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The joint relationship between organizational design factors and HR practice factors on direct care workers job satisfaction and turnover intent

Kim, Jungyoon; Wehbi, Nizar; DelliFraine, Jami L.; Brannon, Diane

Health Care Management Review:
doi: 10.1097/HMR.0b013e31828c8b8f

Background: Human resource (HR) practices, such as training and communication, have been linked to positive employee job commitment and lower turnover intent for direct care workers (DCWs). Not many studies have looked at the combined interaction of HR practices and organizational structure.

Purpose: The aim of this study is to examine the relationship between organizational structure (centralization, formalization, and span of control) and HR practices (training, horizontal communication, and vertical communication) on DCW’s job satisfaction and turnover intent.

Methodology: Data were collected from 58 long-term care facilities in five states. We used latent class analysis to group facility characteristics into three sets of combinations: “organic,” “mechanistic,” and “minimalist.” We used multivariate regression to test the relationship of each of these groups on DCW’s job satisfaction and turnover intent.

Findings: After controlling for state, organizational, and individual covariates, the organic group, which represents decentralized and less formalized structures and high levels of job training and communication, was positively related to job satisfaction and negatively related to intent to leave. On the other hand, the minimalist group, which is characterized by low levels of job-related training and communication, showed no significant differences from the mechanistic group (referent) on job satisfaction and intent to leave.

Practice Implications: These findings imply that managers in long-term care facilities may want to consider adopting organic, decentralized structures and HR practices to retain DCWs.

Author Information

Jungyoon Kim, PhD, is Assistant Professor, Department of Health Service Research & Administration, University of Nebraska Medical Center, Omaha. E-mail:

Nizar Wehbi, MD, MPH, MBA, is Assistant Professor, Department of Health Service Research & Administration, University of Nebraska Medical Center, Omaha. E-mail:

Jami L. DelliFraine, PhD, is Associate Professor, Division of Management, Policy, and Community Health, School of Public Health, University Texas Health Science Center at Houston. E-mail:

Diane Brannon, PhD, is Professor, Department of Health Policy & Administration, The Pennsylvania State University, University Park. E-mail:

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins