Navigating Leadership Challenges: Care Home Managers' and their Staffs' Experiences of Enabling Person-Centred Dementia Care, A Qualitative Study.

Abstract

Care home managers' leadership is widely recognised as shaping how staff provide care for people living with dementia. However, evidence remains limited on what enables managers to enact this role and sustain person-centred approaches within day-to-day care. This study explored managers and staffs' experiences of facilitating person-centred care using an interpretative phenomenological approach. Twenty participants (ten managers and ten staff) from ten care homes took part in online semi-structured interviews. Data were analysed using Colaizzi's seven-step method. Participants viewed managers as key enablers of person-centred care, yet described this role as constrained and not always achievable in practice. Organisational and regulatory demands such as staffing shortages, administrative burden, and limited autonomy were perceived as major barriers, shaping what staff and managers felt able to prioritise. Managers countered these pressures, by being visible and available to staff, encouraging open communication, using staff meetings and appraisals to address concerns, and supporting staff reporting of poor practice. Values-based recruitment, emphasising empathy and kindness over formal qualifications, were also described as central to sustaining person-centred practice. However, staff were often unaware of these leadership strategies, which were frequently experienced as workarounds rather than embedded organisational processes. Examples of person-centred care focused on supporting residents' choices in everyday routines and taking additional steps to understand individuals' backgrounds when information was limited. Peer learning groups were valued for reducing managerial isolation and promoting shared problem-solving, whereas online and mandatory training were widely seen as insufficient. Findings highlight a persistent tension between managers and staff aspirations for person-centred care and the realities of practice shaped by system pressures, risk management, and resource constraints. Sustaining culture change requires long term organisational commitment, context sensitive leadership development, and structural support that extends beyond individual managers' efforts.