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Concern continues to be expressed about the persistence of poor quality care in some American nursing homes, despite a plethora of professional and legislative initiatives designed to raise standards. In this study of 164 nursing homes in Texas, the concept of 'complex adaptive systems' was used. This concept attempts to model the many forces which impact upon staff in any organisation, so as to understand more fully their actions, and hence promote those managerial strategies which improve performance. The results indicated that a more open communication style on the part of the director of nursing, with nurses being able to express their opinions without fear of retribution, was related to lower use of restraints, and a range of other beneficial outcomes for residents.