title: Local interaction strategies and capacity for better care in nursing homes: a multiple case study.
abstract: BACKGROUND
  To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff.
  
  
  METHODS
  We conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases.
  
  
  RESULTS
  Participants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these 'local interaction strategies'. We categorized these two sets of local interaction strategies as the 'common pattern' and the 'positive pattern' and summarize the results in two models of local interaction.
  
  
  CONCLUSIONS
  The findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.
authors.affiliation: Duke University School of Nursing, DUMC 3322, Durham, NC 27710, USA. ruth.anderson@duke.edu.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Anderson
authors.forename: Mark P
authors.initials: MP
authors.lastname: Toles
authors.forename: Kirsten
authors.initials: K
authors.lastname: Corazzini
authors.forename: Reuben R
authors.initials: RR
authors.lastname: McDaniel
authors.forename: Cathleen
authors.initials: C
authors.lastname: Colón-Emeric
mesh_terms: D000328:Adult; D005260:Female; D006270:Health Facility Administrators; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008485:Medical Audit; D008503:Medical Staff / Q000458:organization & administration*; D008875:Middle Aged; D009657:North Carolina; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D058996:Quality Improvement; D000078329:Workforce; D055815:Young Adult