1 M. Cohen & D. Wagner, “Social Work Professionalism: Reality and Illusion,” in C. Derber, ed., Profesionals as Work: Mental Labor in Advanced Capitalism (Boston, Mass.: G. K. Hall & Co., 1982) (“Derber, Professionals as Workers”). An alternative view is put forward by Andrew Abbott, The System of Profession 8–9, 318 (Chicago: University of Chicago Press, 1988), who presents a persuasive argument that “a firm definition of profession is both unnecessary and dangerous.” He argues that there is ambiguity about what is a profession because profession “means at once a form of organization, a level of social deference, an association with knowledge, a way of organizing personal careers…‘Profession’ thus enjoys a vibrantly real but highly elusive existence, qualities that make it both worthwhile and impossible to discuss objectively.”.Google Scholar

2 Derber, “The Proletarianization of the Professional: A Review Essay,” in Derber, Professionals as Workers; Eliot Freidson, Profession of Medicine: A Study of the Sociology of Applied Knowledge (New York: Dodd & Mead, 1970) (“Freidson, Profession of Medicine”); R. Hall, “Professionalization and Bureaucratization,” 33 Am. Soc. Rev. 92 (1968); Peter Blau, Wolf Heydebrand, & S. Stauffer, “The Structure of Small Bureaucracies,” 31 Am. Soc. Rev. 179 (1966); W. Kornhauser, The Mental Health of the Industrial Worker (New York: Wiley, 1965). Others have argued, however, that professional and bureaucratic principles are compatible; see Arthur Stinchcombe, “Bureaucratic and Craft Administration of Production.” 4 Admin. Sci. Q. 168(1959).Google Scholar

3 Quinney, R., “Occupational Structure and Criminal Behavior: Prescription Violations by Retail Pharmacists,” 11 Soc. Probs. 179 (1963).CrossRefGoogle Scholar

4 In developing a single measure of this type Quinney was unable to examine the independent effects of professionalism and business orientations, nor could he test for any possible interaction between the two.Google Scholar

5 Chappell, Neena L. & Barnes, Gordon R., “Professional and Business Role Orientations among Practicing Pharmacists,” 18 Soc. Sci. & Med. 103 (1984).CrossRefGoogle ScholarPubMed

6 Chappell and Barnes did not attempt to examine the main effects net of each other or for a possible interaction between the two.Google Scholar

7 Quinney, 11 Soc. Probs. at 181–82.Google Scholar

8 Chappell & Barnes, 18 Soc. Sci. & Med at 108–9.Google Scholar

9 Derber, professionals as Workers.Google Scholar

10 M. Rokeach, The Nature of Human Values (New York: Free Press, 1973).Google Scholar

11 Valerie Braithwaite & William Scott, “Values,” in John Robinson et al, Measures of Personality and Social Psychological Attitudes (New York: Academic Press, 1990) (“Braithwaite & Scott, ‘Values’”).CrossRefGoogle Scholar

12 Freidson, Profession of Medicine (cited in note 2).Google Scholar

13 Chappell, & Barnes, , 18 Soc. Sci. & Med 107.Google Scholar

14 Kronus, Carol L., “Occupational versus Organizational Influences on Reference Group Identification,” 3 Sociology of Work & Occupations 303 (1976); Freidson, Profession of Medicine; Jerome E. Carlin, Lawyers on Their Own (New Brunswick, N.J.: Rutgers University Press, 1962).CrossRefGoogle Scholar

15 Braithwaite, John & Geis, G., “One Theory and Action for Corporate Crime Control,” 28 Crime & Delinq. 292 (1982).CrossRefGoogle Scholar

16 Victor, Bart & Cullen, John B., “The Organizational Bases of Ethical Work Climates,” 33 Admin. Sci Q. 101 (1988).CrossRefGoogle Scholar

17 W. Goode, “The Theoretical Limits of Professionalization,” in Amitai Etzioni, ed., The Semi-Professions and Their Organization (New York: Free Press, 1969).Google Scholar

18 Eliot Freidson, Professional Powers (Chicago: University of Chicago Press, 1986).Google Scholar

19 T. Johnson, Professions and Power (London: Macmillan, 1973).Google Scholar

20 Braithwaite, Valerie & Law, Henry, “Testing the Adequacy of the Rokeach Value Survey,” 49 J. Personality & Soc. Psychology 250 (1985); Braithwaite & Scott, “Values.”.CrossRefGoogle Scholar

21 Commonwealth/State Working Party on Nursing Home Standards, Living in a Nursing Home: Outcome Standards for Australian Nursing Homes (Canberra: Australian Department of Community Services & Health, 1987); John Braithwaite, Toni Makkai, Valerie Braithwaite, Diane Gibson, & David Ermann, The Contribution of the Standards Monitoring Process to the Quality of Nursing Home Life: A Preliminary Report (Canberra: Australian Department of Community Services & Health, 1990) (Braithwaite et al, “Preliminary Report”); John Braithwaite, Valerie Braithwaite, Miriam Landau, Diane Gibson, & Toni Makkai, The Reliability and Validity of Nursing Home Standards (Canberra: Australian Government Publishing Service, 1992); John Braithwaite, Toni Makkai, Valerie Braithwaite, & Diane Gibson, Raising the Standard: Resident Centred Nursing Home Regulation in Australia (Canberra: Australian Department of Community Services & Health, 1992) (“Braithwaite et al., Raising the Standard”); Valerie, Braithwaite, John Braithwaite, Diane Gibson, & Toni Makkai, “Assessing the Quality of Australian Nursing Home Care,” 16 Australian J. Pub. Health 89 (1992).Google Scholar

22 See Braithwaite, John & Makkai, Toni, “Testing an Expected Utility Model of Corporate Deterrence,” 25 Law & Soc'y Rev. 7 (1991).CrossRefGoogle Scholar

23 Id.Google Scholar

24 For more details, see Braithwaite et al., Preliminary Report (cited in note 21).Google Scholar

25 See id. for further information regarding the two samples.Google Scholar

26 Id. at 40–50. Braithwaite, et al, 16 Australian J. Pub. Health.Google Scholar

27 Quinney's measure of criminal violations was based on official state and federal records (11 Soc. Probs.: cited in note 3); Chappell and Barnes's measure of practice behavior comprised seven activities on which pharmacists assessed themselves (18 Soc. Sci. & Med.; cited in note 5). In this study one measure of compliance is presented—government-assessed compliance. We also had a second measure of compliance involving self-assessment. Self-assessed compliance was measured at the time of the interview with the director of nursing. The director was shown the ratings assigned to each of the standards by the inspection team and asked whether or not they agreed with the ratings. If they did not, they were then asked what they thought the correct racings were for the home. Mostly the director of nursing agreed with the inspection teams' assessment of the home. It is of note that there were occasions when the director of nursing assigned the home a lower rating than did the team. Clearly, these two measures of compliance are not independent, and this is shown by the high correlation between the official recording of compliance with the self-reported compliance—.88. For this reason we choose to only present results for government-assessed compliance. However, analysis of self-assessed compliance produced substantially the same results.Google Scholar

28 The average level of disability for each home was estimated by taking each resident's service need and multiplying it by the number of average hours of nursing and personal care (NPC) required per week by a resident with that classification. The residents service need (based on information supplied by the nursing home), also referred to as the resident's classification index (RCI), can range from 1 to 5. The standard hourly rates, as of 1 July 1988, are: 27 for an RCI of 1, 23.5 for an RCI of 2, 20 for an RCI of 3, 13 for an RCI of 4, and 10 for an RCI of 5 (Australian Department of Community Services & Health, New Nursing and Personal Care and Staffing and Funding Arrangements, 24 June 1988 (CNH 88003 (NG)).Google Scholar

29 Braithwaite et al., Preliminary Report 115–29 (cited in note 21).Google Scholar

30 Riportella-Muller, Roberta & Slesinger, Doris P., “The Relationship of Ownership and Size of Quality of Care in Wisconsin Nursing Homes,” 22 Gerontologist 429 (1982).CrossRefGoogle ScholarPubMed

31 Id.; see also Molloy, George E., “Quality Assurance and the Survey Process,” 5 J. Long-Term Cure Admin. 1 (1977); Michael Koetting, Nursing Home Organization and Efficiency—Profit versus Non-Profit (Lexington, Mass.: Lexington Books, 1980) (“Koetting, Nursing Home Organization”); Bradford H. Grey, ed., Fore-Profit Enterprise in Health Care (Washington, D.C.: National Academy Press, 1986) (“Grey, For-Profit Enterprise”).Google ScholarPubMed

32 See Holmberg, R. H. & Anderson, N. N., “Implications for Ownership for Nursing Home Care,” 6 Medical Care 300 (1968); Yong, S. Lee, “Nursing Homes and Quality of Health Care: The First Year Result of an Outcome-oriented Survey,” 7 J. Health & Hum Resources Admin. 32 (1984). Catherine Hawes & Charles D. Phillips, “The Changing Structure of the Nursing Home Industry and the Impact of Ownership on Quality, Costs, and Access,” in Grey, For-Profit Enterprise; Riportella-Muller & Slesinger, 22 Gerontologist.CrossRefGoogle Scholar

33 Unfortunately the data do not enable us to distinguish between sole owners and partners, and the two groups will be referred to as owners from this point on in the article.Google Scholar

34 The alpha coefficients for all the scales are based on the standardized items.Google Scholar

35 In those cases where there were missing data, the mean was substituted for all items used to construct the scales. While wanting the items to have equal weight in the scale, we did not want to standardize scores around a mean of zero. The traditional practice of converting to Z-scores reduces interpretability in some instances; information about whether the sample lies above or below the midpoint can be important for interpretation and is lost when items are converted to Z-scores with a mean of zero. To simplify scale construction and description, all scales in this article were constructed in the same way.Google Scholar

36 An ordinary least squares regression assumes that the model is linear and additive (Michael S. Lewis-Beck, Applied Regression: An Introduction (Beverly Hills, Cal.: Sage Publications, 1980). In estimating the model listwise deletion of missing data was used. Preliminary hierarchical regressions resulted in the same substantive conclusions drawn from the final model presented here. The exception was that when the organizational items were entered into the model as the first block, mean disability of residents was significant at.05 (one-tailed, same sign). These results are available from the authors on request.Google Scholar

37 This is true whether we use an official measure of organizational compliance or a self-reported measure of compliance.Google Scholar

38 As part of the funding arrangements all nursing homes are guaranteed a minimum occupancy rate of 98% by the federal government.Google Scholar

39 This was also found to be the case when we substituted the self-reported measure of organizational compliance for the government-assessed compliance measure.Google Scholar

40 A number of North American studies on type of nursing home and quality care have a significant correlation between compliance ratings and type of home ownership with for-profit homes having lower compliance. See Molloy, , 5 J. Long-Term Care Admin., and Koetting, Nursing Home Organization (both cited in note 31); Yong, 7 J. Health B Hum Resources Admin. (cited in note 32). An earlier study had shown no relationship between ownership and quality of care; see Holmberg & Anderson, 6 Medical Care (cited in note 32). A later study found an interaction between size and type of ownership in its impact on quality care. Large nonprofit homes had lower compliance than large for-profit homes. See Riportella-Muller & Slesinger, 22 Gerontologist (cited in note 30).Google Scholar