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

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4 Scopus citations


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 fndings 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 fndings may inform future research on facility- and corporate/executive-level leader interactions and how these interactions impact quality outcomes.

Original languageEnglish (US)
Pages (from-to)e281-e290
Issue number4
StatePublished - Jul 13 2018


  • Decision making
  • Leadership and management
  • Organizational and institutional issues
  • Quality improvement

ASJC Scopus subject areas

  • Gerontology
  • Geriatrics and Gerontology


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