title: Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.
abstract: OBJECTIVE
  To evaluate the effectiveness of a leadership and management program in aged care.
  
  
  METHODS
  Double-blind cluster randomized controlled trial.
  
  
  METHODS
  Twelve residential and community-aged care sites in Australia.
  
  
  METHODS
  All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%).
  
  
  METHODS
  A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care.
  
  
  METHODS
  The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only.
  
  
  RESULTS
  At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0.07-0.52; P = .01); and were rated higher on the overall leadership outcomes (mean difference 0.35, 95% CI 0.13-0.56; P = .001) as well as individual manager outcomes: extra effort (P = .004), effectiveness (P = .001), and satisfaction (P = .01). There was no evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety.
  
  
  CONCLUSIONS
  While the CLiAC leadership program had direct impact on the primary process outcomes (management support, leadership actions, behaviors, and effects), this was insufficient to change the systems required to support care service quality and client safety. Nevertheless, the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost.
authors.affiliation: Sydney Nursing School, The University of Sydney, Camperdown, New South Wales, Australia. Electronic address: yun-hee.jeon@sydney.edu.au.
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Jeon
authors.affiliation: Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, New South Wales, Australia.
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.affiliation: Sydney Nursing School, The University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: NHMRC Clinical Trials Center, The University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cunich
authors.affiliation: Sydney Nursing School, The University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Tamsin H
authors.initials: TH
authors.lastname: Thomas
authors.affiliation: Center for Healthy Brain Aging, University of New South Wales, New South Wales, Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chenoweth
authors.affiliation: Center for Research in Aging, Health, and Wellbeing, Australian National University, Acton, Australian Capital Territory, Australia.
authors.forename: Hal L
authors.initials: HL
authors.lastname: Kendig
mesh_terms: D001315:Australia; D016000:Cluster Analysis; D004311:Double-Blind Method; D005260:Female; D005851:Geriatric Nursing; D006270:Health Facility Administrators / Q000193:education*; D006801:Humans; D007318:Inservice Training / Q000592:standards*; D007857:Leadership; D008297:Male; D008875:Middle Aged; D010563:Personnel Turnover; D011787:Quality of Health Care; D012648:Self Care; D011795:Surveys and Questionnaires
keywords: Clinical leadership; care quality; leadership styles; long-term care; work environment