RESUMEN
BACKGROUND: Leadership has a vital role regarding quality of care in nursing homes. However, few studies have explored upper-level managers' views on how to assure that residents receive high quality of care. Therefore, this study's aim was to examine how managers of top-quality nursing homes define, develop and maintain high-quality of care. METHOD: We used interpretive description, an inductive, qualitative approach. Our research included 13 semi-structured interviews with 19 managers. We analyzed their input using reflexive thematic analysis, which is an iterative approach. RESULTS: Quality development and maintenance are cyclic processes. Managers in high-performing nursing homes lead with high commitment towards a person-centred quality of care, creating appropriate working conditions and continuously co-creating a vision and the realization of quality of care together with employees. CONCLUSIONS: This study confirms that, in high-performing nursing homes, a person-centered approach-one where both residents and employees are at the center-is essential for quality development and maintenance. The most effective managers exemplify "person centeredness": they lead by example and promote quality-focused working conditions. Such strategies motivate employees to provide person-centered care. As this means focusing on residents' needs, it results in high care quality.
