Aims The aims were first to explore strategies for both structural and organizational reform by the process of action research, and second to use collective self-inquiry by all study participants as a way of examining problems and deciding on actions to bring about change. Rationale It was hoped that this process would empower the staff, aged residents and family members to own and therefore be meaningfully involved in improving practice and care standards. Background/introduction Three aged care centres expressed a desire to enhance the quality of care provided in order to meet the criteria for accreditation. They wanted to participate in a process that would assist them in critically examining their resource allocation, service delivery patterns and outcomes for residents. Research methods Original data were collected in three different aged care facilities over a three-year period from 1996 to 1998 in order to seek answers to the usefulness of action research in the change process. The methodology included participant observation, interviews and focus group discussions with all participants. Results/findings Organizational change occurred across the three centres with subsequent changes in the outcomes for both residents and staff. The themes which emerged from the data analysis process and which enhanced the participatory process included the need for flattened organizational structures and management's willingness to fully support the process and to be more transparent. The factors that inhibited the process included the organizational culture and tokenistic support by management. Discussion/conclusion Participatory action research was found to be a successful process for identifying and acting on the enhancers and inhibitors to structural and organizational reform.