Understanding How Organizational Culture Shapes the Experience of Direct Support Professionals Who Work with People with Intellectual and Developmental Disabilities: A Meta-Synthesis

Background and Purpose: Direct support professionals (DSPs) are central to the quality of life of people with intellectual and developmental disabilities (IDD), yet high turnover rates significantly affect the quality and consistency of their services. Studies on DSP turnover have found that a supportive work environment, including fair wages and workload, is key to job retention and satisfaction. Given that DSPs are critically important to the people they support, further investigation on how organizational culture shapes the full experience of DSPs is warranted. To the author’ knowledge, this is the first meta-synthesis (i.e., systematic review in qualitative research) that integrates findings across individual qualitative studies and develops an overarching interpretation of the phenomenon to better inform research, policy, and practice.

Methods: This study utilized a meta-synthesis to understand how organizational culture shapes the experience of DSPs. The initial search identified 885 articles with relevant terms in six databases and two journal websites that were published from 2010 to 2023. Studies were included if they were (a) written in English, (b) focused on the lived experience of DSPs, (c) primary research, and (d) conducted using qualitative methods. After screening the titles and abstracts, 17 articles were selected for full-text review. Of the 17 articles, seven articles met all inclusion criteria and reported a substantial number of direct quotes from the participants. Using inductive thematic analysis, the author began with open coding and allowed the codes and themes to emerge during the integration and synthesis phase.

Results: The initial findings show that while DSPs across different countries perceived their work as worthy and rewarding, they did not feel valued or supported by the management both monetarily and professionally (e.g., low wages and minimal training). Oftentimes, the relationship between the DSPs and the management was hostile, due to conflicting expectations and a lack of communication. These tensions were apparent across all themes, and they were mostly indicative of a toxic work culture. After codebook development, data revealed an overarching theme with elements that were congruent with organizational justice within organizational culture literature. The findings suggest that DSPs react to fairness and justice perception through four different aspects of organizational justice: distributive justice (e.g., poorly compensated for the workload), procedural justice (e.g., no voice or a sense of process control), interactional justice (e.g., unfair interpersonal treatment by the authority), and relational justice (e.g., lack a sense of belonging).

Conclusion and Implications: This meta-synthesis revealed the collective experience of DSPs through organizational justice within an organizational culture framework. Understanding the experience through a justice perspective helps us predict variances in work attitude and behaviors as well as job retentions and turnovers. Notably, despite the differences in local culture and policies, the collective experience of DSPs across different countries was similar. The overall findings suggest that managing justice and fairness are critical to the longevity of DSPs and improvement of quality of life of people with IDD. Doing so requires a systemic commitment to create and foster a justice culture within direct support organizations.