• Joachim P Sturmberg, Len Gainsford, Dimity Pond, and Nicholas Goodwin.
• College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
• J Eval Clin Pract. 2024 Apr 1; 30 (3): 511520511-520.

AbstractNursing homes struggle to meet the needs of their residents as they become older and frailer, live with more complex co-morbidity, and are impacted by memory impairment and dementia. Moreover, the nursing home system is overwhelmed with significantly constraining organisational and regulatory demands that stand in the way of achieving resident-focused outcomes. These issues are compounded by the perceptions of poor working environments, poor remuneration, and poor satisfaction amongst staff. The system is beyond the state of 'reform' and requires a fundamental redesign based on first organisational systems understandings: a clearly defined purpose and goal, shared values, and system-wide agreed "simple (or operating) rules". A 'fit-for-purpose' future requires a complex adaptive nursing home system characterised by seamless 'bottom-up and top-down' information flows to ensure that the necessary 'work that needs to be done' is done, and a governance structure that focuses on quality improvement and holds the system accountable for the quality of care that is provided.© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.

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