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Cesagen · Research

Care Home Organisations Implementing Cultures for Excellence (CHOICE)

Martin O'Neill

Start date


Affiliated staff

Win Tadd

Funded by

Study funded by Department of Health and Comic Relief


Positive public messages about institutional care are rare with a perception that mistreatment is commonplace, but providing robust research evidence in this field raises challenges of definitions and obtaining robust data. From the small amount of research into mistreatment in institutional settings some indicators, markers and risk factors have been identified. Commonly occurring organizational features associated with reduction in care quality have been identified. Both concrete behaviours and subjective experiences of residents are important in understanding the prevalence of mistreatment and experiences need to be understood in the context of reasonable expectations of trustworthiness in relationships.


The study will analyse positive and negative care experiences in relation to the contexts, cultures and factors that positively or negatively pre-dispose to their occurrence through:/p>

  • Examining the experience of residents with particularly complex care needs and vulnerability in order to highlight key practices implicated in positive and negative experiences.
  • Determining the individual circumstances, organisational cultures and practices most likely to encourage, or inhibit, the provision of high quality of care for older people living in care homes.
  • Analysing the relationship between experience of care and frequency of existing measurable indicators of quality (e.g. inspection reports, complaints, safe-guarding issues).
  • Identifying examples of empowering practice.


  • In-depth case studies of care homes to examine a UK-wide cross-section of providers.
  • Participative research methods using comparative case study design to integrate specifically developed methods to examine the positive and negative experiences of institutional care as an integrated part of organisational culture.

Case study plan:

  1. Structured observation of care of residents with complex needs to set focus for:
  2. In-depth qualitative ethnographic observation and interviews examining organisational culture in relation to good care/mistreatment.
  3. Measurement of quantifiable key indicators of quality.
  4. Cross-case analysis 

Further information

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