title: How organizational factors interact to influence the quality of care of older people in the care home sector.
abstract: OBJECTIVE
  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.
authors.affiliation: Lecturer in Occupational Therapy, School of Allied Health Professions, University of East Anglia, UK a.killett@uea.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Killett
authors.affiliation: Senior Lecturer in Organisation Studies, University of Manchester, Manchester Business School, UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Hyde
authors.affiliation: Lecturer in Human Resource Management and Organisational Behaviour, The University of Sheffield, University of Sheffield Management School, UK.
authors.forename: Diane
authors.initials: D
authors.lastname: Burns
authors.affiliation: Professor of Mental Health, UWE, Bristol, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.affiliation: Senior Lecturer in Health and Society, University of East Anglia, School of Allied Health Professions, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Poland
mesh_terms: D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D017149:Private Sector; D011787:Quality of Health Care
keywords: elder care; organizational dynamics; participatory research