Table 4. Determinants coded to the inner setting domain.

Construct	Determinant
Structural Characteristics	Continuing care retirement community [71, 92, 93] County medical care facility [106] Facility certification status [36] Facility certification type [78, 87] Facility provides skilled/specialist services [36, 62, 71, 80, 82, 91, 92, 95, 110, 115–117] For-profit facility [13, 16, 32, 35, 36, 45, 47–52, 54, 57–65, 71, 72, 74, 76, 80–87, 90–93, 95, 103, 104, 106, 108, 113, 115–123] Geographic location [13, 40, 45, 54, 61, 64, 79, 85, 87, 92, 94, 106, 117, 124, 125] Government-owned nursing home without a shared owner in hospital referral region [93] Higher number of years of facility in operation [45, 53, 93, 110, 115] Hospital-based facility [14, 16, 36, 61, 62, 71, 74, 78, 91, 93, 95, 104, 106, 126] Hospital participating in a clinical surgery registry [105] Larger size facility [13, 14, 16, 34–37, 45–47, 49–52, 54, 57–64, 71, 72, 74, 77, 78, 80–83, 85–87, 91–97, 105, 106, 108, 113, 114, 116–118, 120–124, 126–128] Level-1 trauma centre [105] Major teaching hospital [105] Model of ownership [62, 77, 78, 92, 96, 97, 107, 123, 126, 129, 130] Number of years organisation has engaged with accreditation [121] Nursing home co-location [127] Nursing home located near psychiatric hospital [102] Nursing home participating in community nursing home programme [111] Nursing home with shared owner of another nursing home in hospital referral region [93] Nursing home with specialist registration [110] Revenue source [78] Safety-net hospital status [105] “social workers and admission coordinators [in poorly-performing nursing homes as measured by compliance] were instructed to fill beds with Medicare residents before accepting Medicaid residents” [131]
Networks & Communications	Chain membership [13, 47, 49–52, 54, 58–63, 74, 76, 80, 82, 90, 92–96, 104, 106, 108, 113, 116, 122, 123, 132] Higher facility consultation with families [52, 76, 90, 116] Higher facility consultation with residents [71, 90, 116] Higher staff meeting frequency [133, 134] Higher use of information technology [81, 124, 134–136] Notification method for residents with potential infection [133] Nursing home has resident/family council [93] Nursing home is associated with other compliant facilities [137] Nursing homes that use a satisfaction survey [138] Process standardisation across chain [94] “In the historically high-performing nursing homes (NH1 and NH2), administrative and direct care staff used multiple modes of communication to care for residents and their families” [131] “In both homes, the flow of information, both hierarchically and laterally, was important to meeting resident needs quickly and thoroughly” [131] “In the low-performing nursing homes (NH3 and NH4), the conflicting message regarding the organizational mission, that is, the explicit (resident care) versus the implicit (economic viability and regulatory compliance), fragmented and confused staff” [131] “Problem resolution resulted in the creation of new forms, additional steps, problem intensification, and communication breakdown within and across disciplines and departments” [131]
Culture	Changing from non-profit to for-profit facility [139] Higher culture change focus [140, 141] Higher focus on reducing hospitalisation [133] Higher focus on patient-centred care [103, 108, 142, 143] Nursing home strategic focus [144] Organisational disposition towards regulation [41, 137]
Implementation Climate
Tension for Change	More strict enforcement [53, 93, 115, 145–148] “participants expressed an awareness of the pressure they feel to reduce the overall reported rate to fulfill regulatory requirements and maintain or improve their star rating via the CMS public-reporting system to denote nursing home care quality” [149]
Compatibility	“The powerplan was stressed as the key to correct documentation and thereby improved compliance with the metric” “a coordinated, and inevitably, standardized approach to treating sepsis based on both policy requirements and clinical expertise. They also produce the documentation necessary for meeting and reporting on regulatory sepsis metrics” [18]
Relative Priority	Provider concern about regulatory enforcement [45]
Organizational Incentives & Rewards	No studies
Goals & Feedback	No studies
Learning Climate	“Staff across and within all disciplines [in high-performing nursing homes as measured by compliance] were involved in problem solving and decision making; staff were reminded that decision making and creativity improved with multiple perspectives” [131]
Readiness for Implementation	No studies
Leadership Engagement	Accredited facility [105, 118, 150–152] Higher ownership turnover [84] Receipt of a quality award [153] “In the high-performing homes, the leadership behaviors of the NHA and the DON created a clear, explicit, and coherent mission, a strong sense of purpose, for the organization….The importance of leadership relationship behaviors and the congruence of the stated and lived mission of the home were strikingly different between high- and low-performing homes” [131]
Available Resources	No studies
Access to Knowledge & Information	No studies
Other	Staffing Higher administrative staffing [14, 54] Higher agency/contract staff levels [46, 143, 154, 155] Higher degree of nursing centralisation in a nursing home [36] Higher food-service staffing [156] Higher housekeeping staffing [14, 156] Higher infection control professional quality [134] Higher job satisfaction [157] Higher level of certified medication aide staffing [158] Higher level of staff training [91, 94, 110, 116, 133] Higher level of trainee nurse aides [158] Higher licensed practitioner/vocational nurse staffing [14, 47, 49–51, 54, 57–61, 63, 77, 81, 82, 93, 95, 108, 114, 123, 143, 156, 158] Higher nurse aide absenteeism [132] Higher nurse aide staffing [14, 15, 34, 36, 47, 49–51, 54, 57–61, 63, 81, 82, 93, 95, 108, 114, 123, 126, 127, 143, 156, 158, 159] Higher ratings for work effectiveness and practice environments in nursing homes [108, 120] Higher ratio of registered nurses as against other nurse and care staff [35, 57, 59, 97, 109, 113, 143, 160] Higher registered nurse staffing [14, 15, 35, 49–51, 54, 58, 59, 61, 63, 66, 93, 95, 96, 107–109, 113, 114, 122, 123, 127, 143, 154, 156, 158, 159, 161] Higher social services director caseload level [84] Higher specialist staffing [14, 34, 36, 57, 91, 116, 156, 162] Higher staff turnover [35, 52, 54, 76, 97, 133, 134, 143, 154, 160, 163–169] Higher staff workload [84, 133] Higher total nursing staff [35, 36, 47, 57, 60, 61, 72, 81, 83, 105, 107, 126, 158, 161, 164] Higher total staffing [52, 91, 94, 116, 122, 154] Nursing home meeting minimum staffing standard [60, 161] “Administrative leadership behaviors that fostered staff appreciation included routine practices such as having adequate staffing levels and resources to do the job (e.g., resident lifts); helping out on the floor by making beds, passing meal trays, and assisting residents when needed” [131] Financial Facilities that provided finances training, meetings or expert consultation related to infection control [133] Higher facility costs [64, 76, 82, 97, 106, 130, 170–173] Higher facility income [52, 64, 110, 172] Higher facility market share [174] Higher facility profitability [13, 51, 97, 175, 176] Higher staff salary levels [128] Higher proportion of private payers [62, 97, 116] Higher proportions of publicly-funded service-users [13, 14, 16, 35, 36, 46–52, 54, 57–59, 61, 62, 64, 66, 76, 77, 80, 82, 86, 87, 90–92, 95, 97, 104, 106, 107, 109, 110, 113, 114, 116] Admissions Accepts Medicaid admissions [35, 71, 80, 83, 115] Accepts Medicare admissions [71, 104] Higher admission rate [82, 96] Hospitals accepting critical access or rural referrals [86] Higher occupancy levels [16, 46, 47, 49–51, 54, 55, 57–61, 63–65, 82, 90–93, 95, 106, 110, 113, 119, 126, 154] Ownership Recently-acquired nursing homes [93, 177] Poor quality nursing homes that were acquired by a chain [177] Higher quality of acquiring nursing home chain [177] Infection control Additional job responsibilities for infection control staff Participation in infection control collaborative [133, 134] Types of resources used to determine and treat infection [133] Chains Physical plant standardisation across a nursing home chain [94]