Nicholas Goodwin

Nursing 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.