle average resnclential group slze dropped (f~onn 15 -
20 Ijcfore I N 8 t o 8 - 9 tn 20C)P), team sxze consequently was also reduced. 7 ' h ~ led co sn-rallcr TISS tcarns that became more vulnerable to changes due ro turnover, bur also to DSS rephcen~crrrs (whether or not rernporar~l~~) and transfers within rhe samc org;rnlz;luon. Historical studies relate turnlover LO the soclal starcis oc rhc 13rofess1on, lal~os marker circumstances and also to cultural factor5 such as t11e custom of Dutch women to stop w o r k ~ n g %?hen thcy ~ n a r n c d (firsr half of the 361 '' ccntui-y) or the vast and stable w o r k h r c e of rcLigous nuns and brocliers 1n thc res~dcnr~al care Six persons zmth 111, parucularly In the South of the Netherlairds bctwccrn 1879 and 1'350. There are n o liistorlcal stuches o f IJSS team nncr~ibershtp clianges.
Tlie prcscilt Durch residcnual carc f i r persons w t h ID C O ~ I ~ S I S C S 133 difkrcnr facllrtles scimng 33,634 cl~cnts and crslplojlng a workforce of 54,0261 rndiv~duals (of wli~ch 45,219 IISS). Tlne avelage age of the residents is 38 years (8Yo older t-han 631;
rn terms rrf thc trad~oonal 'levcls of fi~nrtionit~g', ~11c reszdcnraal populatiuri of p e r x ~ ~ s w l t h 1 D can be characterrzed as h a v ~ n g 1m11d (1 r n ~ d c r a t c /33°*03, severe (33 OJu) aincl profound (24'/0) lntellecitual d~sabll~ty. Although Dutch iesldcnnal care up rdl r l ~ e 3 9903 could largcly be labeled as congregate on carnpus nnstarut~o~~ill carc, a stgnnficasat proporlion (over 35 O/<I) of the clients rs iiow 1~tr111g .off cat17pi1s' In community Is;lscd group l.romt.~ ;rlrd aparnnents. Rotli ors and QJ cc.lmpu~ ~ I - O L L " P C
st111 61nncuor1 under the sarne L ~ c l m ~ n ~ s t r a u o ~ r and govieriaatice bocily. TB'1114 s!llfc
~ h o v l d ~hcrclore be seen as a process of ~ns.tlr~aue>nd nranshrrnait~un and dc- coczt-oiltfi~tlon uatlrcr rlaan de I I ~ S ~ I . L I ~ I O L ~ ~ ~ I X ~ B ~ C ) I I .
Chap1c13 coFF~brs A systemam remcw of the plrofess~ollal as ~vell as of tlre cc~cn~Vic rcsc:~rcla l~rerarurc 1.0 (1) doculzactat tlae relevan~ce of the phenomlet~on of fj.eyucilt LISS ten111 ~.iictmbcrsh~p chansrs, (2) to ldcnufy correlates of DSS turrzozrcr and [cam 11iornbcrshtp c1i:iinges and (3) to ~dctluf'l. operanonahzauons of 'DSS rcasax
~71~11123crs121p clliillgesl.
( I ) 'l'hc. E . ~ ~ ~ C V ; I E I C C O F 13SS changes IS o ~ ~ c . x ~ ~ h c l n l a r i g 1 ~ rlocurnenrecl in rlic
~ x Y " ( ~ ~ w ) I I ~ ~ litesaturc. Clrents, bnirllcs of clnencs as well as prufess~onais compl,ilti :tbc.aut b o ~ h the c'xtunr ot'P)SS tc;im r n c ~ ~ i b e s s h ~ p changes In pracacr and about the
~ c f i ~ ~ t c n c y ot' ~l'rc: problem decplle repeatcd calls for artet~don by parcjlp-:
; ~ ~ ~ c ) c l ; t r r o ~ ~ s . ,'\11 relc~ililt stakelioldcrs coirsider freclucnr DSS chxsages as a serious
clualln~ of care risk and even as a barrier for the quality of life of pcrsoils ~vrtlx 111 ln
long cerm care and cspepaally tn residential care. Frequefu DSS chalrgcs arc. belacrred to have a il~egamre Irnpacr on rhe chcili's atracl~rnrnt to srgn~ficanl pcrsorns
m
hrs~mmed~atil- eiIxrlronrnemt and to tlxc chtnl-IISS conumurrtcatlon I:requrtlt I355 changes are seen as a h ~ t ~ d r a to getang fanulaar t-vlrb thc c l ~ r n r ' ~ needc, to dct~-elopm~ adequate respolzsivencss of carc workers and to btul.Ctl~>g rile necessalv m s r for personla1 suppnrr. For the organdzauon, frequclrt DSS te:un c h n l ~ ~ e s negatively affect the chenc's and fanzrl~cskcc~sumer trust. l'or care nslcR S U I ~ ~ S O ~ "
companlcs, 13SS changes therefore arc hot11 a suategc i l ~ ~ d qualqi issue.
(23 AZtholl~h the 'theory of membersl-~ly, dycranwcs' of ,4rrnw and RIcGrath ( 1 9 5 ) nnclildcs kemporak patrernlng of mel-i-rbcr changes' as a variable, tl-ncrc src ncr emplancal stu&es o n team dytxumrcs and tne~llber changes a~rallablc that ;\Ie relex ant to long term care sltuanons. (In the other hand, rlicrc are several ~ntcmnt~ol.lal stucbes on DSS turnover. h review of thesc studlos Icad ro the idei~t~ticatiun of 4 1 rele-uyans organizational corl-elates (Table 3.1) Because DSS charrges 111 res~~lclltral teams appear to be srgnlficandy affccrcd by ~lztra-orga~-i~zanonal Sactors, a sclccuorv of SUCL? corselaecs was madc olz tlae basis o f crnl~~ncal l~searcll cvidcncc. "Thns exentually rcstrlted mrr five charactenstics of r l ~ e orgaruizat~oi~al team contest (hctors: bc~lity, llvlng g o u p size, on versus off campus Ilvrrlg group, c'luster s ~ x c (numlocu of teams cor~gregzated in the same l~rgher orgnn17atlonaY gruuprng) a i ~ d
~rrtens~ty csf clients supporrs needs rn d ~ e lnvr~ag group) and four team ch:~racxer~st~cs (factors: 13SS job sal-lsfacnon, perceived autnnony, \\rarlr stress and uolc clar-tty).
(33 Fixplcrrariot? of emlp~ncal htel-:~t~~xc usrvelled ~OLII-teen dlfferci?~ aj-?ip~-oachcb 114 the rneasurenaetll of turnover. Analjisls and uansposacmon of thcso rncasurcs 111to IISS team mernbersl~ip change measures resulted In rihrce &st~ncuve rneasut-clncnt ~-ypcs:
team s t a b ~ l ~ t y (STAB) reflecang team cot~tinuitj- based 011 the pr~1pornc3.11 01' team ~nembcrs that1 aye still o t ~ the heam after a pcdod of one year;
ac]nissiata rare of 11cw mcmbcrs (1LVt;R) i-eflecung team dsconul-ruiry based
011 h e of lrew team nxe~~rbers that srrcam ILILU ream ovci. a onc year Periucl, regardless of tl-rc purpcmc o r length of thew i~~crnbershlp (zernporarj- rc%llcf or rcl-?ilacctnen~t), atzd
average llengtlz ccasll nlclazb~ca-sl~~l-, rc-ilecrtng nl~e 211 umgc lenl;lh scrvlcc of ail members o f a par~luular rram ('J"C)\xlf+;~
Sltrce conr~nutz-y, duscnnntrulc-y and icngr-la o f tcanzl 1ne1r-rbcrsl1i17 rcp~rcscraa dlflcrcire dllllenslons of ream chalages ('i~-m-ow et. a]., 2000) 211d bccau~e~ 01' lit-addoclc ;~rlt-I
h,fltchc]l" srecomlncr.ldation (1 9%) 1 o ~ l s l l ~ g ~ C E I - e ~ h a n (l.11~ Inearure" (11% tLlrn()vcr
srucjlcs). tlrr ~l~~~~ types of measures wIl 1>1: rctalncd fix FU~~IL~CI. 0~3~r;bl1011aj17al~c)11~
and usc 111 study.
C117apwr -1 IS an exploration of rclev~nt contexts h r ~ h c study of DSS tc:arn incrnbcrsh~p char~gcs 'The hast sccuo~-r or' thli chapicr dcals ~ v ~ r l a res~dr~ln~al c,we ior l ~ ~ r s o n n \ * l t i ~ I 0 as 'senrices9. The
purpose
o i the scnrlcc $ 4 lo r a t i s $ cl~cnr nccds.?'he I'>SS Lean, 1s at t1-x centre o i the serlirlce encounter ~ C ~ - V I . ~ C I I t h e fi~cd~ty and 114 cjrcnz.
1)~s
eftllc;mcy a n d cl~ent pcrccfi~ctl sen.lcc clunlrty arc closcl) bnkecl arid c;ln be seen as nvo sides o f the same coln. Tlacrcfr,rc., I[ wtrulcl bc rclc~~ant 8 0 s ~ u d )rhc irrlpact o f DSS il-eanlj rnembcrshp clranges o n 130th team efficacy facroas and clicnt pcrccrved cjualliy r r f the sen~rce.
la- 1s argued that senice markctlng offers a relevant frame for the study of DSS
~ l ~ a n g c s impact on both team efficacy and yual~ry output. S-Iarthne and 1:errell"s ernp~rlcal model for the management of customer-contacr serwlce employees (199h) present!: an cprgaruzing frame f a r DSS team efficacy charactenstics as explored 1x1
chaptcr 3. C~ronsocas' model of customer li7ercelweu' quality (1 97019 presents a frame for the conceprualizario of chent perceived qualtry ~n two d ~ ~ n e n s ~ o n s : technrcal cfiuallry (cot~tcnt rclated) znd f ~ u ~ ~ c ~ o ~ ~ a l clunhty (relatcd to the ISSS - chent r e l a ~ o n s h ~ p ) . I t is argued that in services for persons with (severe) 115, che cl~elrt sysrcm (person wlth ID and his or her family and socral network) should be conce~vcd as the cxtendcd client. I-'arnely perccpt~ons of quaho~r of casc therefore arc selevatl~ ~tldrcarors of the organrzaaonal outcome.
In the second secuon of this chapter, the semlcc marketrng approach I S srtuated wrtfiin quahry rnanagemcnl models that are frequcndy used rn the Ilutch resrdential services i ~ ~ d u s t r y (1.e. ihc European l X Q M Exccllencc model and the PITKC; quarhty sysccln o l the Dutc1.a association o f JD service provld~rs).
Chapter 5 su~mmarizcs rhe rcsults of the tliree prevro~ls chapters an3 offers a pwehrnlnary olganizaaon of reicvan~ correlates of DSS n-lornbers~ai~ cl~angcs ivtihm a gel~cral rheoreucal modcl ( f i g ~ r c
S1).
I
Pcrcelved service qualityO r ; q , i ~ ~ s r ~ ~ . i i o ~ ~ ~ t J / ~ L ? O I : F (4): fac111~y In general, slze c , i DSS tcam clustci, orr
/
offC X ~ I ~ X I ~ 11271129 gscl~~p, living gi-0~113 size, and I I Y I I - I ~ group ~ntonslty of suppores
(5
f:ictors).
$l.\.S' f ~ m ~ t YI/C~'PSEIPIY~J~ ii'r,rrr<r.r flJ1i7): ream stabrlniy- (ST:Wlf), a c l ~ ~ u s s ~ o n rate t.rf ncw
ti~cr-p~bcss (INI:IZ) ancl ;ax-er:zgc Icnglh o i team nz~.tnl>ershlp (TI(=IiVC;) (3 measures).
Iknv)~ ~[jii'tsgl (13): lob saclsfacilon, role c l ~ - i ~ y , self-cfficacy raang and cl~zpcrwerme~~t
as four L ~ : I I I I edficacj~ E-onchnorral factors (4 facscsrs).
IFi~/rrttj P I ] F ( ; [ ' I I ~ I , ~ .r(>ruzc.~ ifttrlji!jr (C): I oclan~cal qualr ty a n d h n c tic mal qualtty (2 facrors) . C h a l x c ~ 5 ,!so forrn~alw~cs r l ~ c prcl~mttias-). research questloils.
Pant Id En~piricd stuciy
Cllaptw 6 deals \v~dl the underplnl~mg of the prciimunar!; theorctiical 1710621. I2rrst, 1';lit.eUectuai chsab~hty is enpla~ned as rhc- cxpresslon of krnlta~ons 117 rnclrvrdual h c n i o m n g urltl~in a sot:ial context. T11e ccrntcsnnal rranlrc o l lawn~an f u n c t ~ o ~ > ~ r r g offers the theoretical basis of supports. Clzaractensucs of rile person's envlronllment are closely related to thc cluahcy and Impact o f supports. C:onnnulty o f the imcro- context and espec~ally of the relationship bet\vre~i cllc dtsabled person and h ~ s support providers are defined as cnacal to the qmallrq of supports anel hence of thc funcnoning of persoils w ~ r h ID. T h c soc~:~l-ec<slogical thcot? of Brtlno Bsronfenbrermer offers a number of statements that arc e2atec1lv releviir.nt to rhe cormhnul~ of micl.o-context supporrs aacl apply ct, 130th tho hmrrg group and al~c farmlp context as well as t c ~ tlzetr mutual relations. Socid-ecc>logy therefixe ser\.cs as a basas for rhze thcoret~cal utlderpisirajlng of rllc rcsearch model. '\Y;~rhm ~ l u s ~Yieor~, d ~ s c o ~ l n n u i t y of DSS memberslz~p 1s a barrier r o the functron~uig of pe-rsoil.; \g4mh ID, bur11 du-ecdy (through relatromsh~ps of rcstclents and DSS) and ~nd~rccrly (through rclaaonshlps betweela DSS and r ~ s ~ d c n t s Y a m ~ l y ) . Scconci, the ernptrlcal rnodcl oT Hartline and Ferrell is further explored. It 1s argued rllaat ~ h t s n~odel ts compatible w t h Bronfenbrernncr's social-ecologcal statenlents. Marthne and Ferrcl's s o d e l expla~ns the rclado~as between cfficacy corld~rlclins for ser\.icc teams and custcomcr perceaved quabtjr of she semce. DSS changes can be conccivcd as irrapehlg factors for both team efficacy and client system quali~r percqmrsns Third, t o wahdate the method for meas~arernent of quality pcrcepmris sumc theclrcttcal problems of conccpmahzing and rneasurrng customer sansfaction ancl fam~ly qslahty perccpuons in rcsldenhial care are discussed. k:~nall~r, rhe spccrfic rcscarcl-r cluestions are ar~culated and situated wrthln rhe vahdated research modcl.
Each lcescarch qt~estion will be answered separately for each of the ~ h r c c USS rneasuses.
Whar IS tl.re sclat~clln I~cr\.h:ee.n organi~~ntzuna1 ch:nmcrcr~sncs (5 I;rctrxs) x ~ f
resiclenuaJ set-.lrlccs and 13SS tcaliz t a l e l ~ ~ b e ~ s h ~ p changes?
\%hat 1s the relanon betw~ccn IISS teatn mernbcrslilg~ changcs arid ! L . : I L ~
efficacj (4 factors)>
uivluat 1s the relauon 13c17rxrccn DSS rcain in~fo~t)ct.sh~p changes and hrnii)"
perccrved sen-lcc clualircy (2 factors)?
\Xr'll8t 1s the rejanon bct\c.crn tcam effic;>c\ ;rnd famzlly pcrccnvcd <el-t 1Cc qu;~ltty?
130 1"lSS learn t~zernbersl~lp changcs affect thc relat~on bcrwecn rc;rln efficacy and h m ~ l y perccivrd setTrIcc. ~ I L I Z ~ I X ~ ?
Can an cmpnncal mot{c) be consuvcted of the S organ~zai-~t~nal factors, tlru 3 DSS rean1 bnc~llber~hlp cllarrg-cs measures and [ h e 4 ~ f f i ~ ; l c ) ~ ti~ctc~rs predict faanily pcrccn-ccl senlcc qillallty (2 factors)?
Q:E~aprzr 7 descnlxs the research dcs1g11 jcxplcurat~vef cross-scc~cjnnl) and the a>peratlonahzanons of all factors and DSS charrgc rneasuret-nlcnns rnro rerearchal~lc
~.:lr-~al.dt.i;. T13c valrd~ry and rrliabllarj (TaI3lc 7.2) o f scales and rneasur-el~lerats are cllscui*ccl '1 k b o qucstfcsnnatrcs wcrc conuc-11rrd: one foe. a IJSS sumcy (cornpnsing 1
rc2an e f ~ c a e ) mea,iuresj and one for a clients famd)- sulvey (compmrtsing 7 q~ealin?
n s were mcasurcinentsy, Dara o n o r g a n ~ ~ a u o n a l charactensucs and of DSS chan,c
I C I T I C ~ L ~ C ~ from the f ~ a l ~ t ~ c s admiti~strat~ve databases. Research qucsteons are analysed e~rbcr In terms of variations (I?IFilOV.l) or c o r r e l a ~ o n s and m u l ~ p l e fiacrarcb~cal) xegresslon (airer a rcst for h~esarsbical structure of tlrlc data). Research qucstmn h s amxvercd rhrcrugh paib analysrs (followaag ail analogous procedure as used by Flatrtsrl er al., 1339 Ck 2001). T l ~ c resealcl? populaaon consrsrs of five 13urch ~.rslclenr~al fac~lztics (1,813 chents); their charactcnsucs In rclauorr to rhe chaaacterisrtcs of the naaonal populatnon o f res~denaal faclliues are clescnbed (Table 7.1). T h ~ s chapter concludes m t h r e f o n n u l a ~ n g the snx research cprestnons and rihc~r subcltiesucli~s (consadcnng spectfic factors) tn their operat~onal~zeil f(~rmars.
Chapter 8 presents rhe results based on 1,151 returned DSS ~ L I L T C ~ (65 pzrccnt) and 1,023 rcturncd fam~ly su~nrcys (60 l~crccr?t). Results are based on data horn 188 living groups and 188 LISS teams I-esysccuvely. 1Seforc the research cluesnons arc answerccl, an ovesvlcw of IISS team nleinber5hlp changes 1s presented accorcilng to the t l ~ r c c rneasurerncrll types (Table 8.1). Ovcr all t ~ a t 7 ~ stolnh/j~ (STAH) In tElr 188 I3SS tcfims IS 66.5 percent of actual team s h e (SIJ = 71.5); reversibly, this means an
average 1nslab1llt-y of 34.5 perccni. Over all Hew a / / t ? ? i r . r ~ o ~ ~ ~ (INFR) as a I Z I C ~ S U T C of team chscon~~nuat-y fire 64.5 pcscealt of accual tcarn slze (SD = 18.8), rnearvlrlg tliar sia 21 ;rccam of 10 DSS o n rhc average 6.4 now 'faces' are ~ntruduccd t o the: rcstdcrrts
\wthrt? ;I crnc year pcrtc~cl. It should be noriccd that the averagc DSS turntrver 111 all five facdlties is 1 4.2 perccrrr. O r c r all ltrgib n j se~vlce for ESSS 111 then present team:, 1s
43.4 months (SLI = 28.3). Res~tlts show consideral~.rle \ianaOon arad a uade range for all measures. Multilevel atlslysts showed h a t 92 percent respectively 86 pcrcelac o i nhc v:ln:allcc o f chc pcrcen'cd q u a l ~ t ~ r variables is ,lccnunrtcd firr- on the (cam Icvcl, ciustci ianc! facilrt?r level !.leld. no crgn~ficanr propustioll of thc zraslancc. lo [llcl-cf<)rc dociclcd to nl-~plj- i\NC3Zr.\, corrcla~ion and regrcss~on tcehnfqucs.
F,
I Ilc r c ~ u l ts c:ui Ila: s i ~ i t ~ m a m ~ c d as faIlo\vs ('l'ablc S l fi,b,cj:
Tnblt S l s Sumnvaq afresi~lrs for research qzrrstiorrs 1,2,3, for each DSS chnngc rtreastlrr (STAB, INFK &
TOWG). W = 188 DSS trams.
EP.es;earch cjuesc~cm Dbh r r d i : ~ rnenlbcfih~p chai~:ge* (Pi\) and iubquo.non ~ C B S I . I ~ C \
\?A\13 lNFR I t4U'C>
1 Relalion bcrxveen organn~zlrronal c h a m c t e n s r ~ c ~ and I%.'
1 1 ~ ' ~ C I ? I L P
.
> * *1 2 C l u ~ t c r slze - - - -
1 3 C)nJc>fk c:unpus i I
1 1 I 1% Irlg p o u p rrle i i
Table S l b Surnrnary of rcsdas for reseaxch questloans 4 & 5, far each DSS change rneasurc (STAB, lNFK Clc
TOWG), N = 188 DSS teams.
-
411 wasrlr qucstmn L a n 1 ! 1 ~ \~e~ecr\cci ~ L I \ ILC t11~,1111\
~ ~ l d ~ ~ l h ~ ~ ~ ~ ~ ~ ~ l ~ ~ l r
letllnirnl (~unrtcntl 1 rtncncrn.tl (rel.liii?~ls) .i Rcl,>tl<rn benvecn lean1 efficarv :rnd
iF#trnul\, con cd 1~17 ICC clual~n
1 1 I~nb sa~l$ffictron
+
t !-1 2 Ilt,le r 1,inq" -t + I
I 3 Sclf clficacl tanrrg 4
4 4 l ~ ~ ~ ~ l ~ ~ ~ > \ ~ e l l ~ 1 ~ ~ l ~ C 4
5 P\? .I, moderilto~ x a ~ r a b l e for the c o r ~ r Y . ~ i ~ o ~ ~ bu\bcenl trdm cfficaqp and
]Table S l c Summan, ofrcsulte for research quesvlon 6. Empmcd model predlcring hmil) perceived s e m c e oluality (fuulcnocvnal).fnom aU wanablrs of Organizational cbaracrensucs, DSS chamges and T e a m efficaqz- W = 180 I)SS reams
Job
"-,
Ghaplcr 9 offers the conclusions and a discussaon of tlne results. It 1s concluded t l ? a ~ in all facrlnries the ~ 3 7 , ~ of DSS team me~nlrrcrship changes 1s consideral~ly Rlgher tlwn t l ~ c himover at tlre general facility level. For quahq of care studies as wclE as for nzanagernct>t practices rhts is an importan1 outcome sltlcc turrroxrer measures clearly undereslina~atc the acrual mount of DSS changes ac the level of rlze cen-tcc ancouncer alad consequently ahs impacr odz q u a h v of care.
l~acelsttes do not cbffer o n rhc STLIB mcaswrc. Srabtlity seems closely zssoclatcd witla rurnovcr. 'They do differ though oil the INFIX measure rh;le more rcflecrr,
~~arcrnal staff^ rcplacernmt :and trsnsfcr practices as wcll as wn the 'TIQDWC measuric xepr~srllnrtlg tlrc iltrcrage lcrrgth of seiwce In the team. l_.argcs Iizvang grolzp srAc and larger clusrcr cotatexts appeal fnvorable c r ~ n d l ~ c ~ n s liv~th respect to DSS changes:
small liv~ng groups a~xd sin:ill clusiers (i.e. R T relauvcly texv t c ~ m s ) are assnc~~itccl wtth h ~ g h c r 12SS changcs.
TOIIWC; i ~ t - Icngtlr of scrvtce In tcizln IS clearlj posllively correlatecl \w1rlTP7 t h v crfic;tc)r llzeasilircs o i job s a ~ ~ s f a c t ~ o n , role claricy, self-efficacy ratllrg and elnpo\vcxmcni of ille ream. Stability 1s pos~uvely correlated mch self-cfficzc:~cy rating iun~l ~ ~ m ' ~ c n v " d ~ l l ~ p ( ~ ~ ~ r t ~ ~ e i a t of IC:LIII n~ernbrbl.s.
'l'hc s a ~ n c posruqrc corrclanoll i s found between T(4\YG and both the tcchn~cal a~ic!
~ l n o t ~ o n a l bnnlly p c r c c ~ ~ c d cluuhy of care. S'carn c o l u t ~ n u l ~ 1s posltlvely assojclarcd u-1111 fxrn~l!~ claali~y pcrcrptlons. The saiile nssoaztlon 1s foutzd betx1.7een all four l o j r r z ~ ctficac) factors and fi~n.rlly perccivecl f~~nctlclnal cluahc! T h s result reflccr s ;a 'rrrlrtor. cffcct' bctx.ecn staff ]lob s;lhsiacuon and chclats .;andacuon with sentice.;.
111gh 101, aatabfactaorz 1s associated 1 ~ 1 t h high customer sat~sfacnorz, alt1.rougI.r no
C C I L L S ; ~ ~ ~ c f f c ~ t can b0 c ~ ~ i ~ c l ~ ~ d e d from OUT daca and - in the perspect1r.e of' thc hret-acurc (Schraz1cle.r et a]., 1998) - an 1nteractn.e ef;ece 1s more 13robablc.
Team srabihq- (STAB) IS a moderator (3F tlie relanon b r ~ w e c n the efficacy factors icjb sausfacuorr md role clanih; on the one hand, and hncaonal percel.r-cd qu:lliri.
o n tIie [otller. Tlus imphcs rhar team stabll~ty 1s a s e n s ~ t ~ z ~ i ~ g factor b r the relation Ituenwerr ream efficacy and perccit~ed quahq: low stablhev 17 assocraccid urlrh 121g1, correYaCkor~ between team efficacy measures (job sarishcn~311 ant1 role clar~t'!') atnd perceived functional quahtv; hg11 s m b t l ~ t j ~ IS as5oc~iate.d 5 ~ 1 ~ 1 1 3w correlaeuon between these factors. I n tnsrable teams or relac~vel?; new teams, the nzlrrror effect seems t o be stronger.
Path analysis shows that the best predrcrion of fanuly pcrcc~ved fumcaonal q u a h e 1s o b t a n e d by a cornb~tiauon of job sausfacuon, length of s e ~ ~ l c c In team (TO\lirC;) lislng group s u e , cluster size and laltcnstqc of' slapports as shown iii Tablc SIC. E g sE70uld b e noaced that a cjlrect posnuve path between cluster stye m d brnlly pcrccivcd semlce quahty appeals also hughly probable (p=.067; sec T'nblc 138. I ) . 3'l-1s IS col~sistent wtth the conclusion that larger team a i d ccl~~stet size ;Ire
associated vnt11 favorable (lower) DSS team mcm"ehrship chnrugcs.
T h e discussioil of the rcsults starts with the hnxtaaons t r f tlrls speclkic rcscarch projccc. There are several critical rct-rlarks tlzaa sllzould be cctnsdcrccl. (1) Only fivc D u t c h facthues out of 133 were included In tlus project; (his was not an a d random sclcctnon alrhougl-2 the popwlarjol~ charactenst~cs (lcvcl of Functioning a11d agc) of the five hcnliitnes arc rcpresentatlve Par tlie nanonal populattol~ of rcsrdcnual cl~cnts.
(2) rilthough reladons betweeii DSS chaligcs and other ~rarualslcs were studled, no causal effects calm be concluded from &IS cross-seca~onal study. (33 AIY analyses w-ere conducted at the team level, nieatling that
A1
indiVtdual data were agqregxtcd rcs the team level. Tliis accounts for a loss of variabil~ty ar the ~ n d ~ \ ~ d u a l levcl.I-lowever, DSS rs a team pheriomenoaz and a combnred study of DSS Icala-2 ciiicacy facr-c>rs and client system outcome lrecessirates the aggegatioi~ o l data.
I?;le~w-theless, the same data are open to separate anal~rscs \v~rlun rllc scopc of I3SS efficacy factors or the family qualiq percel>tlolz factors.
TI-re ihscuss~on cnncltzdes \vtih rocornme~~clatlo~is for rcscal-cli a f i d pracorcc.
e I he
-
hllowtr~g rccorni~ie~~dar.~ons are rnade:RescarcEa
Research with respect ro the impact of srafi turnover- o i l u r g : u ~ ~ l ~ a t ~ r ~ n ~ t l prclccsucs (sucEi as team efficac)- and eificrcncy) and outcomc (such ;is tea111 j2crL3r1l~at1cc measures and bcnchmarkrrig) shc,uld also pa), arrcnnon lo ac~wal tcam n r c r n l ~ c r s h ~ [ ~ changes as a separate facttar.
'Sl~e-re ts a reliiarkablc c o m p a n l ~ l ~ t r ; bcmccn socual-ccolng1cal rhcory of l - r u r n a ~ ~ R~llcuoniz~g ancl senrlco markctl~zg ~llcory ant1 model\. l ' h ~ s cornpa1~111lt1-y ~x ~ - o o l u J In 1 1 ~ scmlcc- dyads o f s~aff-c-claent jnterat tlons at ihc Icvel c3f the scrvlcc cncounrcr Rcscarcll cln qualirj- perfclrmnncc of profc~ss~nnal supptrr! scrvlces rn hcaltll carc
S ~ O L E ~ ~ bencfie from rlus compatll~rliy to enhancc valtclrfy and rclcv;~ncc.
Rrr.carch ~ 1 - i cfficaci ancl qu~hty uutcornc of DSS rcanns in serrlces fur persons w t l ? I l l 5huuld benefit from the body of cheoreacal and srmpmcal knowledge of lhc. sctmce rnarketrng cllsclpi~ne.
131acrice
1.55s tcam ~nenazbersh~p srabtbq and d~sconnnuiv are q u a h ~ v incbcators and shodd be addrcshed 111 health care cjuahltl;. 1~0hcy and pracnce.
RcpOaccrnetlt: of I3SS je.g to rel~cve colleagues on sick Pcawc, vacatlosl er cererz) shoulcl Ije organrzed as close to the pnmary team as possmble (and not from remote pools o f rclicf sufl).
I f frequent or sub3tanrral DSS changes in a patrtlcular team can not bc avoldecl, spcciahatrenucm shcluld lrc g v e n to maamitarm.lng posiuve r e l a ~ o n s liylrh he c l ~ e n ~ 61i31hes (c.g. marc frequent i ~ ~ c c u n g s or speaal i n f o ~ n ~ a a o n about measures rhat arc bclng taken to krllarantee rhe q ~ ~ a h v oh support). Under the qune rlrcumslances, .;peclal atcerub-iion should be given ro cnhanc~ng thc staffs job satlsbruc~n slncc low jtsh s a t ~ b f > ~ t l ~ n 111 a s s o c l a ~ ~ l l with 10w team stabllety rs likely LO be correlated with low pcrcelved servtce cluallty.
'The p o k y of enhancing ~r~divid~~alnaaaon of supports f01. PCISOIIS ~ w t t l ? ID ale
assr~ciaicd wlth a decrease of hvrng group srzc and correspondingly of DSS team s~zc.. S ~ n c c siye appears lo be ncgnr-rvcly associated w ~ r b thr alnounr of rcanrz rncrnbctsh~p changes and rherefore w t h tcam cfficacy condlrrons at-rd pcrcclved cl~nahrg., rhrs presenrs a paradox. Ways shoulcl be found t o rna~r~runiilg l~ighly incllvrdualtzcd support in ir~div~cliiral or vc1-r; small rcsidenrial settmgs (apartments arid hvuscc for 2, 3 01-4) in cumb~nauon with larger tcani c o ~ ~ f i g ~ ~ s a a o n s . It 1%
wggested thxt rhc micro-un~t concept of Donaldson et al. (1998) - that ~nciuclzs larger n11cE in~ercbscipl~narp teams (ii?cluding all rcle~anr support professrorrals 2nd fz~cnlr~ators) - might offer an alteh-nauve way for rhc organrzaaon of restdenu:~!
s u p p o ~ t to persons w1r11 1D.
