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Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.

Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.

Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.

For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.

This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.

This chapter comments on the papers produced as part of the symposium on Law and the Imagining of Difference. The chapter observes that the diversity that marks the human species gives rise to differences across individuals and groups. These differences create a challenge for law, for legal rules, and categories tend, among other things, to flatten or suppress difference. How to ensure that law treats differences properly? One way is to require that legal rules be rationally related to a proper purpose. Another is to require that persons be treated equally. If the principle of equality solves certain problems of flattening, it also may create problems. The key to applying properly the principle of equality, then, is to answer a set of antecedent questions: “who” must be treated as equal to whom, “with respect to what” rights or interests, and “how”? Martha Minow has provided rubrics for addressing these questions in ways that uncover problematic applications of the principle of equality. The chapter addresses the distinct versions of equality presupposed in claims for Douglas NeJaime’s arguments for same-sex marriage, Julie C. Suk’s social and economic approach to sex-based equality, and Megan A. Conway’s and Zanita E. Fenton’s ambitious explorations of the value of equality in the law of disabled persons. The chapter concludes that law can be directly responsive to some claims of inequality, but that other claims will require something other than law.

This chapter uncovers the destabilizing and transformative dimensions of a legal process commonly described as assimilation. Lawyers working on behalf of a marginalized group often argue that the group merits inclusion in dominant institutions, and they do so by casting the group as like the majority. Scholars have criticized claims of this kind for affirming the status quo and muting significant differences of the excluded group. Yet, this chapter shows how these claims may also disrupt the status quo, transform dominant institutions, and convert distinctive features of the excluded group into more widely shared legal norms. This dynamic is observed in the context of lesbian, gay, bisexual, and transgender (LGBT) rights, and specifically through attention to three phases of LGBT advocacy: (1) claims to parental recognition of unmarried same-sex parents, (2) claims to marriage, and (3) claims regarding the consequences of marriage for same-sex parents. The analysis shows how claims that appeared assimilationist – demanding inclusion in marriage and parenthood by arguing that same-sex couples are similarly situated to their different-sex counterparts – subtly challenged and reshaped legal norms governing parenthood, including marital parenthood. While this chapter focuses on LGBT claims, it uncovers a dynamic that may exist in other settings.

This chapter contributes to the discourse of difference by problematizing the sameness/difference trope through the lens of the exceptional. It explores the nature of being exceptional with an expectation that its nature is contingent and variable. At the heart of understanding what constitutes exceptional is its implicit comparison with the average. While exceptional is defined to include both individuals who achieve in extraordinary ways and individuals with a physical or mental impairment, the two definitions are consonant in that both describe individuals who deviate from expected norms. Relying on the insights from pragmatism, this chapter considers community habits exceptional individuals must confront in forming their choices. In this way, it further adheres to the lessons from pragmatism for norm change. The strategies individuals use to alter the effects of being perceived as exceptional contribute to the overall discourse in equality and equal protection and potentially constitute the individual action that formulates change. It examines some approaches to the Americans with Disabilities Act (ADA) derived from civil rights and from economic perspectives and the relevant matrix of choices available to the exceptional to understand the potential for productive change. With this foreground, it examines the choice of exceptional individuals to cover or convey matters of their identity. This chapter pays particular attention to these choices in seeking accommodations under the ADA. Ultimately, this study strives to participate in the conversation seeking to maximize human potential.

Explores the implications for continuity of care of the wide range of policy initiatives currently affecting the management and use of human resources in the UK National Health Service. Draws on the findings of a short study undertaken in 2001 comprising a policy document analysis and a series of expert seminars discussing the impact of the policies in practice. A variety of potential long‐term gains for continuity of care were identifiable in the current raft of policy initiatives and seminar participants agreed that, when these policies are fully implemented, continuity of care should be enhanced in several ways. However, the impact to date has been rather more equivocal because of the damaging effects of the process of policy implementation on continuity within the system and on staff attitudes and values. If continuity of care is accepted as an important element of quality in health care, more attention must be given to developing strategies which support system continuity.

Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.

Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.

Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.

Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

This is a comparative case study of how three high school history teachers in the U.S.A. use art in their practice. The following research question was investigated: How do secondary history teachers incorporate the arts—paintings, music, poems, novels, and films—in their teaching of history and why? Data were collected from three sources: interviews, observations, and classroom materials. Grounded theory was utilized to analyze the data. Findings suggest these teachers use the arts as historical evidence roughly for three purposes: First, to teach the spirit of an age; second, to teach the history of ordinary people invisible in official historical records; and third, to teach, both with and without art, the process of writing history. Two of the three teachers, however, failed to teach historical thinking skills through art.

The authors examine and compare accounting associations' identities in distinct segments of the accounting profession surrounding the 2014 merger of three Canadian accounting associations.

The authors conceive of accounting associations' magazine front covers as a setting for “identity performance” (i.e. a scenery through which identity dimensions are intentionally communicated to target audiences). The authors examine pre-merger and post-merger associations' identity performances that took place between January 2011 and December 2020 and identify 21 broad themes that the authors interpret in terms of identity logics (i.e. professionalism/commercialism) and audience focus (society/association members), underscoring (dis)similarities in identity performances pre- and post-merger.

The authors' analysis reveals distinct identity performances for the different segments of the pre-merger accounting profession and for the post-merger unified accounting association. Identity logics manifest differently: a commercial logic dominated for two of the associations and a professional logic dominated for the third. Identity fluidity was evident in the merged association's shift from commercial toward professional logic when the association ceased publishing one magazine and introduced a new one. Society rather than associations' members dominated as a target audience for all associations, but this focus manifested differently. Post-merger, identity performances continued to focus on society as the audience.

The authors highlight the Goffmanian identity performances (Goffman, 1959) taking place via accounting associations' magazines. The authors adopt a segment perspective (Bucher and Strauss, 1961) that demonstrates that commercialism does not trump professionalism in all segments of the profession. For the first time, the authors juxtapose identity logics (professionalism/commercialism) and targeted audiences to better understand how these facets of accountants' identities compare between segments.