Poor work environments are linked to rushed, missed care that may endanger resident health, say researchers. 

The cross-sectional study used data collected from 93 urban eldercare facilities in Western Canada. More than 4,000 care aides completed structured, in-person interviews. 

Rates of missed and rushed essential care were high in general and even more pronounced in units with less favorable work environments, reported Yuting Song, Ph.D., from the University of Alberta. In fact, care aides in homes with more favorable work environments were 59% less likely to miss care tasks and 66% less likely to rush them.

The two most frequently missed and rushed care tasks were walking and talking with residents, the researchers reported. Furthermore, care aides on units with higher levels of social capital missed fewer care tasks, among other findings.

The researchers measured work environment at the unit level using the validated Alberta Context Tool. Missed care was associated with four modifiable environment factors, they found. These were culture, organizational slack in use of staffing or use of time, and social capital (such as active connections through information sharing).

Managers should view organizational context as a whole, and address several problems at once when developing quality interventions meant to improve resident outcomes, Song and colleagues recommended. This is preferable to targeting single elements individually, they wrote. 

“This finding suggests that work environment … may be an important pathway for improving quality of care,” Song concluded. 

The study was published in JAMA Network Open.