The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes

S. Winters van der Meer*, R. B. Kool, N. S. Klazinga, R. Huijsman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


Objective: To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. Design: A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. Setting: In total, 169 residential care homes for the elderly in the Netherlands. Main Outcome Measures: Change between 2007 and 2009 in client-reported and professional indicators. Results: A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. Conclusion: This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement.

Original languageEnglish
Article numbermzu057
Pages (from-to)378-387
Number of pages10
JournalInternational Journal for Quality in Health Care
Issue number4
Publication statusPublished - Aug 2014

Bibliographical note

Funding Information:
Appreciation is expressed to the following participating organizations: this article is based on data from ActiZ and was supported by ActiZ (the Dutch association for residential and home care organizations in the Netherlands) and the LOC (the supporting national organization for resident boards).


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