Background Public outrage about the treatment of aged care residents in some nursing homes has its origins in a failure in each facility's accountability framework. There is an overwhelming focus on documentation of organisational structures and care processes, detracting from what really matterswhether the wellbeing of residents has been achieved. Objective This article examines processor action-oriented versus outcomes-or interaction-oriented accountability principles and their impacts on aged care residents' care. Discussion A 'performance outcomes approach' provides a more effective and efficient way to achieve high levels of care in aged care facilities. These findings are important in the context of potential recommendations arising from the Royal Commission into Aged Care Quality and Safety.

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