Staff-perceived Conflict between Resident-centered Care and Quality in the Skilled Nursing Facility: Are Both Possible?

ABSTRACTObjectives: The purpose of this study was to understand if and how VA nursing home (CLC) staff experience difficulty in providing care that is both resident-centered (RCC) and concordant with quality standards.Methods: Twelve VA CLCs were selected for site visits, stratified based on rankings on a composite quality measure (calculated from various indicators) and RCC progress (based on a culture change tool). Staff were interviewed about efforts and barriers to achieving goals in RCC and quality, and the interview transcripts systematically analyzed for themes.Results: We interviewed 141 participants, including senior leaders, middle managers, and front-line staff. An emergent theme was conflict between RCC and quality, although participants varied in their perceptions of its impact. Participants perceived three conflict types: 1) between resident preferences and medically-indicated actions; 2) between resident preferences and the needs or safety of others; and 3) limits of staff time or authority...