 Clinical trials have identified interventions that reduce adverse outcomes such as falls in nursing home NH residents but attempts to translate these into practice quality improvement QI techniques have not been successful. Using a complexity science framework, our previous RO1 showed that low connection, information flow, and cognitive diversity among NH staff explains quality of care for complex problems such as falls. Our pilot of Connect, a multi-component intervention that encourages staff to engage in network-building and use simple strategies to make new connections with others, enhance information flow, and use cognitive diversity, suggests that staff can improve the density and quality of their interactions. This 5-year study uses a prospective, cluster-randomized, outcome assessment blinded design, with NHs n16 randomized to either Connect and a falls QI program Connect Falls or QI alone Falls. About 800 residents and 576 staff will participate. Specific aims are to, in nursing homes: 1 Compare the impact of the Connect intervention plus a falls reduction QI intervention ConnectFalls to a falls reduction QI intervention Falls on fall risk reduction indicators orthostatic blood pressure, sensory impairment, footwear appropriateness, gait; assistive device; toileting needs, environment, and psychotropic medication; 2 Compare the impact of ConnectFalls to Falls alone on fall rates and injurious falls, and determine whether these are mediated by the change in fall risk reduction indicators; 3 Compare the impact of ConnectFalls to Falls alone on complexity science measures communication, participation in decision making, local interactions, safety climate, staff perceptions of quality and determine whether these mediate the impact on fall risk reduction indicators and fall rates and injurious falls. Cross-sectional observations of complexity science measures are taken at baseline, at 3 months, at 6 months, and at 9 months. Resident fall risk reduction indicators, fall rates, and injurious falls are measured for the 6 months prior to the first intervention and the 6 months after the final intervention is completed. Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within nursing homes, and to control for covariates associated with fall risk, including baseline facility fall rates and staff turnover rates. 