Leadership, psychosocial work environment, and satisfaction with elder care among care recipients : Analysing their associations and the structural differences between nursing homes and home care

Background Municipal elder care has become increasingly multifaceted, and the quest for quality is a continuing discussion in Swedish elder care. In recent decades, municipalities have prioritized older adults with severe needs. There is also a trend of more elderly individuals receiving care in their own homes. The number of persons 80 years and older will increase by approximately 75 percent between 2015 and 2035. During the same period, the numbers of nursing assistants are likely to decrease. Furthermore, health and social care services have the highest rates of sick leave in Sweden, and the psychosocial work environment plays an important role in reducing sick leave. Perceived support from an organization, leaders and colleagues has been shown to have a positive effect on nursing assistants’ perceptions of the psychosocial work environment in elder care settings. Leadership characteristics or attributes and behaviours have been associated with a healthy work environment. Thus, knowledge regarding the associations between leadership, the psychosocial work environment, and recipient satisfaction in elder care is insufficient. Aims The overall aim of this thesis was to explore and describe the associations between leadership, the psychosocial work environment, and recipient satisfaction in municipal elder care, the changes over time in psychosocial work environment, and the difference between nursing homes and home care. Design and methods This thesis is based on four cross-sectional studies (I-IV) and one study based on repeated cross-sectional analyses (V). Data from three different surveys were used: the Developmental Leadership Questionnaire (DLQ), the Questionnaire for Psychological and Social Factors at Work (QPS), and a recipient satisfaction survey (based on a National Board of Health and Welfare recipient satisfaction survey). Study I analyses first-line managers’ assessments of their leadership and nursing assistants’ assessments of their first-line mana