Journal Article

Quality Improvement in Nursing Homes: Alignment Among Leaders Across the Organizational Chart

Elena O Siegel, Debra Bakerjian and Leehu Zysberg

in The Gerontologist

Published on behalf of The Gerontological Society of America

Volume 58, issue 4, pages e281-e290
Published in print July 2018 | ISSN: 0016-9013
Published online June 2017 | e-ISSN: 1758-5341 | DOI: https://dx.doi.org/10.1093/geront/gnx054
Quality Improvement in Nursing Homes: Alignment Among Leaders Across the Organizational Chart

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  • Geriatric Medicine
  • Biological Sciences
  • Psychology
  • Care of the Elderly
  • Gerontology and Ageing

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Abstract

Background and Objectives

This article describes nursing home (NH) leaders’ involvement in quality improvement (QI) decisions, with an emphasis on the concept of alignment in QI decisions across leaders.

Research Design and Methods

We used a qualitative approach and semistructured interviews to collect data from a convenience sample of 39 NH leaders, including corporate/executive-level leaders and facility-level leaders. Thematic analysis was used to inductively capture key patterns in data.

Results

Variations in alignment emerged as a major theme to describe the interface and interaction among facility- and corporate/executive-level leaders around QI decision making and implementation of QI decisions. For this study, alignment refers to the extent of shared understanding, beliefs, motivations, and implied or explicit agreement among leaders in regards to: (a) goals, values, priorities, and expectations for quality or QI (and/or applicable resources); and (b) expectations for leaders to carry out QI decisions made by other leaders.

Discussion and Implications

This study offers new insights into the complexities associated with leadership alignment toward improving NH quality. The findings provide a glimpse into leaders’ involvement in QI based on their position on the facility’s organizational chart and extend our understanding of the centrality of the concept of alignment in promoting QI. These findings may inform future research on facility- and corporate/executive-level leader interactions and how these interactions impact quality outcomes.

Keywords: Decision making; Leadership and management; Organizational and institutional issues; Quality improvement

Journal Article.  7553 words.  Illustrated.

Subjects: Geriatric Medicine ; Biological Sciences ; Psychology ; Care of the Elderly ; Gerontology and Ageing

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