Management and Performance in U.S. Nursing Homes

Abstract

Accountability pressures have generated complex performance measurement regimes to evaluate and improve public or publicly-funded services. Performance management, however, faces many challenges including the tradeoffs posed by numerous dimensions of performance and a lack of consensus on which organizational and environmental factors can improve these results. This study seeks to understand the effect of management and other factors on different dimensions and measures of performance in U.S. public, nonprofit, and for-profit nursing homes. Using a hybrid data set that combines archival government data on performance in nursing homes with a recent nursing home administrators’ survey, we find that innovative management significantly improves the quality of care. In addition, more innovation and less power sharing in management are associated with serving fewer Medicaid-funded clients. Significant differences in performance exist across public, nonprofit, and for-profit organizations. These differences are notable across both the archival and perceptual models of performance.