: This dissertation examines the effects of organizational culture on quality of life in two nursing homes. Previous ethnographic studies of nursing homes suggest that the bureaucratic regulations meant to improve quality of care lead to an emphasis on organizational efficiency that conflicts with an ethic of caring. This dissertation re-examines this idea by analyzing how different organizational cultures surrounding bureaucratic regulation affect caregivers' abilities to customize care to residents' individual needs. I conduct ethnographic research in two well-regarded nursing homes that are similar in structural characteristics, but vary in organizational culture, particularly in their approaches to bureaucratic procedure. Therefore, this study asks: How do different organizational cultures shape the formation of a caring environment in nursing homes? Previous assessments of quality of life in nursing homes have used brief observation as a source of data, ? alongside patient surveys. The comparative ethnographic design of the proposed project deepens the ? analysis of quality of life by providing a detailed, long-term account of the organizational processes that ? produce different outcomes in quality of life surveys. Ethnography allows me to examine how caregiving ? relationships change over time in response to their surrounding circumstances. Out of this approach I ? develop analytic categories for assessing the degree to which caregivers attend to the emotional needs of residents. The long-term goal of this study is to develop tools for analyzing the effects of different ? organizational structures and cultures on quality of life in nursing homes and other long-term care facilities. As emphasized in the goals of the Agency for Healthcare Research and Quality, organizational efficiency is a necessary aim for improving overall quality of care in health care facilities such as nursing homes. This study seeks to improve our understanding of how health care organizations can maintain a certain level of efficiency, while promoting practices that respond to patients' social, emotional, and spiritual needs. Therefore, this dissertation advances AHRQ's interests in developing measures of health care quality, improving efficiency in health services, and promoting a patient-centered approach to care. ? ? ? ?
