We conducted a series of telephone consultations with individuals from two home health care trade associations, two home care agencies, one adult day services center, four nursing home facilities and one assisted living facility to gain a better understanding of the supervisory structures in each type of organization. We spoke with one informant in each of these organizations. These organizations represented all five states in the Better Jobs Better Care (BJBC) Demonstration -- Iowa, North Carolina, Oregon, Pennsylvania, and Vermont. We contacted mainly larger providers under the assumption that these organizations would have more elaborate supervisory structures that would make identifying the frontline supervisor more complex.
The phone calls allowed us to explore the concept of supervisory functions with the respondents by dividing functions into tasks, allowing us to define frontline supervisors based on the tasks they perform. The calls also allowed us to define tasks in a way that delineate higher order supervision from frontline supervision. For example, while the function of clinical training could be performed by a higher-level employee or an employee outside of the agency, the task of conducting on-the-job clinical training appears to be performed by frontline supervisors, the respondent of interest. As a result of these conversations, ten supervisory tasks emerged as those that best characterize frontline supervision in long-term care organizations:
- Acting as a mentor to DCWs;
- Ensuring that DCWs are giving proper care to clients/residents;
- Scheduling DCWs;
- Initiating disciplinary action;
- Documenting DCW performance problems;
- Recommending training for DCWs;
- Providing feedback (positive or negative) to DCWs on job performance;
- Conducting on-the-job clinical training activities;
- Responding directly to client/resident complaints about DCW performance;
- Responding directly to job concerns raised by DCWs.
Though most of the key informants at each provider readily identified employees as frontline supervisors, because of the diversity among titles and functions within organizations these tasks will be used to define the population of frontline supervisors for this study. We subsequently removed from the list directly responds to client/resident complaints about DCW performance because it is likely that this responsibility is carried out not only by supervisors, but by administrators at different levels within the organization. Also, this task corresponds with the responsibilities to ensure that DCWs are giving proper care to clients/residents and to document DCW performance problems.
Based on these inquiries, we learned that frontline supervisor responsibilities are sometimes shared between two individuals. Specifically, we identified three types of frontline supervisory structures:
One supervisor performs all or most of the functions listed on the protocol.
Two supervisors on the same level of the administrative hierarchy perform supervisory functions, with one emphasizing clinical functions and the other emphasizing administrative functions.
Two supervisors on different levels of the hierarchy (e.g., supervisor and supervisors supervisor) share supervisory responsibility, both performing many of the supervisory functions.
When frontline supervisory tasks are performed by more than one person, all determined to be supervisors will be included in the population of frontline supervisors to be surveyed. We are including information on the tasks performed in the survey instrument itself so that we can identify the tasks performed according to the supervisor.
We also found that in smaller organizations, it is possible that the person identified as the clinical manager may also serve as the frontline supervisor. This is possible because the clinical manager is identified based on his or her position in the organization whereas the frontline supervisor is identified based on the supervisory tasks performed. These persons will be asked to complete a Clinical Manager Survey with added Supervisor Survey items to minimize respondent burden.