Doing better to do good: the impact of strategic adaptation on nursing home performance

Health Services Research, June, 2007 by Jacqueline S. Zinn, Vincent Mor, Zhanlian Feng, Orna Intrator

Although we believe the results of this study provide important baseline information with respect to the performance implications of strategic implementation in nursing homes, there are some limitations to our analyses. First, we were limited to examples of structural and staffing implementation in support of a subacute and rehabilitative care diversification strategy that were available in our data. Other examples (for example, implementation of clinical information systems or staff development initiatives) may also impact performance, but these measures are not available on a national basis.

Second, investment in the implementation of strategic change is not without risk. To adopt a postacute diversification strategy, facilities must hire different staff, retrain existing staff, introduce new care procedures, more actively court referral sources and invest in ongoing liaison with these referral sources. Failure to properly gauge the market and competition for these services could result in losses that are directly attributable to efforts to implement a new strategy. However, data limitations precluded our ability to quantify risk in terms of level of investment. Thus, we cannot determine how much risk increases with the level of investment, as indicated by the value of the implementation score. In addition, because 1997 was the first year that all data items needed to construct the implementation score were recorded in OSCAR, we cannot determine if some strategic implementation occurred earlier.

In conclusion, the performance implications of strategic implementation in nursing homes should be of great concern to both providers and policy makers (Banaszak-Holl, Zinn, and Mor 1996). However, there has been very little research on how nursing home choose and implement strategy, in stark contrast to the extensive research on implementation in acute care settings. A possible reason may be the perception that the phrase "nursing home strategic management" is an oxymoron. That is, the services traditionally provided in nursing homes are not associated with proactive approaches to environmental demands. However, our study demonstrates that effective strategic implementation is an important contributor to nursing home performance. Given the key role these organizations play in caring for frail and vulnerable populations, what enables nursing homes to effectively implement strategy needs to be better understood and encouraged. Future research is needed to explore factors fostering a responsive culture that supports effective strategic change in these critical health care providers.

ACKNOWLEDGMENTS

This research was supported in part by a National Institute for Aging grant (AG# 11624) and a Robert Wood Johnson Foundation Health Policy Investigator Award.

REFERENCES

Alexander, L. D. 1991. "Strategy Implementation: The Nature of the Problem." In International Review of Strategic Management, Vol. 2##(1), edited by D. E. Hussey, pp. 73-113. New York: John Wiley and Sons.