Trigg, Lisa (2018)
Improving the quality of residential care for older people: a study of government approaches in England and Australia. PhD thesis, London School of Economics and Political Science (United Kingdom).
Abstract
Improving the
quality of residential care for older people is a priority for many
governments, but the relationship between government actions and
high-quality provision is unclear. This qualitative research study uses
the cases of England and Australia to examine and compare regulatory
regimes for raising provider quality. It examines how understandings of
quality in each country are linked to differences in the respective
regulatory regimes; how and why these regimes have developed; how
information on quality is used by each government to influence quality
improvement; and how regulatory regimes influence providers to deliver
quality. The study develops a new typology of three provider quality
orientations (organisation-focused, consumer-directed,
relationship-centred) to examine differences between the two regulatory
regimes.
The research draws on interviews conducted between January 2015 and
April 2017 with 79 individuals from different stakeholder groups in
England and Australia, and interviews with 24 individuals from five
provider organisations in each country. These interviews highlighted
greater differences between the two regimes than previous research
suggests. For example, while each system includes a government role for
inspecting or reviewing provider quality, there are differences around
how quality is formally defined, the role and transparency of quality
information, and how some provider quality behaviour is influenced by
different policy interventions.
Two important findings emerge from the study for policymakers and
researchers. First, the importance of considering the broader historical
and institutional context of the care sector overall, not simply the
regulatory environment, as shown by the more welfare-oriented approach
in England when compared to Australia’s highly consumerist approach.
Second, the importance of considering the overall ‘regulatory space’
when designing policy interventions for quality. Policymakers should
consider the effects and interaction of multiple policy interventions,
the impact of funding mechanisms and the activity of multiple
stakeholders, and not restrict attention to those policy interventions
explicitly developed for quality improvement goals
