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We conduct and provide funding for cutting edge research at the intersection of management and medicine. For more information about our research, see our research page. For more information about our funding opportunities, or to explore collaboration with the Center, contact our program manager, Christie Hudson, at

Selected Research

Research at the Center for Healthcare Management is focused on addressing questions such as:

  • How will changes in the demand and delivery of healthcare services affect the quality of care provided?
  • How can we more effectively address the problems of low-wage, low-skill workers in direct care?
  • How do public policy initiatives regarding immigration affect opportunities in the direct care workforce?
  • How can we develop and retain professionals who form the basis of a dynamic and competitive economy?

Quality Care Through Quality Jobs: Retention and Development of the Direct Care Workforce in Pennsylvania

The goals of this project are to inform policy and practice regarding the retention and development of direct care workers. Currently, there are significant shortages of nursing aides and personal assistants who provide care to the elderly. With the aging of the population, demand is projected to continue to outstrip supply.

The problems of shortage are compounded by the problem of high turnover (40% to 100% annually) in this workforce. Persistent high turnover has had dramatic and negative consequences for consumers of these services, the workers themselves, care facilities, and society as a whole.

Our research design is longitudinal and focused on the worker over time, and thus will be able to provide information on the "who?", "why?", and "where?" of turnover. In addition, our research will allow us to examine differences among leavers and stayers in terms of both on-the-job (e.g., culture, leadership) and off-the-job (e.g., family demands) factors. We are also examining the differences among chronic and intermittent job leavers. In these ways, our research allows us to examine patterns of employment among these workers rather than discreet employment events. Moreover, we are gathering multiple measures of various social, cultural, and job-related factors over four time periods. Finally, our research allows workers to report directly on their experiences while at the same time collect objective data on actual job transitions.

Currently, our study sample consists of 1350 direct care workers in the state of Pennsylvania. We are conducting telephone interviews across four waves of data collection at nine-month intervals. Given our design, we will have a total of 4, 305 observations representing at least 830 unique individuals over all four stages of the project. In addition to evaluating trends, we can analyze each wave separately to draw preliminary conclusions.

Supported by: PA Department of Labor and Industry; Heinz Endowments; Jewish Healthcare Foundation

Work Discretion and Job Crafting in the Childcare Industry

Childcare work is unique in that it is low-paying and low-status yet offers a level of discretion in day-to-day activity comparable to that more commonly found in professional work that entails far higher levels of education, pay, and status. Our research examines how childcare workers use this discretion to "craft" their jobs, a process of customizing one's job to better fit one's aspirations and motives. Our research aims to understand the conditions or contexts that permit or stifle this individual and collaborative "job crafting".

In our first working paper, Work Process and Quality of Care: Encouraging Positive Job Crafting in Childcare Classrooms (Leana, Applebaum & Shevchuk, 2008) we demonstrate a significant relationship between job crafting and the quality of care given in childcare classrooms.

Specifically, we found that when childcare teachers and aides work collaboratively to customize their care, the quality of care is significantly enhanced. When childcare workers customize their work individually, the quality of care declines. Our results suggest that the current push in many states to model early childhood education along the lines of traditional K-5 education is a mistake. Instead, the improvisation inherent in working with young children requires a more flexible and collaborative teaching model.

Data for our study were collected in both Pennsylvania and New Jersey between April 2006 and May 2007. Over 330 childcare classroom workers teaching primarily 3-and 4-year olds were surveyed, representing 158 classrooms at 79 sites. Sites included a mix of for-profit and not-for-profit as well as Head Start and public pre-school programs. Trained evaluators observed classrooms and the quality of care using the Early Childhood Environmental Rating Scale-Revised (ECERS-R), a widely used standardized measure of preschool classroom structure and process. The director at each site also participated in an interview as well as completed a survey.

Supported by: University of Pittsburgh Research Council; Schumann Fund