Journal List > J Korean Acad Nurs Adm > v.16(2) > 1051538

Lee and Chung: Structural Factors Influencing the Quality Management Activities in Nursing Homes



Nursing home quality indicators have been focused widely on result outcomes, not for the environment in that quality of service are delivered. This study aimed to examine structural factors influencing quality management activities in nursing homes.


Sample was 170 nursing homes responded to the survey questionnaire which was distributed to the 543 nursing homes nation-wide. Data were collected on structural characteristics, types of services, and quality management activities. Data were analyzed with the descriptive statistics, Pearson correlations, and multiple regression.


Most of the nursing homes were operated as free of charge by the social welfare ownership. Average number of residents was 52.1 with severe and mild dementia and bedridden status. In terms of quality management activities, 34% of the sample had CQI committee that focused their activities on services delivery process, performance appraisal, record keeping regularly. 30.6% of quality management activities were accounted for by the number of residents with dementia, the ratio of RN to residents, rehabilitation services, and social wefare services in nursing homes.


We recommend that more comprehensive quality management activities should be developed as process quality indicators in conjunction with the outcome indicators.

Figures and Tables

Table 1
Structural characteristics of the facilities
Table 2
The current status of quality improvement activities (N=170)
Table 3
The predictors of quality improvement activities (N=170)


This work was supported by National Research Foundation of Korea Grant funded by the Korean Government(KRF-2005-041-E00448).


1. Bates-Jensen BM, Schnell JF, Alessi CA, Al-Samarrai NR, Levy-Storms L. The effects of staffing on in-bed times of nursing home residents. J Am Geriatr Soc. 2004. 52(6):931–938.
2. Berg K, Mor V, Morris J, Murphy K, Moore T, Harris Y. Identification and evaluation of existing nursing homes quality indicators. Health Care Financ Rev. 2002. 23(4):19–36.
3. Bliesmer MM, Smayling M, Kane RL, Shannon I. The relationship between nursing staffing levels and nursing home outcomes. J Aging Health. 1998. 10:351–371.
4. Bostick JE, Rantz MJ, Flesner MK, Riggs CJ. Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc. 2006. 7:366–376.
5. Byun JK. Evaluation of nursing homes and policy suggestions. Health Welf Policy Forum. 2001. 56:5–16.
6. Castle NG. Administrator turnover and quality of care in nursing homes. Gerontologist. 2001. 41(6):757–767.
7. Centers for Medicare and Medicaid Services (CMS). Appropriateness of minimum nurse staffing ratios in nursing homes. 2001. Retrieved October 5, 2008. from http://www.camgov.medicaid/reports/rp1201home.asp.
8. Chung J. Development and application of nursing service quality indicators in nursing homes. J Korean Acad Nurs. 2007. 37(3):401–413.
9. Paulus D, Jans B. Assessing resident satisfaction with institutional living. J Gerontol Nurs. 2005. 31(8):6–11.
10. Donabedian A. The quality of care: How can it be assessed? JAMA. 1988. 260:1743–1748.
11. Harrington C, Zimmerman D, Sarita LK, Robinson J, Beutel P. Nursing home staffing and its relationship to deficiencies. J Gerontol B Psychol Sci Soc Sci. 2000. 55(5):S278–S287.
12. Harrington C. Regulation nursing home: Residential nursing facitlities in the United States. BMJ. 2001. 323:507–510.
13. Harrington C, Woolhandler S, Mullan J, Carrilol H, Himmelstein DU. Does investor ownership of nursing homes compromise the quality of care? Int J Health Serv. 2002. 32(2):315–325.
14. Jensdóttir AB, Rantz A, Hjaltadóttir I, Guðmundsdòttir H, Rock M, Grando V. International comparison of quality indicators in United States, Icelanic and Canadian nursing facilities. Int Nurs Rev. 2003. 50(2):79–84.
15. Jung EW, Jeong SW, Seo Y, Choi DB. Related factors to the service level of aged care facilities in Korea. Korean J Hosp Manage. 2007. 12(4):22–44.
16. Kim MS, Lee SH. Development and application of service quality indicators in nursing homes: structureprocess evaluation. J Korean Acad Nurs Adm. 2008. 14(2):131–143.
17. Korea Health Industry Development Institute. Development of tools and evaluation system for quality improvement of hospital based home health care. 2002.
18. Korean National Statistical Office. Population projects for Korea. 2006.
19. Kovner C, Mezey M, Harrington C. Research priorities for staffing, case mix, and quality of care in U. S. Nursing Homes. J Nurs Scholarsh. 2000. 32(1):77–80.
20. Lee J. Validity and reliability of the Korean version of the observable indicators of nursing home care quality evaluation instrument. J Korean Acad Nurs. 2008. 38(3):474–482.
21. Ministry of Government Legislation. Welfare of the aged Act. 2008. Retrieved December 11, 2008. from
22. Ministry of Health & Welfare. The current status of social welfare center. 2006. Retrieved March 10, 2006. from
23. Ministry for Health, Welfare, and Family Affairs. The current status of elderly care center. 2008. Retrieved Dec 4, 2008. from
24. Morgan JC, Konrad TR. A mixed-method evaluation of a workforce development intervention for nursing assistants in nursing homes: The case of WIN A STEP UP. Gerontologist. 2008. 48(Spec No 1):71–79.
25. Organization for Economic Cooperation and Development (OECD). Policy brief: Ensuring quality long-term care for older people. 2005. Retrieved October 10, 2005. from
26. Rantz MJ, Hicks L, Grando VT, Petroski GF, Madson RW, Mehr DR, et al. Nursing Home Quality, Cost, Staffing and Staff mix. Gerontologist. 2004. 44(1):24–37.
27. Scott-Cawiezell J, Vogelsmeier A. Nursing home safety: A review of the literature. Annu Rev Nurs Res. 2006. 24:179–215.
28. Schnelle JF, Simmons SF, Harrington C, Cadogan M, Marcia E, Bates-Jensen BM. Relationship of nursing home staffing to quality of care. Health Serv Res. 2004. 39(2):225–250.
29. Wagner C, van der Wal G, Groenewegen PP, de Bakker DH. The effectiveness of quality systems in nursing homes: a review. Qual Health Care. 2001. 10:211–217.
30. Zimmerman S, Gruber-Baldini AL, Hebel JR, Sloane PD, Magaziner J. Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration, and social factors. J Am Geriatr Soc. 2002. 50(12):1987–1995.
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