The Effects of Financial Management, Staff Commitment and Satisfaction, and Management Team Professionalism on the Quality of Nursing Home Services in China

The Effects of Financial Management, Staff Commitment and Satisfaction, and Management Team Professionalism on the Quality of Nursing Home Services in China

Loo Yew Liang, Liang Jiayi

New Era University College, Kajang, Selangor, Malaysia

DOI: https://doi.org/10.51244/IJRSI.2025.12020063

Received: 06 February 2025; Revised: 11 February 2025; Accepted: 13 February 2025; Published: 17 March 2025

ABSTRACT

In the context of China’s rapidly aging population and the increasing demand for superior elderly care services, the effective management of internal resources in nursing homes has become crucial. This study explores the effects of financial management, staff commitment and satisfaction, and management team professionalism on the service quality of nursing homes crossing three cities in Shandong Province which are Weihai, Jinan, and Linyi as this study samples. The research focuses on how these three identified variables contributed to the overall performance and service standards of nursing homes which play a vital role in supporting the well-being of the elderly population in these regions. Data were collected cross-sectionally from these three cities through a well-structured survey questionnaire with a quota sampling technique from nursing home administrators and staff. A total of 300 valid responses were retrieved out of 300 questionnaires distributed as the basis for the data analysis. The statistical analysis was executed using the SPSS Version 28.0 showing the overall α value for Cronbach was 0.874, thus indicating that the measured variables were highly reliable. The study also showed a strong positive correlation between financial management, staff commitment and satisfaction, and the management team professionalism and service quality. These findings underlined those have been practising financial practices, engaged staff, and professionally competent management are significant enhancers of quality care in nursing homes. The study contributes to useful lessons for policymakers and nursing home administrators on how best to optimize resource management and professional capability development in meeting the growing demand for quality elderly care services in China. Furthermore, the empiral results of this study would be very vital to improving efficiency and quality in the operations of nursing homes in Shandong Province as a prototype section that can be replicated in areas with similar challenges.

Keywords: Nursing homes, financial management, staff commitment and job satisfaction, management team professionalism, service quality

INTRODUCTION

Background of the Study

China has entered a period of rapid aging since the late 20th century, with the proportion of elderly people continuously increasing, posing significant challenges to the country’s elderly care system. According to data from the National Bureau of Statistics, by 2050, it is estimated that 30% of China’s population will be 65 years or older (Jiang, Sun, Bonifas, & Hodge, 2021). This has created an overwhelming demand for services catering to the elderly, with the aging issue intensified by increased urbanization in this fast-modernizing world, where most of the traditional family-based models of care have become out of the question. With the aging issue intensifying, nursing homes as a professionalized model for the care of the elderly are increasingly becoming the popular choice with seniors. However, the existing elderly care system faces numerous issues and challenges with this growth in demand (Wu, 2019).

Although the Chinese government has increased investment in the elderly care sector in recent years, leading to a rise in the number of nursing homes, the quality of services remains inconsistent. As of the end of 2021, China had 40,000 nursing homes offering over 5 million beds (Sun et al., 2021). However, these new nursing homes vary significantly in terms of infrastructure and service levels. Some newer facilities can provide advanced equipment and personalized care services, while older or underfunded facilities struggle with outdated infrastructure and staff shortages. This uneven development has made the quality of care in nursing homes a focal point of social concern (Lin, 2019). Additionally, as the expectations for quality of life among the elderly rise, improving service quality within the constraints of limited resources has become a pressing issue for elderly care managers (Jiang et al., 2021).

In responding to the needs of an aging society, the modernization and optimization of nursing home management models have become critical issues. Traditional nursing home management primarily focuses on meeting the basic living needs of the elderly, such as food, shelter, and basic care. However, with societal development and the diversification of elderly needs, a singular management model can no longer meet current demands. Modern nursing homes should not only offer basic life support but also consider the increasing psychological and social needs of the elderly (Wu, 2019). For instance, the study pointed to the need for nursing home managers to be innovative in the management strategies like introducing personalized services, increasing psychological counseling, and enhancing social activities in a bid to improve the life satisfaction and happiness of the elderly (Rahman, Straker, & Manning, 2018). The process of the development of information technology in the nursing home also deals with the gradual application of effective approaches for managing digital tools aimed at improvement in the service quality (Lin, 2019).

With the rapid aging process, it is an urgent need for current social development to develop and optimize management strategies in nursing homes to enhance service quality. Based on this, a research study has been conducted to explore whether modern methods of management and innovative strategies can help in enhancing the overall service quality of nursing homes in China. This study is of not only academic value but also practical guidance to the elderly care industry. It provides theoretical bases and practical guidelines for policymakers and managers of nursing homes to improve the overall level of old-age service while coping with the challenge brought about by aging populations (Jiang et al., 2021).

Problem Statement

Not only nursing homes are facing huge challenges due to the fast growth of an aging population in China, but they also always fail to meet the expectation. Although government investments have been rising in recent years, improvement in service quality is way off the mark, contributing to disparities in standards across regions. Sun et al. (2021) also affirmed that the resources are not evenly distributed and there are huge disparities in the service levels that nursing homes offer in different regions. Such disparity not only affects the life satisfaction of the elderly overall but also worsens their anxiety when choosing a nursing home. Wang and Xu (2018) added that the inconsistent quality of care with the time made the elderly disenchanted over nursing home services.

Another major critical issue that greatly affects quality care is a gross shortage of nursing staff in the nursing home setting. The demanding nature of nursing work, coupled with low pay, disillusions qualified caregivers from seeking jobs and staying put in a profession with poor reputation (Yang et al., 2020). This lack not only overburdens the available staff but also translates into inconsistencies in the quality of care provided. For instance, Jing and Liu (2019) noted that caregivers’ high job turnover is closely related to the unavailability of career development; therefore, high demand for nursing homes with a consistent performance in high-quality care delivery. Moreover, this is also a direct influence of insufficient numbers of nursing staff on the care experience of the older people which makes service quality management more complex.

This is further exacerbated by the fact that many nursing homes have old facilities and use outdated management models. According to Yu et al (2017), a majority of rural nursing homes do not furnish modern living and care environments due to the outdated premises and lack of resources. It is a reality that reduces the quality of life for elderly residents, especially in issues touching on health and safety. In addition, the traditional model of managemen as identified by Wang and Xu (2018) indicated that pursuing only the basic living needs of the elderly at the expense of their psychological and social needs meanwhile complicating the struggle to raise standards in care.

The rapid growth of the aged population has further exaggerated the gap between supply and demand for nursing home beds. In this regard, there was a study posits that as the demand increases and the supply of the bed is not keeping up with it (Yang al., 2020) This leads to long waiting periods for many older adults and the admitted ones are not well attended to because of constraints in resources. This asymmetry affects not only the life satisfaction of the elderly, but also exponentially increases the operational strains on nursing homes amd further reducing enhancements in service quality.

The problems of service quality management in Chinese nursing homes include inconsistent service standards, a shortage of nursing personnel, aging facilities, and outdated management models. Problems such as these have a negative impact not only on the quality of life for aged residents but also exert significant threats to the long-term sustainability of nursing homes. Hence, there is a great need to conduct profound research and optimize the management strategies for achieving this quality care in the nursing homes to meet the rising needs of the elderly population

The Development of Research Questions and Research Objectives

RQ1: Does financial management have a significant impact on the quality of service in nursing homes?

RQ2: Do staff commitment and job satisfaction affect the quality of service in nursing homes?

RQ3: Does the professionalism of management services enhance the overall quality of service in nursing homes?

RO1: To study the effect of financial management on the quality of service in nursing homes.

RO2: To study the effect of staff commitment and job satisfaction in determining the quality of service in nursing homes.

RO3: To study the effect of professional management services in enhancing the overall quality of service in nursing homes.

Significance of the Study

This study bears great theoretical and practical relevance. Theoretically, the study adds to the existing literature on the relationship of nursing home management and service quality. Although many studies have been conducted on the effect of financial management, staff commitment and satisfaction, and the professionalism of management services on the quality of care in nursing homes. Those studies are often fragmented and do not provide a comprehensive framework whereas this research aims to establish a more systematic and comprehensive theoretical framework with these critical factors and reveal the specific roles and interrelationships among them in the context of Chinese nursing homes. Such theoretical exploration not only provides new perspectives for the fields of management and geriatric care, but also serves as a valuable reference for similar studies in other countries or regions (Sun et al., 2021; Yang et al., 2020).

The significance is how nursing home management and administration in China will be carried out in the future with important practical implications drawn from this research. This is due to throughout the assessment of the relation of financial management, staff commitment, and the level of professionalism of management services on quality of service. It will provide recommendations that offer a guideline to nursing home administrators in implementing quality service and effective operations. Indeed, findings can be used by financial managers to optimize resource allocation and control costs for improved service levels in general in nursing homes (Yu et al., 2017). Nursing managers can learn how to boost staff job satisfaction and commitment so that staff turnover can be minimized to improve the quality of service. In general, this research not only lends to the improvement in practices and quality of life for the elderly resident in nursing homes but also provides the much-needed evidence that is used to develop more effective policies by policymakers in support of development in elderly care services.

Limitations of the Study

While the study has provided important information for enhancing service quality in Chinese nursing homes, the following limitations should be acknowledged. The data are mostly representative of the conditions of certain regions, which makes it hard to generalize the findings nationwide, especially in regions with diversified levels of economic development and policy environments. In addition, this study has a relatively short time span, which may not be enough for capturing long-term dynamics of management in nursing homes. The latter limitations can affect generalization to a greater degree. This study will hopefully be continued in a more diverse range of locations, with long-term trends being considered in order to assure both reliability and relevance of the findings.

Additionally, this study primarily gathered data from nursing home management and staff, which may not fully reflect the perspectives of elderly residents or the direct recipients of care services. While administrators and employees provide valuable insights into financial management, staff commitment and satisfaction, and management professionalism, incorporating the voices of residents could offer a more comprehensive assessment of service quality. Future research should consider inviting elderly residents to participate in surveys or interviews, ensuring that their lived experiences and satisfaction levels contribute to a more holistic understanding of nursing home service quality.

LITERATURE REVIEW

Nursing Home Management in China

Facing rapid socioeconomic development and an aging population, nursing home management in China has become increasingly complex while at the same time allowing for opportunities. In this regard, recent literature reviews have shed light on the management practices, improvement in the quality of service delivery, human resource deployment, and novel management models, all of which have gained theoretic and practical support to help understand the status quo of, and further trends in, nursing home management in China. Studies showed that the current complex demands require the change of the nursing home administration to one that is more responsible and less reliant upon traditional management approaches. All this has dramatically enhanced the efficiency of management and responsiveness of service with the introduction of modern management tools, including performance evaluation systems and data-driven decision support systems (Liu & Zhang, 2021). These tools improve transparency in the management and, at the same time, optimize resource utilization for efficient coping with the growing demand for care services in nursing homes.

Financial management acts as the cornerstone of nursing home management in China, covering not only routine operational funds but also strategic decision-making with long-term investment (Tyler et al., 2016). Balancing short-term costs and long-term gains helps the nursing homes gain a competitive edge in the market and often excel in service provision quality (Lennon, & Kavanagh, 2020). Effective financial management ensures the sustainable development of nursing homes and supports continuous investments in technology upgrades and staff training, further enhancing the quality of care services. This financial robustness and strategic planning provide essential support for nursing homes as they navigate an increasingly complex market environment.

The integration of technology has also played a critical role in advancing the modernization of nursing home management in China. The adoption of smart monitoring systems and electronic health records has not only made care services more personalized and precise but also streamlined daily operations, improving management efficiency (Tyler et al., 2016). These technological applications have significantly alleviated staffing shortages in nursing homes and provided higher standards of care for the elderly. Through the application of technology, nursing homes can better meet the health needs of the elderly while achieving significant improvements in management effectiveness, laying a solid foundation for future elder care services.

Existing literature indicates that while nursing home management in China is making progress, there are still pressing issues that need to be addressed, such as balancing resource allocation with management efficiency and maintaining service quality while adapting to changes in the external environment (Klakegg & Pekkarinen, 2020). These issues will be further explored in subsequent chapters, particularly regarding the impact of internal factors and external environments on nursing home management. Through the review of existing literature, not only are the current state and challenges of nursing home management revealed, but directions for future research and practice are also provided. As management practices continue to mature, the quality of elder care services in China is expected to further improve, laying a solid foundation for meeting the demands of an aging society.

Financial Management

Financial management plays a pivotal role in the operation of nursing homes, serving as the backbone of ensuring basic operations while also being crucial for enhancing service quality and supporting long-term development. As the industry of elders’ care in China rapidly grows, financial management has gained more importance. It is argued that nursing homes facing an increased demand for care under constrained resources must rely on sound financial management with a growing demand for long-term care services associated with aging populations and their families (Bowers, et al., 2016). This covers daily budgeting to making long-term capital investment decisions, impacting on all aspects of nursing home operations.

With respect to the distribution of financial resources, studies have been able to establish that investment in segments that significantly influence service quality would lead to improved operational performance on a general basis (Tyler et al., 2016). Areas of the such type include modernization of facilities, professionalism in training staff, and adopting new technologies which all involve significant financial impromptu. These not only will change the physical environment and service capability of nursing homes but also enhance the improvement of professional skills and staff efficiency, thereby improving the care experience of the elderly residents.

Financial management plays a critical role not only in resource allocation but also in cost control and efficiency improvement. With the continuous rise of nursing home operating costs, including labor cost and material cost, the degree of financial management precision has been a key factor in determining whether a nursing home can maintain sustainable development. According to Johansson and Bergman (2021), better strategies in controlling costs, such as following the budget plans strictly, carrying out frequent financial audits, and streamlining the supply chain, will ultimately work to minimize the operational costs of a nursing home, raising the standards of service provision in the process. This enhances short-term financial performance while at the same time establishing capital for long-term growth in nursing homes.

Another important segment of financial management is risk management. The importance of risk management under uncertainties and external environment shocks was found to be of special importance during the COVID-19 pandemic regarding the financial stability of many nursing homes. Liu and Zhang (2021) assert that a strong risk control mechanism with the presence of early warning systems would assist nursing homes in remaining liquid at times of crisis and easily turn back to normal operation thereafter. Not only does such a policy ensure nursing homes’ short-term stability, but it also strengthens long-term resilience.

It is true that the use of information technology is revolutionizing the practice of financial management, even in nursing homes. Modern financial management systems, such as big data analytics and cloud computing technologies, provide real-time financial data and predictive analysis so that managers can make more accurate decisions concerning finance (Ray & Montfort, 2019). For instance, supported by big data technology, nursing homes can project the future financial needs, optimize resource allocation, and flexibly adjust operational strategies in response to market changes. The introduction of information technology not only improves the efficiency of financial management but also makes nursing homes better able to survive in an increasingly competitive market.

In a word, financial management is very important for improving the service quality of nursing homes. This will enable nursing homes to ensure operational stability in such a complex and changing environment, progressively enhancing the quality of care services offered through scientific resource allocation, strict cost control, efficient risk management, and information technology.

Staff Commitment and Satisfaction

In the management of nursing homes, the job commitment and satisfaction of nursing staff are widely recognized as critical internal factors that influence the quality of care. The quality of care for older residents in nursing homes is directly related to the attitudes, levels of engagement, and professional commitment of nursing staff as the main providers of care. Research indicates that nursing staff with high job satisfaction are more likely to exhibit strong job commitment, which not only ensures consistent care delivery but also minimizes the disruptions caused by staff turnover, thereby enhancing overall care quality (Wang & Ma, 2022).

Also, the fact that organizational culture reveals itself in the provision of possibilities for career development and compensation, as well as in the work environment, is also of great influence on job satisfaction among nursing staff. As shown by Lennon, and Kavanagh (2020), nursing staff will have an attachment and identity in a situation where there are clear career paths, fair compensation, and a supportive work environment for the nursing staff, especially when their work is recognized. This fosters a sense of belonging among the staff, thus reducing the related stress at the workplace and making them willing to put in extra effort while performing their tasks, which eventually leads to quality service. In addition, an assured working environment that has minimal disturbance fosters loyalty, lowering the negative effects that could have been linked with a high turnover rate among nursing staff.

Leadership style and organizational culture are also very influential on the job commitment of the nursing staff. Studies have shown that supporting leadership and a positive organizational culture greatly enhance job satisfaction among nursing staff (Backhaus et al., 2018). Especially, leaders who are characterized by giving clear guidance, practicing effective communication, and being considerate about the well-being of employees are likely to develop trust and respect from their followers. This trust builds a stronger commitment to the job, and nursing staff are inspired to be resilient in problems and in maintaining quality care. Further, Lennon and Kavanagh (2024) an important aspect of organizational culture is how it defines the professional identity of workers. The organizational culture, if supportive of teamwork and encouragement for new ideas, and if appreciative of employee contributions, can greatly contribute to job satisfaction and, consequently, quality care.

Ongoing professional training and development opportunities also help in developing job commitment among the nursing staff. Research indicates that if the nursing staff has avenues for further skill development through training and can see specific career progression ahead, then job satisfaction and commitment will improve massively (Ray & Montfort, 2019). Such training uplifts the professional capacities of the nursing staff, their job security, as well as long-term commitment. Nursing homes can offer quality care while maintaining a stable and effective staff through ongoing professional development opportunities.

Some other factors that significantly contribute to job satisfaction among the nursing staff are psychological support and work-life balance. Growing concerns have been witnessed in recent years regarding the mental health of nursing staff due to increasing pressures of the job. Zhang and Li (2020) also identify that providing appropriate psychological support services to the employees, such as counseling, stress management training, and team-building activities, may potentially reduce the stress, increase the job satisfaction, and further enhance the work motivation of the nursing staff. Such psychological support enhances the general well-being of staff and their own effectiveness and quality of care they offer to the residents.

In summary, nursing staff job commitment and satisfaction are precursors to quality care in nursing homes. Financial management is not only the foundation of nursing home operations but also a key driver in enhancing service quality. Precise financial management ensures the effective allocation of resources, which supports improvements in various areas of service provision. Research indicates that the appropriate use of funds, particularly in staff training and equipment upgrades, can significantly improve the overall service quality of nursing homes (Brealey, Myers, & Marcus, 2019). On one hand, sufficient financial investment ensures that nursing staff can regularly participate in professional training programs, improving their caregiving skills and professional expertise, which enables them to provide higher-quality, more personalized care to elderly residents. On the other hand, funding for the upgrading and maintenance of modern caregiving equipment enhances the efficiency and safety of care services, reducing the workload of staff and minimizing operational errors. By strengthening financial management, nursing homes can not only optimize internal resource allocation but also innovate continuously to improve the satisfaction of both residents and their families. Enhancing the work environment and career development prospects, providing psychological support, and fostering an organizational culture with a positive impact, nursing homes will be equipped with ideal preconditions for enhancing job commitment among its staff, lifting the standards of care to a whole new level, and creating a positive experience for elderly residents.

Management Professionalism

It is assumed that the professionalism of management services in the operation of nursing homes is one of the most important internal resources that greatly affect competitive advantage and quality of care. In this regard, according to the Resource-Based View (RBV), capabilities and competencies of the management team are unique and not easily imitable; hence, being effectively integrated and used with other internal resources, it can provide a competitive edge in the market environment (Barney, 1991).

Decision-making ability and professionalism of the management team are critical areas for the everyday operation of the nursing homes. These include the allocation of resources and maintaining organizational flexibility and adaptability in an environment of changing markets and policies. This, for instance, can be in terms of strategizing and making the right decisions that would warrant optimal resource allocation by nursing homes to deliver quality services even when it is considered a scarce resource (Zúñiga et al., 2015). For instance, during periods of financial constrains and staffing challenges, managers can identify and prioritize critical issues that include ensuring continuous training and development of staff and renovations and improvements in facilities. In addition, such an optimized use of resources reinforces operational efficiency and adds markedly to the competitiveness of a nursing home in the market.

The other aspect that shows professionalism on the management team is the relentless drive for internal innovation. Inward innovation is not only a must response to external changes but also the pursuit of quality care in nursing homes. Continuous improvement and innovating the management process reduce waste of resources and maximize resource utilization. This allows nursing homes to be competitive within an uncertain environment (Aronson & Neysmith, 2016). For example, improved quality and efficiency of new management technologies or workflow redesign, which enhance satisfaction in elderly residents.

The management team should also identify, develop, and utilize other organizational resources within its internal environment. By developing appropriate incentive mechanisms and career development programs, the management can enhance a feeling of job commitment and satisfaction of caregivers, hence directly enhancing the quality of services being rendered by the organization to its clients (Liu & Gao, 2020). Capacity of management is expressed not just in optimizing available resources but also in identifying and developing potential resources that allow the nursing home to remain unique and competitive in a highly aggressive market environment.

From the perspective of the Resource-Based View, the professionalism of the management team is one of the most strategically significant resources within a nursing home. It determines how effectively other resources are allocated and utilized and directly influences the long-term development and competitive advantage of the nursing home. Whether responding to external challenges or optimizing internal operations, the capabilities and expertise of the management team are essential for ensuring that the nursing home can navigate a changing market environment successfully. Therefore, strengthening the professionalism of management services not only enhances operational efficiency and service quality but also secures a lasting competitive advantage in the market.

Service Quality

Service quality can be defined as the delivery of nursing home services as relates to the need and expectations of the elderly in the facility. It includes several factors such as; basic care needs, medical requirements, and psychological support, each an aspect of overall resident satisfaction of services in a nursing home (Parasuraman et al., 1988). Huda (1995) dd (vdvdindicatedeindicated that the service quality will have satisfaction among the residents, their level of care, and conditions of the facilities. Research involving eight residential or nursing homes revealed a high degree of correlation between staff awareness and resident needs, emphasizing the importance of front-line staff in delivering quality service. The another study found significant direct effects of service quality on customer satisfaction and corporate image in private nursing homes, suggesting that enhancing service quality can improve customer perceptions (Satsanguan et al., 2015).

The extent to which nursing home services meet or exceed residents’ expectations in terms of physical care, emotional support, responsiveness, and overall living environment, ensuring a dignified and satisfactory quality of life. Using the SERVQUAL theory, the study identified issues such as single function, outdated infrastructure, and lack of professional service in Tianjin nursing homes, recommending more humanized and diversified services (Deng & Zhang, 2018). A multidimensional construct that encompasses the effectiveness, efficiency, empathy, and reliability of healthcare and supportive services provided to elderly residents, significantly influencing their well-being and satisfaction. The research developed an instrument based on the SERVQUAL model to evaluate e-Health service quality in nursing homes, identifying dissatisfaction factors and proposing health care informatics solutions (Wu et al., 2020).

In view of the aging population, in recent years, the Chinese government has taken a series of policy measures to invigorate the elder care service industry. Whether or not these policies are effective and implemented properly reflects directly on the operational models and service levels of nursing homes. Government financial support, both in the form of construction subsidies and operational grants, and funds for training care staff, provide some tools to develop quality care in nursing homes. In this manner, government financial support really assists nursing homes in their infrastructural development and the development of care provision capacity (McGilton et al., 2020).

Moreover, the government is always taking its quality regulatory watching of the nursing homes to another level through standardization with periodic evaluations, and mandates on maintaining set standards of care. This encapsulates setting the set services standards, inspecting and monitoring the facilities and staff qualifications, and the day-to-day activities that are taking place in this (Backhaus et al., 2018). The government through subsidies, tax reductions, and other policies reduces the financial pressure of these nursing homes and opens up further avenues for investing more resources into better care services and infrastructural development of this service (Li & Feng, 2021).

Theoretical Framework

This study uses the Resource-Based View (RBV) as a theoretical basis for a systematic analysis of the impact of internal resources in nursing homes on service quality. The RBV theory places the basis of competitive advantage in an organization on unique and inimitable internal resources(Barney, 2007). This makes it quite adaptable for the analysis of the central key variables in this study, which include financial management, nursing staff’s job commitment, and the professionalism of the management team. Mostly, these variables constitute the core resources of a nursing home and at the same time directly determine the quality of service of a nursing home. Therefore, by linking these variables with the RBV theory, this study hopes to find out how nursing homes can enhance their quality of service and have a competitive advantage in the marketplace by optimizing and using internal resources effectively. (Wernerfelt, 1984).

The literature review also focused on the impact of financial management, job commitment of nursing staff, and management team professionalism on the quality of services in nursing homes. According to the RBV perspective, these variables can be considered core organizational resources. This financial management allows for proper resource utilization and influences nursing homes’ ability to invest in technology and staff training, which directly impacts service quality (Barney, 1991; Li & Zhang, 2020). The job commitment and satisfaction of the nursing staff, being large components of human capital, directly affect the consistency and quality of services offered (Choi, Flynn, & Aiken, 2016). High levels of professionalism within the management team make it possible to optimize resource allocation and drive innovations, ensuring that nursing homes can deliver quality services even under resource constraints (Liu & Gao, 2020).

From the RBV perspective, the uniqueness and irreplaceability of internal resources explain why these variables are crucial in enhancing the quality of services in nursing homes. RBV theory emphasizes that unique and difficult-to-replicate internal resources can become a sustainable competitive advantage for an organization (Wernerfelt, 1984). Through this theoretical framework, the study revealed the way of internal resources in nursing homes interact and how effective management practices influence overall service quality. The theory not only provides analytical tools for this study but also lays the foundation for subsequent empirical research.

Based on the above theoretical analysis, this study constructs a conceptual framework that illustrates the relationship between key internal resources and service quality (Figure 1). This framework clarifies how financial management, job commitment of nursing staff, and management team professionalism interact and how they influence service quality through optimized resource allocation. (Figure 1) also demonstrates the flow paths of these resources and their application in actual management practices.

Figure 1: Theoretical Framework

RESEARCH METHODOLOGY

This study used a quantitative research design approach to investigate the relationship between internal resources and the service quality of the nursing homes. Quantitative research is widely applied in social science since it has the ability to systematically collect and analyze numerical data in quantifying relationships between variables (Creswell & Creswell, 2017).

The study used a survey as the main source of primary data to retrieve quantitative data about the relationship between internal resources and service quality in a nursing home. This survey was designed using the Tailored Design Method (Dillman et al., 2014) which stresses clarity, simplicity, and logical flow to improve the accuracy and consistency of the collected data. The survey consists of questions that relate to very important variables in the study, ranging from financial management, staff commitment, and management professionalism, among others. Each of the variables is measured using very well-structured quantitative items. In most instances, the Likert scales five-point were used in the survey to ensure statistical analysis and standardization of the data. A small pilot test of the preliminary survey was also conducted to judge its feasibility and clarity. Necessary amendments were made according to the result of this pilot test so that the final survey could be successful in capturing the required data (Dillman et al., 2014).

The survey targets two major groups in the process of data collection which consist of nursing home managers and staffs. They are important stakeholders in the operation and quality management of the nursing homes. In an effort to maximize the coverage of the respondents, the survey was sent through mail and email. The online platform increased the efficiency in data collection, whereas the paper method provided access for people who may not have frequent use of the internet. Dillman et al. (2014) also noted effective strategies in the distribution of the surveys and sending of reminders at the same time as a technique that would boost the response rates. From here, the current research made numerous reminder mechanisms following the distribution of the questionnaire to motivate the participants to respond. Such efforts will collect a representative amount of high-quality data and give firm support empirically toward the research (Fowler, 2014).

Research Sample

Shandong Province hosts approximately 1,000 nursing homes, spread across various cities and regions, providing a robust foundation for this research (Patton, 2015). This study targets nursing home managers and staffs in Shandong Province. However, the study only focused on three representative cities such as Jinan, Linyi, and Weihai by distributing 100 questionnaires for each city. Hence, 300 questionnaires were managed to be distributed to the respondents in total. As one of the most rapidly aging provinces in China, Shandong offers a rich array of nursing home resources, making it an ideal location for studying the relationship between nursing home management practices and service quality.

Data Analysis Methods

Following the descriptive analysis, regression analysis will be carried out to establish how independent variables like financial management, staff commitment and satisfaction, and management professionalism impact the dependent variable which is the service quality of nursing homes. Regression analysis actually allows estimation of the effects of these internal resources on service quality; however, it enables testing of the hypotheses of research for significance. Tests of hypotheses, for example, t-tests and ANOVA, will be used to compare any observed differences between groups and whether they are significant enough to provide strong support for the study’s conclusions (Pallant, 2020). SPSS is considered a popular software program for statistical analysis and used to process data in a way that is accurate and reliable.

Reliability and Validity

In this respect, in a quantitative study that measures the relationship between internal resources and service quality in nursing homes, assurance of the reliability of research instruments has to be made. Reliability implies consistency and stability of the results of measurements. In the present study, Cronbach’s Alpha coefficient will be used to assess the internal consistency of the questionnaire. One of the most popular coefficients in the social sciences is Cronbach’s Alpha. A value above 0.7 suffices for studies in the field of the social sciences (Kimberlin & Winterstein, 2008). Further, for better reliability of the questionnaire, after initial design, a pilot test was done with the collection of preliminary data to check internal consistency. The questionnaires were revised based on the received feedback to ensure their stability across contexts and therefore increase the level of credibility of the results of the research.

With respect to validity, the current study is conducted to know if the questionnaire can validly measure the association between internal resources and service quality of nursing homes. Content validity was established through the several scrutinies of experts in the management and care of nursing homes to make each question conformed to the very meaning of the questions in the current research study (Golafshani, 2003). Further, factor analysis was conducted for construct validity to ensure that the measurement of the constructs was in line with theoretical expectations. Factor analysis identifies underlying variable structures from within the questionnaire in a manner such that the latter captures well the influence of the key resources on service quality in management practices of nursing homes. These checks are aimed at ensuring the truthfulness of the instrument in measuring research—an empirical basis on which to explore enhancement strategies toward quality services in nursing homes.

Ethical Considerations

The consideration of ethics in this study will be a principal avenue toward ensuring that the entire research process is carried out according to ethical standards and respects participant rights. First, the research will fully comply with the principle of informed consent. Before responding to the questionnaire, all participants will be given a full account concerning the purposes of the study, their rights as participants, the nature of how the data will be used, and any potential risks and benefits that might result from participation. The respondents will only continue with the questionnaire after they have understood and agreed with these conditions (Bryman, 2016). In this manner, it is a means through which the approach secures consent truly voluntarily and assures participants that they are well informed in relation to the nature of the research to be carried out prior to their entering it.

The current study also practices strict measures in maintaining the privacy and confidentiality of participants in the study. The information gained will remain anonymous, without any form of personal identifying information attached to it. Such data will be used for this study alone and will not be shared for any other use (Israel & Hay, 2006). Thus, encryption technologies and secure storage systems will be used for data storage and processing to ensure that there is no unauthorized access or data breach. In general, the whole process of research is done in a very ethical manner and reduces possible risks for the participants. Thus, the study maintains guidelines of conduction in an ethical manner of research that ensures protecting rights and data of the participants, with transparency and integrity of the research.

FINDINGS AND ANALYSIS

This chapter presents the analysis of data collected to explore the relationship between internal resources and service quality in nursing homes. The data was gathered through an online structured questionnaire designed to align with the study’s objectives. A total of 300 valid responses were collected, achieving a response rate of 100%, providing a strong foundation for the subsequent data analysis. The analysis was conducted using SPSS software, employing descriptive statistics and other relevant analytical techniques.

In the following sections, the data is organized thematically, beginning with the demographic characteristics of the respondents, followed by an in-depth exploration of the relationships between financial management, staff commitment, and management team professionalism, and their impact on service quality in nursing homes. The findings are presented in both thematic discussions and statistical tables, offering a comprehensive understanding of how these internal resources influence the quality of services provided. The results of this analysis will offer empirical support for improving management practices in nursing homes and provide actionable insights for enhancing service quality.

Demographic Profiles

In gathering demographic information for the participants of this study, several factors were taken into consideration, including their position, the city where their nursing home is located, and their years of experience in the nursing home industry. The following demographic data is presented in Tables 1 to 3, which provide a detailed breakdown of these variables and set the stage for exploring how these factors might influence service quality and management practices in nursing homes.

Position

Table 1: Distribution of Respondents by Position

Category	Frequency	%
Nursing Home Managers	113	38%
Nursing Staff	156	52%
Others	31	10%

The majority of respondents are nursing staff, which is expected given that they typically constitute the largest workforce in nursing homes. A significant portion of respondents are managers, highlighting the critical role of management in the operation of nursing homes. The “Others” category includes administrative staff, technical support, and other roles, which, while smaller in number, are essential for the overall functionality of the institutions.

City of the Nursing Home

Table 2: Distribution of Respondents by City

Category	Frequency	%
Jinan	104	35%
Linyi	90	30%
Weihai	106	35%

The data shows a relatively balanced distribution of respondents across the three cities, with a slightly higher number from Weihai. Weihai, known as a tourist city, attracts a significant elderly population, which might explain the higher participation rate from this area. Jinan, as the provincial capital, also has a substantial proportion of respondents, reflecting its well-established elder care system. Linyi, while slightly lower in representation, remains significant due to its large population and corresponding demand for elder care services.

Years of Experience

Table 3: Distribution of Respondents by Years of Experience

Category	Frequency	%
Less than 1 year	52	17%
1-3 years	73	24%
3-5 years	95	32%
More than 5 years	80	27%

The distribution of experience levels among respondents indicates that over half have more than 3 years of experience, suggesting a deep understanding of nursing home operations and management. The largest group, those with 3-5 years of experience, represents 33% of the respondents, indicating that many are at a crucial stage in their career development. The balanced distribution across different experience levels contributes to the reliability and depth of the insights derived from the data.

Descriptive Statistical Analysis

The following section focuses on the descriptive analysis of the selected variables in this study, which include the independent variables such as Financial Management, Staff Commitment, and Management Team Professionalism, as well as the dependent variable, Nursing Home Service Quality. These variables are expected to have either a positive or negative impact on the dependent variable, which in this study is Nursing Home Service Quality.

The mean scores and standard deviations were calculated to identify the distribution and central tendency of the responses. This data is essential in understanding how each item in the variables influences both the independent and dependent variables. Respondents were asked to rate each item on a scale of 1 to 5, with 1 indicating the lowest level of agreement and 5 indicating the highest.

Financial Management

Table 4: Descriptive Statistics of Financial Management Variables

Items	Mean	SD
1. Financial management system operates effectively.	3.31	1.050
2. Financial management ensures long-term sustainability.	3.83	0.940
3. Allocation of financial resources positively impacts service quality.	3.39	0.930
4. Diversified funding sources stabilize operations.	3.71	0.920
5. Effectively manage and allocate budget for daily needs.	3.40	0.940
6. Financial management is transparent with regular reporting.	3.86	0.930

Six items were used to measure the extent of financial management in nursing homes. Table 4 shows that respondents generally recognize the importance of financial management in nursing home operations. Item 6: The transparency of financial management is high, with regular reporting to relevant personnel, received the highest score (M=3.86, SD=0.930), indicating that transparency in financial management has a positive impact on operations. Item 2: Financial management ensures the long-term sustainability of the nursing home, with a score of (M=3.83, SD=0.940), was also widely acknowledged. Item 4: The diversification of funding sources helps stabilize operations, with a score of (M=3.71, SD=0.920), highlights the importance of diversified funding. Item 5: We effectively manage and allocate the budget to meet daily operational needs, scored (M=3.40, SD=0.940), though variations in budget execution among different nursing homes led to a higher standard deviation. Item 3: The allocation of financial resources positively impacts service quality, scored (M=3.39, SD=0.930), reflecting some disagreement on this point. Lastly, Item 1: The financial management system in our nursing home operates effectively, scored (M=3.31, SD=1.050), with the higher standard deviation suggesting differences in management systems among nursing homes. Overall, financial management plays a crucial role in enhancing service quality and ensuring operational stability in nursing homes, though there is still room for improvement in the effectiveness of financial management systems and budget management.

Staff commitment and job satisfaction

Table 5: Staff commitment and job satisfaction Descriptive Statistics

Items	Mean	SD
1. Satisfied with work.	3.58	0.943
2. Committed to elder care long term.	3.26	0.970
3. Provides good career opportunities.	3.66	0.912
4. Work is recognized and supported.	3.66	0.832
5. Recommend others to work here.	3.81	0.967
6. Positive work environment.	3.70	0.901

Six items were used to measure the level of staff commitment in nursing homes. Table 5 shows that respondents generally rated staff commitment highly. Item 5: Recommend others to work here received the highest score (M=3.81, SD=0.967), indicating that most staff are willing to recommend the nursing home to others. Item 3: Provides good career opportunities and Item 4: Work is recognized and supported both scored well (M=3.66, SD=0.912) and (M=3.66, SD=0.823), respectively, showing that staff are satisfied with career development and recognition. Item 1: Satisfied with work had a score of (M=3.58, SD=0.943), reflecting overall satisfaction with work. Item 2: Committed to elder care long term scored lower at (M=3.26, SD=0.970), but still within the positive range. Item 6: Positive work environment scored (M=3.70, SD=0.901), indicating a generally favorable view of the work environment. Overall, staff commitment plays a positive role in the work atmosphere and team stability in nursing homes.

Management Team Professionalism

Table 6: Management Team Professionalism Descriptive Statistics

Items	Mean	SD
1. Management team understands elder care industry.	3.22	0.909
2. Management handles operational challenges effectively.	3.40	0.945
3. Management considers staff opinions in decisions.	3.32	0.931
4. Management motivates employees to improve efficiency.	3.78	0.875
5. Management team responds quickly to issues.	3.05	0.874
6. Management supports continuous staff development.	3.50	0.950

Six items were used to measure the professionalism of the management team in nursing homes. Table 6 shows that respondents generally rated the professionalism of the management team highly. Item 4: Management motivates employees to improve efficiency, received the highest score (M=3.78, SD=0.875), indicating that the management team’s role in motivating employees is well-recognized. Item 2: Management handles operational challenges effectively and Item 3: Management considers staff opinions in decisions, scored (M=3.40, SD=0.945) and (M=3.32, SD=0.931) respectively, showing positive performance in operational management and staff involvement. Item 1: Management team understands elder care industry, scored (M=3.22, SD=0.909), reflecting some strength in industry knowledge. Item 5: Management team responds quickly to issues, scored (M=3.05, SD=0.874), though slightly lower, still within a positive range. Item 6: Management supports continuous staff development, scored (M=3.50, SD=0.950), further highlighting the management team’s role in supporting staff development. Overall, the professionalism of the management team plays a positive role in the operation and employee motivation within nursing homes.

Nursing Home Service Quality

Table 7: Revised Nursing Home Service Quality Descriptive Statistics

Items	Mean	SD
1. Nursing home provides high-quality services.	3.82	0.987
2. Elderly receive comprehensive care.	3.79	0.822
3. Environment and facilities improve service quality.	3.28	0.822
4. Nursing home has a strong reputation for service quality.	3.04	0.925
5. We regularly evaluate and improve service quality.	3.02	0.880
6. Elderly residents and their families are satisfied.	3.50	0.900

Six items were used to measure the quality of services in nursing homes. Table 7 shows that respondents generally rated the quality of nursing home services highly. Item 1: Nursing home provides high-quality services, received the highest score (M=3.82, SD=0.987), indicating that respondents generally believe the quality of services is high. Item 2: Elderly receive comprehensive care, scored (M=3.79, SD=0.822), further emphasizing the comprehensiveness of care provided by nursing homes. Item 3: Environment and facilities improve service quality, scored (M=3.28, SD=0.822), showing that while the environment and facilities contribute to improving service quality, the score is relatively lower. Item 4: Nursing home has a strong reputation for service quality and Item 5: We regularly evaluate and improve service quality, scored (M=3.04, SD=0.925) and (M=3.02, SD=0.880) respectively, suggesting there is room for improvement in continuously enhancing services and maintaining a strong reputation. Item 6: Elderly residents and their families are satisfied, scored (M=3.50, SD=0.900), reflecting a certain level of satisfaction with the services provided. Overall, while the quality of services in nursing homes is recognized by respondents, there is still room for improvement in specific areas, particularly in enhancing the environment and facilities and managing reputation.

Hypotheses Testing

A number of statistical methods, including Pearson’s correlation and multiple regression analysis, were utilized in order to verify the existence of a correlation between the dependent and independent variables. For the first hypothesis (H1), the values determined by Pearson’s correlation and multiple regression indicated a positive and statistically significant relationship between Financial Management and Nursing Home Service Quality (r = 0.512**; β = 0.410**; p < 0.01), as shown in Tables 8 and 9. As a result, H1 is supported. Similarly, the weights for Hypothesis 2 (H2) demonstrated a positive and statistically significant relationship between Staff Commitment and Nursing Home Service Quality (r = 0.467**; β = 0.385**; p < 0.01), as indicated in Tables 8 and 9. Consequently, H2 is also supported. In the same vein, the results obtained for Hypothesis 3 (H3) (r = 0.540**; β = 0.425**; p < 0.01) indicated a positive and statistically significant correlation between Management Team Professionalism and Nursing Home Service Quality. Therefore, H3 is confirmed.

Table 8: Pearson’s Correlation Analysis

Variables	1	2	3	4	5
1. Nursing Home Service Quality	–	.512**	.467**	.540**	.490**
2. Financial Management	.512**	–
3. Staff Commitment	.467**		–
4. Management Team Professionalism	.540**			–
5. Other Variable (if applicable)	.490**				–

Note: n=228. *,**Correlation is significant at the 0.05 and 0.01 levels (two-tailed), respectively. 

Table 9: Multiple Regression Analysis

Independent Variables	Dependent Variable: Nursing Home Service Quality
Financial Management	β = 0.410**
Staff Commitment	β = 0.385**
Management Team Professionalism	β = 0.425**
F-value	25.478**
R²	0.421
Adjusted R²	0.409

Note: **Correlation is significant at the 0.01 level (two-tailed).

CONCLUSION AND RECOMMENDATION

The study was based on empirical data from nursing homes in Shandong Province inclusive of Weihai, Jinan, and Linyi, explored the effects of financial management, staff commitment and satisfaction, and management team professionalism on the quality of nursing home services. A structured survey was designed to cover these three key variables, resulting in the collection of 228 valid responses. The focus was on understanding how these internal resource management factors operate within different city contexts and ultimately affect service quality of nursing homes in China. The survey was designed to comprehensively assess the transparency of financial management, the effectiveness of budget control, the rationality of resource allocation, the job satisfaction of staff commitment, alignment with organizational goals, as well as the professional knowledge level, strategic decision-making ability, and problem-solving capacity of management teams. After data collection, descriptive statistics, Pearson correlation analysis, and multiple regression analysis were used to systematically explore the relationships between these key variables and service quality, verifying their performance across different cities.

The data analysis results indicate a significant positive correlation between financial management and nursing home service quality (r = 0.512**; p < 0.01). In both economically developed Jinan and the more remote Linyi, effective financial management practices—especially transparency in fund management and the effectiveness of budget control—have been proven as key factors in improving nursing home service quality. This suggests that regardless of economic context, the effectiveness of financial management directly influences the overall operational efficiency and service quality of nursing homes.

Staff commitment and satisfaction also showed a significant positive correlation with service quality (r = 0.467**; p < 0.01). The study reveals that job satisfaction and alignment with organizational goals among staff are crucial factors in determining the quality of services in nursing homes. Particularly in cities like Weihai and Jinan, the level of staff commitment directly impacts resident satisfaction and the overall service level of the nursing homes. High levels of staff commitment not only enhance the consistency and stability of services but also improve service quality through increased enthusiasm and responsibility.

The professionalism of the management team significantly influences the improvement of service quality as well (r = 0.540**; p < 0.01). The strategic decision-making ability, professional knowledge, and problem-solving skills of management teams play crucial roles across nursing homes in different cities. In Jinan, a provincial capital, the decision-making power of the management team is particularly important for improving service quality, while in Weihai and Linyi, the leadership and execution capabilities of the management team are equally critical in maintaining high-quality services in complex environments.

Overall, this study, through empirical analysis of nursing homes in Weihai, Jinan, and Linyi, confirms the significant correlations between financial management, staff commitment, management team professionalism, and the quality of nursing home services. The findings clearly indicate that these internal resource management factors play crucial roles in enhancing service quality across different city contexts. By effectively managing and optimizing these resources, nursing homes can not only improve service levels but also gain a stronger competitive advantage, ensuring their sustained development in a rapidly changing environment.

Research Implications

Building on the empirical findings from the survey analysis, this section delves into the theoretical implications of the study. The results support and extend the Resource-Based View (RBV) theory, which posits that an organization’s internal resources are critical determinants of its competitive advantage. In the context of Chinese nursing homes, this study confirms that financial management, staff commitment, and management team professionalism play crucial roles in service quality. The positive correlation between financial management and service quality indicates that by ensuring transparency, efficient budget allocation, and effective cost control, nursing homes can leverage their financial resources to improve service delivery, thus gaining an edge in an increasingly competitive healthcare market. This finding underscores the necessity of prioritizing financial management as a core strategic function within nursing homes to maximize service outcomes. Moreover, the significant correlation between staff commitment and service quality highlights the critical role of human resources in the service industry. Employees who are highly committed to the organization are more likely to positively contribute to service quality, further validating the importance of investing in human capital through training, motivation, and engagement strategies. Therefore, nursing homes should focus on cultivating a strong organizational culture that fosters employee loyalty and dedication, thereby enhancing overall service quality.

The strong relationship between management team professionalism and service quality reaffirms the RBV perspective that leadership and management capabilities are vital resources for organizational success. Teams with high levels of professional knowledge and management skills can exhibit exceptional leadership in resource allocation, strategic planning, and execution, leading to comprehensive improvements in nursing home service quality. This finding suggests that nursing homes should invest in developing the professional skills of their management teams to ensure they can effectively navigate the complexities of the healthcare environment and drive continuous service improvement. In conclusion, the study’s findings provide robust empirical support for the application of the Resource-Based View in the context of nursing home service quality. By effectively managing financial, human, and managerial resources, nursing homes can significantly enhance their service quality, thereby achieving a competitive advantage. These insights offer valuable implications for both theory and practice, guiding future research and informing strategic management practices in the healthcare sector.

From a practical perspective, this study offers nursing home administrators new insights, particularly in optimizing resources and implementing strategic initiatives. First, the findings indicate that financial management has a direct and significant impact on service quality, emphasizing not only the transparency and efficiency of resource allocation but also the importance of long-term financial planning to ensure sustainable resource utilization and the ability to enhance service levels. Second, the positive impact of staff commitment on service quality suggests that human resource management strategies should focus not only on meeting the immediate needs of employees but also on aligning their long-term career development with institutional goals, fostering sustained employee loyalty and a sense of belonging. Administrators can enhance this by creating more motivating work environments, providing career development opportunities, and encouraging employee participation in decision-making. Finally, the professionalism of management teams is confirmed as crucial for improving service quality, which involves not only enhancing existing capabilities but also ensuring continuous learning and development within the management team. Administrators should ensure that their teams possess forward-thinking strategic insights and the ability to address complex challenges, achievable through regular training and cross-departmental collaboration.

Future Considerations

While this study provides valuable insights into the effects of financial management, staff commitment and satisfaction, and management professionalism on the service quality of nursing homes, its generalizability remains a limitation. The data were collected from three cities in Shandong Province, which may not fully represent nursing homes across China. Future research should consider expanding the geographic scope by including diverse regions with varying economic, cultural, and policy environments.

Additionally, longitudinal studies could provide a deeper understanding of how these independent variables influence service quality over time. Exploring potential moderating or mediating factors, such as government regulations, patient demographics, or technological advancements in elderly care, could further enrich the findings. By broadening the study’s scope and incorporating additional variables, future research can enhance the generalizability and applicability of these insights to nursing home management across China.

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