Social networks of nursing staff and organizational performance. A study in long-term care facilities

Over the years, there has been increasing attention for the role of social networks in explaining performance differences between organizations. Yet, research on social networks within healthcare organizations in general and long-term care facilities specifically has been rare, despite growing interest in explanations for differences in performance. In this thesis, we study informal social networks of nursing staff and organizational performance in different care settings for residents with dementia in the Netherlands. Three types of social networks are investigated: communication and advice networks between nursing staff of dementia units, and networks between nursing staff and relatives or acquaintances of residents. Ties between nursing staff and relatives/acquaintances of residents cross the boundary of the organization. For this reason, we name these ties boundary-crossing networks as they place employees in direct contact with third parties outside the organization. We argue that social networks of nursing staff influence behaviour of nursing staff and care processes of dementia units, which in turn will influence the quality of life of residents, and ultimately organizational performance in long-term care. First, we investigate the structure of communication and advice networks of nursing staff on dementia units. Overall, communication and advice networks of nursing staff in long-term care are relatively cohesive. This fits with the high level of cooperation that is needed to provide good care to residents. Communication and advice networks are more cohesive in smaller units and are also shaped by characteristics of staff members. The results furthermore show that communication networks are important for staff’s job satisfaction. A boundary-crossing tie with relatives/ acquaintances of residents is mentioned by two-fifths of the nursing staff. Our findings show that in units with these boundary-crossing networks staff treat residents with more respect and are more at ease with residents. Social networks are also positively related to staff’s organizational identification which, in turn, is related to their work motivation and their behaviour towards residents. We also find that more cohesive communication networks of nursing staff are positively related to the social support that is experienced by staff members. Furthermore, in units with a more supportive culture less challenging behaviour of residents is reported. In this thesis, organizational performance is defined as the aggregated quality of life of individual residents in long-term care units. We study if social networks are directly related to three aspects of quality of life of residents with dementia: frailty, depressive symptoms and social engagement. Our results show that cohesive communication, advice, and boundary-crossing networks of nursing staff are positively related to the social engagement of residents. No relationship was found between social networks and frailty or depressive symptoms of residents. Overall, the study demonstrates differences in organizational performance of long-term care dementia units with regard to the quality of life of residents. These differences can be partly explained by the cohesiveness of informal social networks of nursing staff of the units.