Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the 'right' leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.KEY WORDS -residential care, nursing homes, culture, quality of care, dementia.

This paper advances participatory methods in management research. We propose the term participatory organizational research to describe this adjunct to action research. We illustrate the potential of the method to allow sometimes unheard organizational members to generate alternative perspectives that can offer the potential for the co-production of new forms of knowledge that are locally relevant. Participatory methods originate from work with marginalized groups and have been used more commonly in community and organizational development. The aim of such research is, generally, to change the social and organizational conditions within which participants operate by using their perspectives as active participants to develop alternative possibilities. As such, this research method has significant potential for management researchers in providing the means for unheard organizational members to voice their perspectives: a central component, we argue, in knowledge co-production. Based on a participatory study of care quality in elder care institutions, we examine in detail how participatory organizational research can enable voice and explore some of the structural limitations particularly in respect of research ethics

Key Points Question Did the delivery of services within a cancer system change during the first year of the COVID-19 pandemic? Findings This population-based cohort study conducted in Ontario, Canada, found a total of 4 476 693 cancer care services during the first year of the COVID-19 pandemic, compared with 5 644 105 services in the year prior, representing a reduction of 20.7% and suggesting a backlog of 1 167 412 cancer services during the first pandemic year. Limited change was observed in systemic treatments and emergency or urgent imaging examinations and surgical procedures, while major reductions were observed in cancer screening tests, biopsies, surgical treatments, and new consultations for systemic and radiation treatment. Meaning These findings provide evidence on the deficits in cancer care that occurred during the first year of the COVID-19 pandemic that are likely to inform continued delivery of care, recovery, and future pandemic planning.

For organizational ethnography we argue that traditional philosophies of onto-epistemological realism be supplanted by interpretive and reflexive thinking to provide fresh theoretical assumptions and new methodological proposals for film-and video-based research. The argument is developed in three phases: First, to establish analytical context, we explore the historical evolution of the ethnographic organizational documentary and discuss habitual problems -methodological, philosophical and technical -filmmakers have faced when claiming qualities of directness and objectivity in their work; that is, through the style of 'film-truth'. Second, to advance new conceptual logic for video-based organizational research, we supplant the objectivist and realist philosophy underpinning traditional documentary filmmaking with sociologically interpretive and reflexive arguments for undertaking ethnography in organizations, a subjective process which importantly yields greater understanding of affect and embodiment. Finally, to define new methodological opportunities, these interpretive and reflexive arguments are marshalled to underpin a strategy of participatory thinking in video-based organizational ethnography -a 'withness' approach facilitating a greater sense of affect and embodiment as well as polyvocal interpretation of visual data; a practice which sees filmmakers, social theorists, participants, and viewers alike united in analytical space.

Institutional abuse is a global issue, sometimes ascribed to the behaviour of a few wicked people. It persists despite regulatory measures, interventions from enforcement and protection agencies, organisational policies and procedures. Therefore, the accurate recognition and early detection of abuse and taking corresponding steps to deal with perpetrators are critical elements in protecting vulnerable people who live in institutions. However, research is less clear about why and how abuse (re)occurs. Using the tame and wicked problem analysis of Rittell and Webber (1973) as a lens, we examine the ways institutional abuse is formulated in care settings. Drawing on case study data from eight care homes for older people, we show how solutions seeking to reduce institutional abuse and improve care quality can cause additional problems. The article reconceptualises institutional abuse through the lens of wicked problem analysis to illustrate the multifaceted and recurring, wicked problem characteristics of residential care provision.

Based on case studies in 12 nursing homes in the United Kingdom, the authors illustrate how financial cutbacks affect job quality and the quality of care. The dimensions of job quality that suffered most were those directly related to the ability of workers to provide care: reductions in staffing, longer working hours, and work intensification. Cuts to labor costs eroded the quality of workers' jobs in all 12 homes but with two differential outcomes: in seven homes, care quality was maintained, and in five homes, it deteriorated. Care quality was maintained in homes where a patient-centered care approach and remaining job quality allowed workers to develop work-arounds to protect residents from spillover effects. Care quality declined in homes where custodial approaches to care and low job quality did not provide workers the time or resources to protect residents or to maintain prior levels of care. A tipping point was reached, leading to a spillover into impoverished care. W orries about the quality of residential elder care are a global concern (OECD 2013). As the number of residents in nursing homes 1 has increased dramatically in recent decades-and will double in the next 40 years (European Commission 2008)-a key challenge is the provision of

This survey was a first attempt to estimate the use of antipsychotics in care homes. Despite measures to reduce antipsychotic use for all people with dementia in England, we found that 12% of care home residents were still prescribed antipsychotic medication. Around half of all care home managers reported they had experienced behaviours they found difficult. Antipsychotic medications and a variety of non-pharmacological interventions appear to be used concurrently in many care homes.

This paper examines organisational aspects of elder mistreatment in light of the findings of the ResPECT Study of Organisational Dynamics of Elder Care commissioned by Comic Relief and Department of Health through the Prevention of Abuse and Neglect In the Care of Older Adults (PANICOA) programme. The study examined the organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. Approach: The study involved a knowledge synthesis of organisational aspects of elder mistreatment in residential care settings. The knowledge synthesis method was purposively adapted for examining the ill-defined and contested concept of elder mistreatment, as the available evidence is in varied forms and dispersed. Extensive searching of databases of academic journals was combined with careful searching for official investigation reports into mistreatment. The review and synthesis was followed by panel meetings with subject matter experts. Findings: This paper identifies and elaborates five organisational factors associated with elder mistreatment; infrastructure, management and procedures, staffing, resident population characteristics and culture. It also indicates macro-structural factors affecting care quality. Investigation reports recognised common structural factors contributing to institutional abuse, however, as ‘problem’ organisations are closed down these circumstances recur elsewhere. Research implications: Further work is needed to understand the interaction between and the influence of these organisational factors on mistreatment. Practical implications: This may go some way towards explaining how care quality can collapse as a result of seemingly minor and unrelated organisational changes. Social implications: Care home safety and quality is an ongoing concern, with popular analysis frequently stopping at the point of describing individual errant behaviour. Policy and practice struggles to take on lessons learned in inquiries. This synthesis deepens analysis of the inter-related factors