How organizational factors interact to influence the quality of care of older people in the care home sector

Anne Killett, Paula Hyde, Diane Burns, Richard Gray, Fiona Poland

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Objectives: To examine how organizational factors affect good care and mistreatment of older people in care homes.
Methods: Eight residential care homes for older people (including private sector, local authority and NHS providers)
took part in a participatory observation-based study of organizational factors affecting care quality.
Results: Grouping organizational factors into infrastructure, management and procedures, staffing, resident population
characteristics and culture, we show the context-sensitive nature of interactions between these factors. These interactions
could enhance care quality where factors combined positively. Conversely, they could amplify difficulties where
one factor came to undermine another, thereby limiting care quality.
Conclusions: This analysis provides empirical insights into how and why similar sector-wide changes to care provision
have differential effects at the care home level. It indicates the situated and unpredictable ways in which organizational
factors interact, implying the need for locally contextualized quality assessment and improvement actions.
Original languageEnglish
Pages (from-to)14-22
Number of pages9
JournalJournal of Health Services Research and Policy
Issue numberS1
Publication statusPublished - Apr 2013


  • elder care, organizational dynamics, participatory research

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