Assessing nursing homes' capacity to create and sustain improvement.

Nursing home leadership and staff in 32 nursing homes were surveyed using an adaptation of Shortell's Organization and Management Survey. An earlier psychometric assessment of Shortell's communication and leadership scales raised concerns about the reliability of these scales in the nursing home setting. Exploratory factor analysis was performed to determine if another scale structure should be considered. Using principal-axis extraction with a varimax rotation, a 5-factor solution that accounted for 47% of item variance was defined.