@article {Okechukwu2016111,
	title = {Supporting employees{\textquoteright} work-family needs improves health care quality: Longitudinal evidence from long-term care},
	journal = {Social Science \& Medicine},
	volume = {157},
	year = {2016},
	pages = {111 - 119},
	abstract = {
	Abstract We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees{\textquoteright} scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n\&nbsp;=\&nbsp;30) and collected monthly for six months after employees{\textquoteright} data collection; (2), employees{\textquoteright} dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents{\textquoteright} incidence of all pressure ulcers (-2.62\%) and other injuries (-9.79\%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94\%) and falls with injuries (-7.57\%). Managers{\textquoteright} concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95\%CI 1.08{\textendash}1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95\%CI 0.59{\textendash}0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality.

},
	keywords = {Occupational Health},
	issn = {0277-9536},
	doi = {http://dx.doi.org/10.1016/j.socscimed.2016.03.031},
	url = {http://www.sciencedirect.com/science/article/pii/S0277953616301319},
	author = {Okechukwu, Cassandra A and Kelly, Erin L and Bacic, Janine and DePasquale, Nicole and Hurtado, David A and Kossek, Ellen E and Sembajwe, Grace}
}
