Preparing nursing-home leaders to overcome challenges and improve care

School of Nursing Assistant Professor Elena Siegel investigates the education and skills needed to improve nursing-home care.

As members of the baby boom generation get older and reach retirement age, they present increasing concerns for the quality and value of nursing-home care. As this “silver tsunami” swells, industry and policy leaders search for ways to improve the effectiveness and efficiencies of long-term care services. Elena Siegel, an assistant professor at the Betty Irene Moore School of Nursing at UC Davis, investigates critical skill sets needed by nursing-home management teams to influence policy, improve care and reduce costs.

“The nursing-home industry carries a long-standing reputation for low quality. We know how to provide care, but unfortunately, implementation of this knowledge into sustainable best practices is unacceptably slow and many homes do not reflect the vast knowledge that already exists,” Siegel explained. “Nursing-home leaders must gain expertise in systems thinking, quality improvement, and fiscal and human resources management to improve care and delivery.”

Siegel brings multiple perspectives to nursing-home research, including nursing, industrial and organizational psychology sciences, and business administration and management experience as a certified public accountant and controller. Her work over the past seven years aims to close an alarming knowledge-practice gap of nursing-home leaders who carry overarching responsibility and accountability for quality improvement in the settings under their charge. Nursing home administrators oversee staff and personnel, financial matters, medical care, supplies and facilities, while directors of nursing supervise nursing staff, oversee patient care and handle administrative functions such as record keeping and budgeting.

“I’m taking the focus off of the front lines. We need to study the management team responsible for putting systems in place to support the nurses and unlicensed staff providing direct care,” Siegel added. “While there is some recognition that leadership and management make a difference, focused research efforts to address nursing-home quality by improving the expertise of management teams has flown under the radar too long.”

Oftentimes, directors of nursing and nursing home administrators are hired into leadership and management positions without ensuring they all have the requisite skills needed to tackle long-standing industry challenges. Siegel recognizes both the incredible work these professionals accomplish and their heavy reliance on on-the-job training.

“There’s an undervaluing and under-recognition of the expertise these health-care leaders need to effectively lead and manage nursing services in these complex, heavily-regulated long-term care environments,” Siegel said. “My goal is to partner with them to reduce their learning curve. My research is slowly making a case to identify the education, practice, and policy efforts needed to effectively prepare and support these nursing-home leaders to successfully tackle the challenges they face on a day-to-day basis.”

Siegel’s research has the potential to influence how nursing home quality-improvement efforts are approached. From examining organizational infrastructure to improving organizational capacity of nursing-home leadership teams, Siegel hopes to bridge practice, policy and academia to develop leadership models that gain across-the-board support from all stakeholders.

“This approach and my long-term goal fit perfectly with the School of Nursing’s core values,” Siegel said. “Let’s make sure the administrators and the directors of nursing have the capacity to carry out the challenging positions they’ve been hired for and turn these settings around to benefit those receiving care.”