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.
