Abstract
BackgroundInternationally, there are concerns about the quality of care in nursing homes. The concept of ‘corporate culture’ as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff’s perspective and to include how the residents describe quality of care.MethodsAn ethnographic design was employed. A purposive sample of four municipal public nursing homes in Norway with long-term care residents was included in the study. Data were collected by participant observation including informal conversation with the staff, and in-depth interviews with 15 residents using a narrative approach.ResultsThe main findings were that organizational cultures could be seen as relatively stable corporate cultures described as ‘personalities’ with characteristics that were common for all nursing homes (conformity) and typical traits that were present in some nursing homes, but that they were also like no other nursing home (distinctiveness). Conformity (‘Every nursing home is like all other nursing homes’) meant that nursing home organizations formed their services according to a perception of what residents in general need and expect. Trait (‘Every nursing home is like some other nursing homes’) expressed typologies of nursing homes: residency, medical, safeguard or family orientation. The distinctness of each nursing home (‘Every nursing home is like no other nursing home’) was expressed in unique features of the nursing home; the characteristics of the nursing home involved certain patterns of structure, cultural assumptions and interactions that were unique in each nursing home. Nursing home residents experienced quality of care as ‘The nursing home as my home’ and ‘Interpersonal care quality’. The resident group in the different types of nursing homes were unique, and the experience of quality of care seemed to depend on whether their unique needs and expectations were met or not.ConclusionIn order to create a sustainable nursing home service the service needs to be characterized by learning and openness to change and must actually implement practices that respond to the resident and his or her family’s values.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1171-y) contains supplementary material, which is available to authorized users.
Highlights
There are concerns about the quality of care in nursing homes
Every nursing home is like all other nursing homes This statement described how nursing home organizations developed their services according to a perception of what nursing home residents in general need and expect
New care staff who were still not aware of the norms in the culture threatened the understanding of what was important for quality of care from the staff’s point of view and as experienced by residents. This ethnographic study showed that the nursing homes had relatively stable corporate cultures described as ‘personalities’ with some characteristics that were common to all nursing homes and typical traits that were present in some nursing homes forming four typologies; residency oriented, medical oriented, safeguard oriented or family oriented
Summary
There are concerns about the quality of care in nursing homes. The concept of ‘corporate culture’ as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. With the shifting demographic towards an ageing population in Western societies, nursing homes will continue to be an essential service provided to individuals for the foreseeable future. Technical care quality can be defined as the extent to which the care provided maximizes the health benefits without increasing risk, a valuation that must be shared by the patient and the practitioner [5]. Three quality domains should be considered when judging total quality: structure quality, comprising quality of the structural factors that affect the performance of care; process quality, or the quality of the direct care that the staff provides; and outcome quality, encompassing the impact for the patient or health care service outcome for the population. A variety of factors affect the processes and structure quality, which again indirectly provide the results for the individual patient, or the outcome of the service offered [6]
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