. Author manuscript; available in PMC: 2010 Sep 1.

Published in final edited form as: J Am Med Dir Assoc. 2009 Aug 5;10(7):498–504. doi: 10.1016/j.jamda.2009.04.002

Table 1.

Items Developed for Nursing Home Medical Staff Organization and Culture Dimensions

1.	Composition of Staff
	how many attendings provide care
	do physician extenders see residents ^a
	extent of “closed staff model”^b
2.	Appointment Process
	formal process for granting attending privileges^c
	does nursing home have a written contract with physicians^c
	does the nursing home employ physicians directly^c
	detail of bylaws^d
3.	Commitment
	Physician cohesion
	collegial relationships among the physicians^e decision-making process is consensus building^e great deal of organizational loyalty^e identifiable practice style which we all try to adhere^e
	Leadership Turnover/Capability
	administrator turnover in the last five years director of nursing turnover in the last five years
4.	Departmentalization
	Physician Supervision
	leadership style as involves checking up on physician^e quality of each physician’s work is monitored closely^e
	Physician Autonomy
	leadership style allows the attending physician greater freedom to act independently^e emphasis on physician individuality^e
	Physician Interdisciplinary Involvement
	physician is primary nursing home representative for families^e physicians are expected to attend care plan meetings^e physicians are expected to assume the leadership role in team meetings^e
5.	Documentation
	Formal Review Process to evaluate physicians^c
6.	Informal Dynamics (Interpersonal Relationships)
	quality of your relationship between medical director and administrator^f
	quality of your relationship between medical director and the director of nursing^f
	relationship between physicians and licensed nurses^f,^g
	medical staff gets no respect in the nursing facility^e,^g

Do nurse practitioners or physician assistants see residents in the facility

percent of residents whose attending is not a community based practitioners

responses measured by yes=1; no=0

responses measured on a 5 point scale anchored by not at all=0 somewhat=1 moderately=2 quite a bit=3 very=4

responses measured on a 5 point scale anchored by strongly disagree=1disagree=2 neutral=3 agree=4 strongly agree=5

responses measured on a 5 point scale anchored by poor=1 fair=2 good=3 very good=4 excellent=5

reversed scored