We conducted five cognitive interviews with individuals who represent our target population -- three supervisors at nursing home facilities, one supervisor at an adult day services center, and one supervisor at a home care facility -- to solicit feedback on question wording, placement, and flow within the questionnaire. These supervisors were asked verbally describe their thought processes as they answered the survey questions. A staff member from the Penn State Survey Research Center recorded the respondents comments and suggestions.
The responses given to the items on the Frontline Supervisor Survey and comments provided by those who participated in the cognitive interviews have been summarized and are shown in Appendix B. The five supervisors who participated have been labeled as R1, R2, R3, R4, and R5. The frequencies are displayed for the purpose of looking at the responses of these five individuals. From these results, we learned which items were not clear to the respondents or were interpreted differently. The questions that our respondents had the most comments for are described below.
Question 8b: I have the opportunity to work in teams.
The meaning of the word team in question 8b differed by respondent. R1 first said "I don't know what you mean by that" but after thinking aloud she answered by defining teams as working with Hospice, Medicare, and the Office of Aging. For R2, the teams she worked with were a geriatric steering committee and a company task force team. R3 interpreted "teams" to mean an interdisciplinary group of people at the organization who develop care plans for clients. R4 understood "teams" to mean DCWs and herself carrying out their duties together.
Question 11c: The extent to which cross-training used as a management practice
R1 indicated that cross-training is done both occasionally and frequently at her organization because DCWs occasionally receive training for administering medication but frequently receive training for physical therapy. R2 said that all regular employees are required to be CPR and first-aid certified, but the requirement is not enforced for employees who work occasionally. R5 said DCWs are trained as a matter of seniority at her organization, and typically Licensed Practical Nurse (LPN) DCW receive more cross-training.
Question 11d: The extent to which self-managed work groups used as a management practice
Two of the respondents, R1 and R5, did not understand who comprised a self-managed work group.
Question 12: What mechanisms are used to handle employee concerns in your organization?
After responding to question 12, each supervisor was asked how they interpreted the term employee concerns. R1 understood "employee concerns" to mean any kind of concern that an employee comes to her with, whether it had to do with their employment circumstances or their ability to provide care to clients. R2 said she was thinking of disciplinary procedures when she first read the question but she then saw that the question that followed covered discipline. R3 mentioned that the organization is part of a union, and the union has a role in handling employee concerns. R4 said the mechanisms listed to handle employee concerns that she checked are available, but not necessarily used. R5 thought of employee concerns as both professional and personal.
Question 14c: How often do DCWs in your organization write in patient/resident/client care charts?
Respondents described procedures that were relevant to care chart documentation, and the extent to which DCWs wrote in charts varied. R1 explained that DCWs have check sheets to fill out which become part of the client's chart. R4 said DCWs at her organization always write vital statistics in the charts, but they are not allowed to document anything else. R5 explained that all DCWs can write on flow sheets, but only the LPN DCW can write in charts.
Questions 16a and 16b asked about DCW participation in career ladder programs. None of the organizations where the supervisors we interviewed work have career ladder programs.
Question 20b: The organizational culture encourages risk-taking.
The meaning of the phrase risk-taking varied by respondent. R1 thought of risk-taking as a spontaneous change in a client's care plan to which she answered disagree. R2 asked if risk-taking meant exploring other avenues or new techniques. She thought the word risk sounded harsh. R3 thought of risk-taking as doing something that was related to residents' care. R4 thought risk-taking implied taking one's chances to make the trip into work everyday. R5 asked if risk-taking meant unsafe behavior and said in terms of DCW personal safety, such as lifting and moving more independently than they should, risk-taking occurs.
Using the comments and suggestions from the cognitive interviews, we examined the items relative to how they will be compared with matched items on the complimentary BJBC Direct Care Worker and Clinical Manager Surveys. In weighing the potential improvement that could be made to questions against the loss of the ability to make these direct comparisons of frontline supervisor-DCW and frontline supervisors-clinical manager responses, we feel that making changes to the wording to these questions is not warranted. However, the cognitive interview exercise helped to flag certain questions and provide information that will be helpful when analyzing responses.