Nursing home managers' descriptions of multi-level barriers to leading person-centred care: A content analysis

Research suggests that person-centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person-centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person-centred care.

To explore barriers to leading person-centred care as narrated by nursing home managers.

A descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person-centred nursing homes. Data were analysed using content analysis.

Multi-level barriers to leading person-centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers.

Multi-level barriers influence nursing home managers' ability to lead and promote person-centred care. Promoting the development of person-centred practices requires efforts to eliminate barriers on person, team and organisational level.

Identifying and overcoming barriers at various levels in nursing home care has the potential to promote person-centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person-centred practices. Multi-level strategies are needed to target challenges at person-, team- and organisational level when striving to develop person-centred care.