Table 4.

CMO connectors and themes.

Connectors	Themes generated from stage 1 and stage 2 data
Trust: creating a safe space for participants to be vulnerable about their needs/knowledge, and building trust through partnership working	Vulnerability in the context of a safe space can enable meaningful education; internal policy (trust or lack of trust to make autonomous decisions); partnerships and relationships; lack of trust in hierarchies; decision-making (care home staff trust own judgement to make decisions instead of referring out).
Power: understanding how power is distributed within relationships; Needs Rounds facilitation will flatten any unequal power dynamics and empowering care home staff to have voice	Empowerment, brave space, partnership and collaboration, reciprocity, sensitive leadership, hierarchies, autonomy, decision-making, and expertise, voice (different voices and how these are heard), regulation (care homes not viewed as experts - Needs Rounds provides evidence), greater regulation based on funding type (e.g. more for publicly funded compared to privately funded residents), and care home type (e.g. if part of a chain can be more restrictive).
Communication: trust and more equal power dynamics can foster good communication; developing mechanisms to improve communication will be a key part of facilitation (eg a resource mechanism being an information sharing template, education around best practice in high quality on advance/anticipatory care planning, documentation and sharing	Decision-making, trust between professionals (across and within agencies), residents, and relatives; resident wishes realised; families feel more informed, involved, and secure in their relative's care.
Resident in their wider system: a whole system approach to improve care quality; care homes are operating within complex systems and focusing solely on the individual risks obfuscating the context	Voice (of residents and relatives); regulation and legal frameworks on decision-making; high quality systemically situated proactive anticipatory/advance care planning; relationships with other health/social care providers.