An organizational design perspective on the monthly self-scheduling process in nursing homes: A multiple case study

Abstract

Aims: To describe the monthly self-scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization-related outcomes.

Design: A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework.

Methods: Data collection was performed in four Belgian NH during Spring 2019 using semi-structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within-case and cross-case analysis was performed. The COREQ checklist was used for reporting the findings.

Results: One group (two NH) used self-scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self-scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes.

Conclusion: Self-scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes.

Impact: This study contributes to the rare literature on self-scheduling in NHs by focusing on the monthly self-scheduling process and by including an organizational design perspective. NH management can become informed of different self-scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes.

Patient or public contribution: Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self-scheduling process.

Keywords: case study; healthcare; leadership; nursing; organization; qualitative; self-scheduling; work attitudes.