研究發現，機構內的在地建制文本構建出統治關係以形塑照顧日常生活，包含課表、排班表等預先規劃好照顧人員職務內容，使其自我遭文本消弭，從事客體化的工作。且機構模仿台灣以家庭為主要照顧的福利思維，藉個案娘／爹的概念加諸於照顧人員以家父長式的威權管教院生。但機構照顧的問題根源自建制文本間的矛盾：課表與排班表強調以團體生活為主，集體行動為優先；但個案娘與ISP卻強調關注院生個別差異，提供個殊式訓練，彼此間備多力分相互抵消。最終，在構成機構基底的課表運轉過程下，照顧服務化作任務導向以生產線型態產出，這也造成機構以控制的意識型態追求照護品質而非生命品質的提升。
其次，評鑑制度原意係提升機構照顧品質並期待機構內院生能夠自主、自決、自我倡議實現有尊嚴的生活品質，藉由層級監視的手段，馴化身心障礙機構配合評鑑應然的秩序，國家透過評鑑認證提供了機構服務品質保證，機構也藉此獲得存在的正當性。然而，卻因過度以管理者的角度擬定指標，使得通則化指標無視了身心障礙者的個別差異，也讓評鑑實施方式參雜過多行政業務督導的影子。機構為取得優良成績的認證，迫使照顧人員的日常照顧生活要符合評鑑指標規定，形成經驗的斷裂，也導致迎合指標規定的行為產生。
最後，本研究建議評鑑制度的評核焦點要從現行的行政－實作－個人的方式調整成個人－實作－行政。並且將評鑑方式由短期、單次性、公告週知的評分法改為不定時、長期性、非特定委員的觀察法，方能真正提升機構照顧品質並協助院生權益倡導。
The social control and quality of total institution has been challenged by sociologists and frontline practiionors. The Taiwan welfare regime uses the institution evaluation to govern the quality of care and performance of the institution for disabled people through design a series of evaluation indicators. This study adopts institutional ethnography approach, supplemented by interviews and field observations to analyze the impact of institution evaluation on an institution for disabled people. Study external evaluation indicators and internal systems, individual service plans, and caregivers' concepts. Implications for how to shape and influence the care work after interweaving are discussed.
The study found that the local institutional texts formed a ruling relationship that shaped daily life in the institution, including the schedules and duty rosters, to pre-plan the contents of the day for the care staff, so that the staff were self-contained and engaged in objectification. Moreover, the institution imitates Taiwan's welfare paradigm, which mainly involves care provided by the family. The caregivers give the perternalistic power to take care the disabled people by concept of “mother or father in the institution”. However, the problem with institutional care is rooted in the contradiction between the texts: The schedule and the duty roster emphasize group life as the main focus, and collective action is preferred; however, the “mother or father in the institution” and the individual service plan emphasize the individual differences among disabled people and provide individually training. The multiple points offset each other. In the end, under the operation of the schedules that form the base of the institution, the care service is positioned for task-oriented output, which means the institution pursues the quality of care rather than the quality of life with a controlled ideology.
Second, the original intention of the institution evaluation was to improve the quality of care at the institution and to encourage the disabled people in the institution to become independent, self-determining, and able to take the initiative to achieve a dignified quality of life. Through the evaluation for certification, the institution provides quality assurance and also obtains legitimacy. However, due to the excessive development of indicators from managers’ perspective, the generalization indicators ignore the individual differences between disabled people and also mix the evaluation implementation method with the shadow of administrative supervision. To obtain the performance certification, the institution must force the caregivers' daily care activities to meet the evaluation indicators and results in a experiences of disjuncture, which will also lead to behaviors that cater to the indicators.
Finally, this study suggests that the evaluation focus of the appraisal system should be adjusted from the current administrative-practical-individual approach to an individual-practice-administration approach. Also, the evaluation method should be changed from a short-term, single-time, scoring method to an irregular, long-term, non-specific committee member observation method to truly improve the quality of institutional care and advocate for disabled people’ rights.
