Leadership and psychosocial work environment in municipality old age care : Differences and similarities between nursing homes and home help services

Introduction. Municipal eldercare is increasingly multifaceted. First line managers in nursing homes and home help services are responsible for personnel, budget and processes. The resources and work conditions of these managers have changed over time. The first line manager is often responsible not only for economic but also for quality development of their unit. Research focusing on first line management within municipal eldercare is lacking in specific contexts, for example, research on leadership in nursing homes and home help services. Aims. The aim of this thesis is to study and analyze perceptions of leadership in eldercare. The main objective is to analyze differences in leaders’ and nursing assistants’ perceptions of leadership in nursing homes and home help services, and to study leadership factors and their associations with psychosocial work environment among nursing assistants who are engaged in eldercare. Design and methods. This thesis is based on two studies, and uses cross-sectional data from two different surveys: the Developmental Leadership Questionnaire, DLQ (Larsson, 2006a) and a Questionnaire for Psychological and Social factors at Work, QPS, (Dallner, et al.,2000). Assessments from 21 leaders and 95 nursing assistants in nursing homes and home help services were analyzed in study I. Assessments from 1132 nursing assistants in nursing homes and in home help services (n=844 nursing homes and n=288, home help service units) were analyzed in article II. The data were analyzed with descriptive and analytic statistics. Results. Nursing assistants in nursing homes assessed their leaders to be more controlling and observant than nursing assistants in home help services. According the leaders self assessment, leaders in home help services were less successful at being supportive, being a good example, and promoting creativity than leaders in nursing homes. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. The leadership factors empowering leadership, support from superiors, focus on human resources and control over decisions were associated with better results on all the variables that were related to the psychosocial work environment in both nursing homes and in home help services. Conclusions and implications for practice. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better conditions for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in organisational settings, it is important to consider the differences in conditions for conducting leadership. To influence nursing assistants’ performance and to increase quality in eldercare in the long term, appropriate leadership is necessary. Therefore, it is important for the leaders to provide support in work, help to develop skills, encourage employees to participate in important decisions, and show interest in nursing assistants’ well-being. Also, the leaders might benefit if they reduce the specialisation of work, which counteracts the possibility to have variation in work in nursing homes and home help services. In particular, nursing homes should benefit if they reduce the amount of role conflicts, and if nursing assistants receive reasonable quantitative work demands. The municipality eldercare should take into account the organisational differences in conducting leadership in nursing homes in relation to home help services. Recruiting leaders with characteristics that are desirable in the specific context will create better conditions for a good psychosocial work environment in nursing homes and home help services