Table 1 Description of the independent and dependent variables

Dependent variable

Coordination

Employee-perceived coordination

Employee questionnaire (investigator-developed)

8 items assessing how often in general:

1) relevant information is reported in a timely manner by other professionals,

2) client care activities are well aligned with other professionals,

3) there are duplicate and overlapping activities with other professionals,

4) no or no current prescriptions/ orders/ medication lists are available,

5) not all or not the right medications are available at a client’s home,

6) no one from the homecare team was involved at the discharge from an inpatient stay,

7) homecare employees do not feel sufficiently informed about a client’s condition (e.g., information is not available, only partially documented)

8) homecare employees receive important information about the client too late.

5-point Likert scale: 0 = never/almost never, 1 = rarely, 2 = sometimes, 3 = often 4 = very often for each item

Mean score over the 8 items:

Cronbach’s α: 0.81

p-value χ²: 0.00

SRMR: 0.05

CFI: 0.86

NFI: 0.82

Higher values mean higher or better coordination, reflecting less coordination problems

Independent variables

Explicit coordination mechanisms

Presence of standards / guidelines for selected procedures

Agency questionnaire (investigator-developed)

5 items asking if guidelines and/or standard operating procedures (SOPs) are available for the following topics:

1) Introduction of new employees

2) Admission of a client to homecare

3) Hospital admissions

4) Emergency situations

5) Medication management

Dichotomous answer option: Yes/No for each item

Sum score over the 5 items:

ranging from 0 = no SOPs at all to 5 = to all 5 topics an SOP

Range VIF: 1.0–2.2

Higher values mean more standard operating procedures (SOP) are available

Electronic data sharing possibilities

Agency questionnaire (investigator-developed)

1 item asking if electronic client documentation allows for electronic data exchange of health records with general practitioners

Dichotomous answer option: Yes/No

Used as dichotomous single item

Case responsible person/managers

Agency questionnaire (investigator-developed)

3 items asking about the allocation of specific case responsibilities and case managers:

1) If the agency works with defined reference nurses that perform all nursing activities from admission to discharge or with a defined reference nurse who is responsible for the entire nursing process for a specific client

2) If the agency works with assignment of case responsible nurses

3) If the agency has trained case managers or care managers

Dichotomous answer option: Yes/No for each item

Sum score over the 3 items:

ranging from 0 = no case responsibilities at all to 3 = strong emphasis on case management/responsibilities

Range VIF: 1.0–1.2

Higher values mean better established reference person system

Exchange vessels

Agency questionnaire (investigator-developed)

3 items assessing if the agency has established vessels for regular exchange:

1) If the agency conducts planned case discussions for complex clients within the homecare team

2) If the agency conducts planned interprofessional/interdisciplinary case discussions for complex clients

3) If handover reports for internal client information exchange are conducted by employees

Dichotomous answer option: Yes/No for each item

Sum score over the 3 items:

ranging from 0 = no regularly exchange vessels at all to 3 = all three exchange vessels in place

Range VIF: 1.0–1.2

Higher values mean higher number of regularly used exchange vessels in place

Communication

Employee questionnaire (adapted from the CPAT [31])

4 items of the CPAT scale assessing communication and information exchange:

1) Assessing if relevant information relating to changes in patient/client status or care plan is reported to the appropriate team member in a timely manner.

2) Assessing if clients’ concerns are addressed effectively through regular team meetings and discussion.

3) Assessing if the team has developed effective communication strategies to share patient/client treatment goals and outcomes of care.

4) Assessing if the patient/client health record is used effectively by all team members as a communication tool.

7-point Likert scale: 1 = disagree, 2 = mostly disagree, 3 = somewhat disagree, 4 = neither agree nor disagree, 5 = somewhat agree, 6 = mostly agree, 7 = strongly agree for each item

Mean score over the 4 items

Cronbach’s α: 0.83

p-value χ²: 0.00

SRMR: 0.01

CFI: 0.99

NFI: 0.98

The higher the values, the higher the agreement and the better the perceived communication and information exchange

Implicit coordination mechanisms

Knowledge of the health system

Employee questionnaire (investigator-developed and adapted from IBenC [32])

4 items addressing how well homecare employees know the health care services in their care region:

1) Available health or social service options

2) Requirements that clients must meet in order to take advantage of the services offered

3) The area of responsibility of the other professionals/health care providers

4) Legal requirements regarding financing of health care services

Each item 5-point Likert scale answer options: 5 = Very good, 4 = good, 3 = moderate, 2 = little, 1 = not at all

Mean score over the 4 items

Cronbach’s α: 0.86

p-value χ²: 0.976

SRMR: 0.001

CFI: 1.00

NFI: 1.00

The higher the values, the better employees rated their own knowledge of the health system

Possibility for continuous education

Agency questionnaire (investigator-developed)

3 items asking about which topics homecare agencies offer annual training for their employees (internal/external)

1) Interprofessionality and/or coordination

2) Health networks (local partners, offerings in region)

3) Legal requirements and regulations in homecare

Each item Dichotomous answer option: Yes/No

Sum score over the 3 items:

ranging from 0 = no annual training possibilities to 3 = in all three domains annual training possibilities

Range VIF: 1.0–1.1

The higher score meaning a higher number of training courses offered in relation to coordination

Role clarity

Employee questionnaire(COPSOQ [33, 34])

2 items of the COPSOQ asking about role clarity

1) are there clear objectives for your work?

2) do you know exactly which tasks fall within your area of responsibility?

5-point Likert scale: 4 = to a very high degree, 3 = to a high degree, 2 = in part, 1 = to a low degree, 0 = to a very low degree for each item

Mean score over the 2 items

Cronbach’s α: 0.70

The higher the values, the better role clarity is rated

Mutual respect & trust

Employee questionnaire (adapted from the CPAT [31])

2 items from the CPAT assessing mutual respect and trust

1) If employees trust the accuracy of information reported among team members.

2) If team meetings provide an open, comfortable, safe place to discuss concerns.

7-point Likert scale: 1 = disagree, 2 = mostly disagree, 3 = somewhat disagree, 4 = neither agree nor disagree, 5 = somewhat agree, 6 = mostly agree, 7 = strongly agree for each item

Mean score over the 2 items

Cronbach’s α: 0.56

The higher the values, the higher the mutual respect/trust and integrating conditions are rated

Accountability, predictability, common perspective

Employee questionnaire (adapted from the three Integrating Conditions scale [35])

4 items from the integrating condition scale assessing accountability, predictability and common perspective

1) If it is clear which members in your care team are responsible for completion of specific tasks. (accountability)

2) If in general the care team knows the steps necessary to address complicated situations when they arise (predictability)

3) If each member of the care team understands the steps required to complete their tasks. (predictability)

4) If the care team has a shared perspective of how each person’s work contributes to the overall goal (common perspective)

5-point Likert scale: 1 = strongly disagree, 2 = slightly disagree, 3 = neutral, 4 = slightly agree, 5 = strongly agree for each item

Mean score over the 4 items

Cronbach’s α: 0.85

p-value χ²: 0.00

SRMR: 0.02

CFI: 0.98

NFI: 0.94

The higher the values, the higher the accountability, predictability and common perspective rated

Homecare agency characteristics

Obligation to serve all clients

Agency questionnaire (adapted from Trageser, Gschwend [36])

1 item asking if the service agreement with the canton/municipalities includes the obligation to serve all clients

Dichotomous answer option: Yes/No

Used as dichotomous single item

Client characteristics

Agency questionnaire (adapted from Trageser, Gschwend [36])

1 item assessing the average care duration per client in 2020

Numeric answer option: average minutes per client

Used as numeric single item

Range of services provided

Agency questionnaire (adapted from SHURP [37])

5 items assessing if specific service offers are provided by the homecare agencies:

1) 24-hours care service,

2) Continuous night care,

3) Oncological care,

4) Palliative care,

5) Psychiatric care

Dichotomous answer options for items 1–5: Yes/No

Used as 5 dichotomous single items

Workforce

Agency questionnaire (adapted from SHURP [37])

1 item asking about the total employment percentage of the employees in the nursing and care sector at the end of the year 2020.

Numeric answer options: Working percentages of employees according to educational background

Proportion of RN (or higher educated) employment percentage compared to all employees in the nursing and care sector of the agency

Used as numeric single item. A higher value represents a higher proportion of RN employment percentage over all employees

Employee characteristics

Employee questionnaire (adapted from SHURP [37])

1 item asking homecare employees about the working percentages (percentage of full-time employment)

Numeric answer option: Employment percentage

Used as numeric single item

Higher values meaning higher working percentage

Employee questionnaire (adapted from SHURP [37])

1 item asking homecare employees about the years of experience in the homecare agency

Numeric answer option: years of experience

Used as numeric single item

Higher values meaning more years of experience in the homecare agency

Perceived staffing

Employee questionnaire (PES-NWI [38, 39])

3 items of the staffing and resource adequacy subscale of PES-NWI

4-point Likert scale: 1 = strongly disagree, 2 = slightly disagree, 3 = slightly agree, 4 = strongly agree for each item

Mean score over the 3 items

Cronbach’s alpha 0.65

Higher values indicating better staffing and resource adequacy

Perceived workload

Employee questionnaire (NASA task-load Index [40, 41])

6 items of the NASA task-load Index

Each item 20-point analog scale answer options: low to high

Mean score over the 6 items

Cronbach’s alpha 0.61

Higher values indicating higher perceived workload

Overtime

Employee questionnaire (adapted from RN4CAST [42] and SHURP [37])

1 item asking homecare employees how often they have to work overtime more than 30 min

5-point Likert scale answer option: 4 = Almost every shift, 3 = once every 2–4 working days, 2 = once every 5–7 working days, 1 = less frequently, 0 = never

Used as ordinal single item

Higher values indicating more working days with overtime

External factors

Reimbursement regulations of residual financing

Agency questionnaire (investigator-developed)

1 item asking on what basis the canton or municipality determined the residual financing of care costs for their agency.

Answers grouped in 4 categories:

1) Compensation of the effective full costs

2) Compensation of agency-specific and predefined costs

3) Use of standard costs, standard deficits, or maximum limits

4) others (e.g., compensation via a global budget)

Used as categorical single item

Client co-payment

Agency questionnaire (investigator-developed)

1 item asking how the amount of the patient co-payment is regulated in their canton

Answer grouped in 4 categories:

1) No patient co-payment (no payment from the client side)

2) Patient co-payment of a maximum of CHF 7.65 a day, which means that the increase can be up to 20% of the health insurance (HI) contribution or direct payment but is limited to CHF 7.65/day

3) Up to 20% of the HI contribution and upper limit of CHF 15.35/day

4) Direct contribution up to the upper limit of a maximum of CHF 15.35/day

Used as categorical single item