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High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

This chapter focuses on critical thinking as a new, powerful, and specialized tool and technique for understanding and analyzing the subtle operations of the free enterprise capitalist market system and its ethics and morality. Everything in the world of consumers and market enterprise systems are determined by our supply–demand system that in turn are determined by our presumed limitless production–distribution and consumption (LDPC) systems. From a critical thinking viewpoint, we study the free enterprise capitalist system (FECS) as a dynamic, interconnected organic system and not as a discrete or compartmentalized body of disaggregate parts. Systems thinking with critical thinking calls for a shift of our mindset from seeing just parts to seeing the whole reality in its structured dynamic unity; both mandate that we see ourselves as active participators or partners of FECS and not as mere cogs in its wheels or as mere factors of its production processes. Critical thinking seeks to identify the “structures” that underlie complex situations in FECS with those that bring about high- versus low-leveraged changes in various versions of capitalism. Specifically, this chapter applies critical thinking to FECS as defined by its founder, Adam Smith, in 1776 to its fundamental and structural assumptions, and as supported or critiqued by serious scholars such as Karl Marx, Maynard Keynes, C. K. Prahalad and Allen Hammond (inclusive capitalism), John Mackey and Rajendra Sisodia (conscious capitalism), and others.