In this multiple-case study, we engaged directors of care of Ontario long-term care (LTC) homes in semi-structured interviews designed to increase our understanding of the influence exerted by organizational and extra-organizational factors on two key aspects of organizational performance: operational efficiency and quality of care. We also examined the influence of these factors on the relationship between efficiency and quality. Through a review of the health services and organization and management literatures, four broad factors identified a priori as influential for one or both performance outcomes were used to guide our data collection: staff characteristics, facility characteristics, extra-organizational influences, and the function of volunteers. Our findings suggest that while both high efficiency and high quality of care are achievable, there are aspects of a home’s operations and realities associated with the LTC sector in Ontario that can make achieving both, simultaneously, exceedingly challenging.

Objective: In line with Irish government and health board policy, existing district psychiatric hospitals are scheduled for rundown and closure, with ongoing care being transferred to general hospitals and community based resources. However it is unclear as to what resources will be required if this policy is to proceed. The objective of this study is to obtain the current needs profile of the inpatient population of one such hospital and to predict what facilities would be needed in the event of closure.

Method: Using a staff completed questionnaire, specially constructed by the hospital rehabilitation team, and which has been used to help predict needs for past successful relocations, information was obtained on all inpatients on a designated day. Each patient was rated as requiring independent, low-support, or high-support accommodation, the nature of which depending on the perceived needs.

Results: This survey shows that the residual population is predominantly middle-aged and elderly with many disabilities and persisting challenging behaviours. The majority have high dependency needs which limits the placements options to high support facilities, which as yet are under provided for in the community.

Conclusion: Further planning and resources will be required if the above policy is to be realised.