The goals of developing the chief clinical manager contact procedures were to establish a strategy for soliciting frontline supervisor contact information and systematically reviewing the tasks that supervisors do to determine how to screen out non-supervisors from frontline supervisors. Chief clinical managers at local provider organizations similar to those in the BJBC study were contacted and asked to provide information about frontline supervisors in their respective organization. We contacted the clinical managers by telephone, briefly described the Frontline Supervisor Study, and asked if they would be willing to indicate which tasks each of their supervisors perform. If they agreed, the list of supervisory tasks was sent to the clinical manager by fax with the following comments:

Thank you so much for helping us with our project evaluating the impact of the Better Jobs, Better Care Demonstration. Please indicate the supervisor of direct care workers who is responsible for each task at [name of provider organization], and as you do so, keep in mind that the definition of a direct care worker for the Better Jobs, Better Care Demonstration is an individual who provides hands-on personal care as a significant part of their job. Although activities may sometimes overlap, we do not include LPNs or RNs in this definition. Also excluded are workers who help with cleaning, meal preparation and chores, but do not provide personal care.

Once you’ve identified the frontline supervisor(s) for your organization, please fax the completed form back to 814-865-3098. If you have any questions or would like additional information regarding this request, do not hesitate to contact me at 814-863-0170. Thank you again for your time and assistance.

Overall, we contacted 12 chief clinical managers, and nine replied. From these nine, we received supervisor task information for 22 supervisors. We learned that, according to the chief clinical managers, not all of the supervisors performed each of the tasks, but most documented DCW performance problems, recommended training for DCWs, and directly responded to job concerns raised by DCWs. Less than half of these supervisors were noted to conduct on-the-job clinical training. Out of the 22 reported to performed each of the tasks on our list:

  • 13 act as a mentor to DCWs;
  • 17 ensure that DCWs are giving proper care to clients/residents;
  • 10 schedule DCWs;
  • 13 initiate disciplinary action;
  • 17 document DCW performance problems;
  • 17 provide feedback to DCWs on job performance;
  • 18 recommend training for DCWs;
  • 13 conduct on-the-job clinical training;
  • 17 directly respond to client/resident complaints about DCW performance;
  • 18 directly respond to job concerns raised by DCWs.

Out of these 22 supervisors, we contacted five to participate in a cognitive interview to test the survey instrument. The results from the cognitive interviews are explained in the next section of this report. During the cognitive interview, supervisors were asked to indicate which tasks for which they were responsible. We compared the tasks each supervisor reported with the tasks their clinical manager reported they did. Table 1 summarizes these comparisons. The chief clinical managers under-reported job responsibilities for Supervisors #3 and #4. For Supervisor #5, the chief clinical manager over-reported job responsibilities. These findings justify the inclusion of the task list on the Frontline Supervisor Survey and support the hypothesis that supervisors’ perceptions of the work environment may differ from those of the clinical managers’.

Based on the information from providers, clinical managers, and supervisors, we developed the definition of supervisor that defines our study population. We intend to be inclusive at this stage; when we conduct the analysis, we will be able to test whether a more restrictive definition affects our finding. If one or more of the following primary supervision tasks is checked, a person qualifies as a frontline supervisor under our definition:

  • Ensure that DCWs are giving proper care to clients/residents;
  • Initiate disciplinary action;
  • Document DCW performance problems;
  • Provide feedback to DCWs on job performance;
  • Directly respond to job concerns raised by DCWs.

In addition, if a person performs at least two of the following secondary supervision tasks, the person meets our definition of frontline supervisor:

  • Act as a mentor to DCWs;
  • Schedule DCWs;
  • Recommend training for DCWs;
  • Conduct on-the-job training.

The clinical managers who participated in this testing gave us feedback on our task list distribution procedures. From their comments, we learned that it is more effective and efficient for most to receive the task list as an e-mail attachment. This approach will work for our population of clinical managers at participating BJBC provider organizations because we have e-mail addresses for most of them. For the few clinical managers that do not have e-mail addresses, we will be able to contact them by telephone and send the task list via fax. The comments that will accompany the task list can be found in Appendix A.

Each returned task list will be reviewed by the Penn State Survey Research Center project assistant. To avoid erroneously excluding supervisors, if only one of the secondary supervisory tasks is checked, she will contact the clinical manager and probe for more information about other responsibilities this person has to double check whether or not the person performs any of the other supervisory tasks.

TABLE 1. Supervisor Tasks Reported by the Chief Clinical Manager at the Pilot Test Organization and by the Supervisors Who were Cognitively Interviewed
Tasks Tasks Reported for Supervisor #1
(Home Health Facility)
Tasks Reported for Supervisor #2
(Adult Day Center)
Tasks Reported for Supervisor #3
(Nursing Home)
Tasks Reported for Supervisor #4
(Nursing Home)
Tasks Reported for Supervisor #5
(Nursing Home)
  Supervisor   Clinical
  Supervisor   Clinical
  Supervisor   Clinical
  Supervisor   Clinical
Act as a mentor to DCWs X X X X X X X X X X
Ensure that DCWs are giving proper care to clients/residents X X X X X X X X X X
Schedule DCWs     X X   X        
Initiate disciplinary action X X X X         X  
Document DCW performance problems X X X X   X     X  
Provide feedback to DCWs on job performance X X X X   X   X X X
Recommend training for DCWs X X X X   X     X X
Conduct on-the-job clinical training activities X X X X   X   X X  
Directly respond to job concerns raised by DCWs X X X X X X X X X X

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