Nursing homes on public display: Reputation management in the new landscape of Swedish eldercare

The general perception of Swedish nursing homes has historically been gloomy. Nursing homes have been associated with a passive, isolated, and institutionalised ‘fourth age’ life. Media reports and the public debate have largely stressed the need for organisational improvements, and called for transparency and control. In recent years, marketisation, audits, and mediatisation have become new conditions that together have shaped the landscape of Swedish eldercare, leading to increased organisational sensitivity to public perception. These changes have made organisational images more difficult to control and cultivate. The dissertation thus examines nursing homes’ publicly displayed images and how nursing home representatives act and react in relation to such images to defend and improve their organisational reputation. The dissertation answers these questions: (1) What kinds of images of nursing homes are constructed in the mass media and social media? (2) What have marketisation, audits, and mediatisation meant for nursing homes’ reputation management practices? (3) How do nursing home representatives manage their organisational reputation in the context of external demands and descriptions? Organisations are theoretically understood as open systems in a dynamic relationship with their institutional environment, and in need of external support to survive and succeed. Organisational reputation is an essential asset in an era of marketisation, particularly for organisations with difficulties demonstrating success and whose goals are uncertain or undefined, such as nursing homes. The analysis is based on 42 qualitative interviews with nursing home representatives, 338 pictures from nursing homes’ Instagram accounts, and 124 newspaper articles about eldercare user satisfaction surveys. The findings show that while the mass media construct nursing homes as places needing continuous improvement and control, the nursing homes’ self-presentations assert that these are settings where life is both normal and better than before. Increased marketisation, audits, and mediatisation have enforced the need to manage reputation by adhering to externally formulated demands, and to provide documented evidence of successful adaption to norms and expectations. Nursing home representatives manage reputation by adjusting organisational activity to external demands on different levels and in different situations: while the validity of externally formulated demands was to some extent dismissed, representatives still express the need to address and act on such expectations. The dissertation shows that the new conditions in the landscape of Swedish eldercare have given way to new institutional logics for reputation management: there is a perceived need to compete and compare; to produce content and communicate images; and to manage and appeal to their intended audience. Organisations attribute validity and adapt to externally formulated demands in different ways. They embrace the validity of external demands and conform; they dismiss and reject demands; they substitute images for action; or they adhere to external demands for the sake of an improved reputation.