ArticlesSharing Lessons From Successes Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing CrisesMartin, Nicky MPA, LNHA, QCP, CDP, IP; Frank, Barbara MPA; Farrell, David MSW, LNHA; Brady, Cathie MS; Dixon-Hall, Janice IP; Mueller, Jessica BA; Rantz, Marilyn PhD, RN, FAAN Author Information Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady). Correspondence: Nicky Martin, MPA, LNHA, QCP, CDP, IP, Sinclair School of Nursing, University of Missouri, 915 Hitt St, Columbia, MO 65212 ([email protected]). This project benefitted greatly from the input of all long-term care homes in Missouri, particularly those that completed a survey, which gave us the direction to identify the exemplar homes. The authors thank and appreciate participation of the following individuals: E. W. Thompson Health & Rehabilitation Center—Kristen West, Amanda Harris, Sara Miesner; Heritage Nursing Center—Skilled Nursing By Americare—Michelle Tolbert, Lisa Tucker; Independence Care Center of Perry County—Dana Korando, Casey Ellis; Luther Manor Retirement & Nursing Center—Tim Brooks, Heather Lohmeyer; NHC Healthcare, St Charles—Seth Peimann, Denise Benson, Daphne Bollinger; Parkview Health Care Facility—Tim Francka; Shelbina Villa—Kim Thompson, Ashley Arnett, Muriah Schuman; Spring Ridge—Assisted Living By Americare—Christina Bloomer; Springfield Rehab & Health Care Center—Troy Lacey; Villages of St Peters Memory Care—Debra Tappe, Carolyn Reagan. The authors are grateful to the QIPMO, Coaching, and ICAR teams for their support and coordination efforts from the beginning of this project: QIPMO team members—Wendy Boren, Katy Nguyen, Crystal Plank, Debbie Pool, and Melody Schrock; Coaching team members—Mark Francis and Libby Youse; ICAR team members—Shari Kist, Amy Moenning, and Sue Shumate. The authors are also grateful to their consultants, who were enormously helpful, B&F Consulting, and David Farrell. The authors appreciate the Missouri Department of Health and Senior Services for the financial support of the QIPMO and ICAR projects, grant nos. AOC19380271 and 49240, respectively. Finally, the authors express their sincere gratitude to all the nursing home residents, families, staff, and organizations that have battled tirelessly during this pandemic. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's website (www.jncqjournal.com). Accepted for publication: August 17, 2022 Early Access: September 26, 2022 Journal of Nursing Care Quality: January/March 2023 - Volume 38 - Issue 1 - p 19-25 doi: 10.1097/NCQ.0000000000000662 Buy SDC Metrics Abstract Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as “positive deviants” with regard to COVID-19 infections and staffing shortages. Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these “positive outliers.” A result-based educational program was designed to describe their actions and staff reactions. Results: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships; (2) positive presence and communication; and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs. © 2022 Wolters Kluwer Health, Inc. All rights reserved.