Charged with caring for frail and disabled elders, nursing homes are complex organizations that operate under high regulatory scrutiny and low public opinion. Despite efforts to improve, many nursing home residents receive poor care. By focusing on residents’ relationships, life experiences, abilities, and preferences, person-centered care represents an innovation in nursing home care. Because person-centered care requires organization-wide change, implementation can be challenging.
The purpose of this research is to apply innovation implementation theory to understand factors and conditions that help or hinder the implementation of person-centered care in nursing homes.
Data come from the Person-Centered Care Program conducted by the Carolinas Center for Medical Excellence. Eight nursing homes participated in the Person-Centered Care Program for 1 year. A multiple-case-study design and pattern-matching logic were employed to examine organizational factors associated with implementation effectiveness. Data sources included semistructured key informant interviews, archival documents, surveys, and expert rankings of nursing homes’ implementation effectiveness.
On the basis of this research, we suggest that effective implementation of organization-wide change in nursing homes is associated with high-quality management communications about the change, organizational readiness for change, and favorable perceptions from direct care providers about the priority of the innovation to the organization. Notably, neither the amount of training nor the financial resources dedicated to person-centered care were associated with implementation effectiveness.
Effective implementation of person-centered care in nursing homes is most likely when management follows through with plans as advertised, when leadership teams have confidence in their ability to meet goals for change, and when change fosters smooth operations in the daily routines of direct care providers.
Cherie A. Rosemond, PT, PhD, GCS, is Fellow, Institute on Aging, The University of North Carolina at Chapel Hill, Chapel Hill. E-mail: firstname.lastname@example.org.
Laura C. Hanson, MD, MPH, is Professor, Division of Geriatric Medicine and Center for Aging and Health, The University of North Carolina at Chapel Hill.
Susan T. Ennett, PhD, is Professor, Department of Health Behavior and Health Education, The University of North Carolina at Chapel Hill.
Anna P. Schenck, PhD, MPH, is Research Scientist, The Carolinas Center for Medical Excellence, Cary, North Carolina, and Associate Dean for Public Health Practice and Director, The Public Health Leadership Program, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill.
Bryan J. Weiner, PhD, is Professor, Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill.
This research was funded by the Centers for Medicare and Medicaid Services under contract 500-02-NC03.
The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.