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AbstractPurpose -This paper aims to find ways to improve the performance of social and medical establishments through a new organizational structure and the use of quality management methods. Design/methodology/approach -The research is based on an empirical study of a number of French establishments providing primary and secondary data, collected through interviews and records, on their management styles and results. Findings -The research shows that the present management of such establishments lacks effectiveness and efficiency and that their networking and the implementation of quality principles and tools could improve their global performance.Research limitations/implications -The process of internal and external evaluation of establishments still being in progress, it is not possible yet to draw definitive conclusions on the effectiveness of the solutions proposed. The study will have to be completed when all the evaluations have taken place. Practical implications -The findings of the study imply that a real new perspective is needed, and can be a reflection basis for establishments to reconsider their management in order to meet stakeholders' expectations. Originality/value -The paper casts a new look on the management of homes for the elderly, in particular and organizations providing social services, in general. It can offer food for thought to all actors in this sector.