Publications by Author: Hurtado, David A

2017
Kossek EE, Thompson RJ, Lawson KM, Bodner T, Perrigino MB, Hammer LB, Buxton OM, Almeida DM, Moen P, Hurtado DA, et al. Caring for the Elderly at Work and Home: Can a Randomized Organizational Intervention Improve Psychological Health?. J Occup Health Psychol [Internet]. 2017. Publisher's VersionAbstract
Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record
Bray JW, Hinde JM, Kaiser DJ, Mills MJ, Karuntzos GT, Genadek KR, Kelly EL, Kossek EE, Hurtado DA. Effects of a Flexibility/Support Intervention on Work Performance. American Journal of Health Promotion [Internet]. 2017 :0890117117696244. Publisher's VersionAbstract

Purpose:To estimate the effects of a workplace initiative to reduce work–family conflict on employee performance.Design:A group-randomized multisite controlled experimental study with longitudinal follow-up.Setting:An information technology firm.Participants:Employees randomized to the intervention (n = 348) and control condition (n = 345).Intervention:An intervention, “Start. Transform. Achieve. Results.” to enhance employees’ control over their work time, to increase supervisors’ support for this change, and to increase employees’ and supervisors’ focus on results.Methods:We estimated the effect of the intervention on 9 self-reported employee performance measures using a difference-in-differences approach with generalized linear mixed models. Performance measures included actual and expected hours worked, absenteeism, and presenteeism.Results:This study found little evidence that an intervention targeting work–family conflict affected employee performance. The only significant effect of the intervention was an approximately 1-hour reduction in expected work hours. After Bonferroni correction, the intervention effect is marginally insignificant at 6 months and marginally significant at 12 and 18 months.Conclusion:The intervention reduced expected working time by 1 hour per week; effects on most other employee self-reported performance measures were statistically insignificant. When coupled with the other positive wellness and firm outcomes, this intervention may be useful for improving employee perceptions of increased access to personal time or personal wellness without sacrificing performance. The null effects on performance provide countervailing evidence to recent negative press on work–family and flex work initiatives.

2016
Moen P, Lee S-R, Oakes JM, Fan W, Bray JW, Almeida DM, Hammer LB, Hurtado DA, Buxton OM. Can a Flexibility/Support Initiative Reduce Turnover Intentions and Exits? Results from the Work, Family, and Health Network. Social Problems [Internet]. 2016. Publisher's VersionAbstract

We draw on panel data from a randomized field experiment to assess the effects of a flexibility/supervisor support initiative called STAR on turnover intentions and voluntary turnover among professional technical workers in a large firm. An unanticipated exogenous shock—the announcement of an impending merger—occurred in the middle of data collection. Both organizational changes reflect an emerging employment contract characterized by increasing employee temporal flexibility even as employers wield greater flexibility in reorganizing their workforces. We theorized STAR would reduce turnover intentions and actual turnover by making it more attractive to stay with the current employer. We found being in a STAR team (versus a usual practice team) lowered turnover intentions 12 months later and reduced the risk of voluntary turnover over almost three years. We also examined potential mechanisms accounting for the effects of these two organizational changes; STAR effects on reducing turnover intentions are partially mediated by reducing work-to-family conflict, family-to-work conflict, burnout, psychological distress, perceived stress, and increasing job satisfaction. The effect of learning about the merger on increasing turnover intentions is fully mediated by increased job insecurity. STAR also moderates the negative effects of learning about the merger on turnover intentions for different subgroups. Findings provide insights into the effectiveness of an organizational intervention, the dynamics of organizations, and how competing logics of two organizational changes affect employees’ labor market expectations and behavior.

Hurtado DA, Okechukwu CA, Buxton OM, Hammer LB, Hanson GC, Moen P, Klein LC, Berkman LF. Effects on cigarette consumption of a work–family supportive organisational intervention: 6-month results from the work, family and health network study. Journal of Epidemiology and Community Health [Internet]. 2016. Publisher's VersionAbstract
Background Observational studies have linked work–family issues with cigarette consumption. This study examined the 6-month effects on cigarette consumption of a work–family supportive organisational intervention among nursing home workers.Methods Group randomised controlled trial where 30 nursing homes across New England states were randomly assigned to either usual practice or to a 4-month intervention aimed at reducing work–family conflict via increased schedule control and family supportive supervisory behaviours (FSSB). Cigarette consumption was based on self-reported number of cigarettes per week, measured at the individual level.Results A total of 1524 direct-care workers were enrolled in the trial. Cigarette consumption was prevalent in 30% of the sample, consuming an average of 77 cigarettes/week. Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes, while no reduction was observed among smokers at usual practice sites (b=−7.12, 95% CI −13.83 to −0.40, p<0.05) (d=−0.15). The majority of smokers were US-born White nursing assistants, and among this subgroup, the reduction in cigarette consumption was stronger (b=−12.77, 95% CI −22.31 to −3.22, p<0.05) (d=−0.27). Although the intervention prevented a decline in FSSB (d=0.08), effects on cigarette consumption were not mediated by FSSB.Conclusions Cigarette consumption was reduced among smokers at organisations where a work–family supportive intervention was implemented. This effect, however, was not explained by specific targets of the intervention, but other psychosocial pathways related to the work–family interface.Trial registration number NCT02050204; results.
Okechukwu CA, Kelly EL, Bacic J, DePasquale N, Hurtado DA, Kossek EE, Sembajwe G. Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care. Social Science & Medicine [Internet]. 2016;157 :111 - 119. Publisher's VersionAbstract

Abstract We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (−2.62%) and other injuries (−9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (−17.94%) and falls with injuries (−7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08–1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59–0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality.

2014
Hurtado DA, Berkman LF, Buxton OM, Okechukwu CA. Schedule Control and Nursing Home Quality; Exploratory Evidence of a Psychosocial Predictor of Resident Care. Journal of Applied Gerontology [Internet]. 2014. Publisher's VersionAbstract

Aim: To examine whether nursing homes’ quality of care was predicted by schedule control (workers’ ability to decide work hours), independently of other staffing characteristics. Method: Prospective ecological study of 30 nursing homes in New England. Schedule control was self-reported via survey in 2011-2012 (N = 1,045). Quality measures included the prevalence of decline in activities of daily living, residents’ weight loss, and pressure ulcers, indicators systematically linked with staffing characteristics. Outcomes data for 2012 were retrieved from Medicare.gov. Results: Robust Linear Regressions showed that higher schedule control predicted lower prevalence of pressure ulcers (β = −0.51, p < .05). This association was independent of staff mix, staffing ratios, job satisfaction, and turnover intentions. Conclusion: Higher schedule control might enhance the planning and delivery of strategies to prevent or cure pressure ulcers. Further research is needed to identify potential causal mechanisms by which schedule control could improve quality of care.

2012
Hurtado DA, Sabbath EL, Ertel KA, Buxton OM, Berkman LF. Racial disparities in job strain among American and immigrant long-term care workers. Int Nurs Rev. 2012;59 (2) :237-44.Abstract

BACKGROUND: Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect. AIM: This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237). METHODS: Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155). RESULTS: Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders. CONCLUSION: Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.