Abstract

Background: The Department of Health (DH) and Comic Relief have commissioned a multidisciplinary research team from the Faculty of Health at the University of East Anglia, University of Stirling, University of Worcester and Cardiff University, to explore the individual circumstances, organisational cultures and practices most likely to encourage or inhibit the provision of high quality care for older people living in care homes.

Objective: This presentation will examine early findings from the project, facilitating debate with an audience of international academics and policy makers . Study aims and rationale: This study is exploring the relationship between the organisation, management and delivery of care and the experience of care within residential settings. Practice experience suggests that care homes with very similar resources and demands can provide vastly different experiences of care, and equally that the same person working as a carer may work very differently in different care settings. In organisational studies, culture refers to assumptions, values and norms shared by and influencing how members of an organisation behave and interact. Organisational culture is therefore likely to play an important role in shaping the care experience. The research is designed both to provide new theoretical insights and answer important practical questions, namely: •W hat are the impacts of organisa3onal culture in residen3al and nursing homes on care delivery for older people, in terms of resident and staff experiences? •W hat are the links between organisa3onal cultures and care delivery for older people in residen3al care/nursing homes? •H ow do residents and staff impact on organisa3onal cultures in care/nursing homes?

Methods: The comparative case study design incorporates an element of participative research methodology. The study has been conducted in three phases. In the first phase we carried out interviews with key informants of current thinking on the care of older people, abuse and high quality care in institutional settings to provide a context for the sampling of cases. In the second phase a linked series of 12 case studies of care home settings is being carried out in Wales, England and Scotland. In each case study the PIECE-dem observational framework is carried out giving detailed information on the care of residents with high levels of complex needs. The analysis of this information is used to focus ethnographic data collection (interviews, observations, documents) in order to gather data on organisational culture in relation to care practices. This presentation is part of the third phase of final analysis and findings development.

Results: In a care home the built environment can signify unspoken norms and values. Conscious reflection is needed by care home staff to ensure that this does not constrain or limit practice. Shared vision and understanding of purpose and practices between staff and managers contribute to the development of a connected community. Such shared vision can be achieved in a range of ways. The ‘home’ is a social construction managing the projections of disparate stakeholders, and needs to balance these actively. Leadership should empower staff as effective individuals.

Slides