Assuring Quality in Nursing Homes: The Black Box of Administrative and Clinical Leadership-A Scoping Review

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Background and Objectives: Licensed nursing home administrators (NHA) and directors of nursing (DON) are responsible for nursing home quality and assuring optimal performance and job satisfaction/retention of their nursing home workforce. NHA/DON-focused studies have generated important foundational knowledge over the last three decades; yet, targeted research is needed to understand and apply the complexities of the black box of this top management team. This scoping review identifies, reviews, synthesizes, and maps the topical areas of research in NHA/DON positions in U.S. nursing homes. Research Design and Methods: We conducted searches of 5 databases, yielding 3,479 records; screening/review yielded 88 unique records. We used thematic analysis to code the primary foci of the studies and the variables associated with the concepts of interest. Results: Most papers (n = 40) focused on role characteristics, 23 examined approaches to management and leadership, 24 focused on perceptions about the role, and the remaining 12 examined role structure. The role-related themes linked to outcomes (n = 42), processes (n = 27), and structures (n = 30). Discussion and Implications: We highlight important gaps for future research and offer a call to action for research, policy, practice, and education collaborations to accelerate the rate of research and translate the findings into best practices for NHA/DON to lead and manage the nursing home workforce and build capacity to ensure person-centered, high-quality care. Based on foundational descriptive studies, it is time to use what is known to design and implement interventions that enhance the capacity of NHA/DON to improve the structures, processes, and outcomes of nursing homes.

Original languageEnglish (US)
Pages (from-to)E147-E162
Issue number4
StatePublished - Jun 1 2021


  • Administration
  • Donabedian
  • Long-term care
  • Management
  • Workforce issues

ASJC Scopus subject areas

  • Gerontology
  • Geriatrics and Gerontology


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