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Organizational Culture among Nurses Working in the Public Health Sector on the Island of Crete -Greece

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  • University of Crete, Faculty of Medicine
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... A passive-defensive culture is considered as an overriding belief that nurses have to communicate with others in ways that do not intimidate their job security. An aggressivedefensive culture encourages employees to approach tasks in forceful ways in order to protect their status and job security (3) . ...
... If nurses are committed to their organization, the organizational changes can be managed successfully. It is best when it is based upon a faith in the importance of the inventiveness and if staff nurses want it to succeed (3,9) . ...
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Culture within an organization is very crucial; it plays an important role in the hospital and is considered a main predictor of the organizational commitment; subsequently, the organizational changes can be managed successfully. The present study aimed to assess the organizational culture perception as a predictor of organizational commitment and attitude toward organizational change among nurses at Al-Ahrar Teaching Hospital, Sharkia Governorate, Egypt. For this research, a descriptive correlation design was used. A simple random sample of 221 nurses were chosen from the above mentioned setting. To fulfill the purpose of this study three tools were used in data collection, organizational culture inventory, organizational commitment scale, and attitude toward organizational change instrument. Results showed that 91.90 % of nurses had a positive perception of the constructive culture. On the other hand, 76.9% and 74.7% of them had negative perceptions of aggressive defensive and passive defensive cultures, respectively. Likewise, 57.50% of nurses had high level of organizational commitment. Moreover, 76% of studied nurses had positive perception about attitude toward change. Furthermore, organizational commitment was significantly and positively correlated to all types of the organizational culture, where p-value < 0.01. Besides, there were significant and positive correlations between organizational attitude toward organizational change as regards all types of the organizational culture and organizational commitment where p-value < 0.01. Conclusion: The constructive culture was the most influential and predictor type of the organizational commitment; however, the passive defensive culture was the most influential and predictor type of the attitude toward organizational change. Recommendation: The nurse manager should schedule regular meetings with staff nurses to define and communicate the organizational culture before the initiation of the change process. [Azza Abdeldayem Ata, Zaineb Naiem Abd-Elhamid and Asmaa Kamal Ahmed. Organizational Culture Perception as a Predictor of Organizational Commitment and Attitude toward Organizational Change among Nurses. Biomedicine and Nursing 2019;5(2): 106-114].
... Close associations have been found between organizational culture and patient safety and satisfaction with the healthcare services as well as the effectiveness of the activity of healthcare institutions [1][2][3]. A number of studies have 141 shown that organizational culture is one of the main factors that affect changes implemented for the improvement of patient safety and the quality of the provided services [4][5][6][7][8]. ...
... Nursing personnel in healthcare institutions closely cooperate with patients ant may positively or negatively affect the overall organizational culture of a healthcare institution [9,10]. The evaluation of the nurses' opinion about the organizational culture may help to identify the features of an institution's organizational culture as well as the effectiveness of these features in promoting the desirable organizational processes and results [5]. Institutions that provide services in the fields of obstetrics-gynecology and neonatology treat highly vulnerable patient groups, and thus assurance of the quality of healthcare and the safety of the patients is of utmost importance. ...
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Background. Institutions that provide services in the fields of obstetrics-gynecology and neonatology treat highly vulnerable patient groups, and thus assurance of the quality of healthcare and the safety of the patients is of utmost importance. The type of the organizational culture at a healthcare institution determines the organization’s abilities to develop, achieve better results, initiate changes, and implement new methods. The evaluation of organizational culture in such institutions would help to understand and improve patient safety and satisfaction with the healthcare services as well as the effectiveness of the activity of healthcare institutions. The aim of the study was to identify the type of the organizational culture at a healthcare institution that provides services in the fields of obstetrics-gynecology and neonatology based on the evaluation of nurses’ and midwives’ opinions. Summary of the work. The evaluation of the nurses’ and midwives’ opinions about the organizational culture was performed by using the Organizational Culture Assessment Instrument (OCAI). The overall response rate to the survey was 100% (n=233). Summary of the results. The results of the study showed that during the studied period, the Hierarchy culture predominated. The analysis of the components Dominant Characteristics, Organizational Leadership, Organization Glue, and Strategic Emphases revealed the presence of various types of organizational culture, with the Hierarchy culture (D) being dominant. The analysis of the components Management of Employees and Criteria of Success showed that during the studied period, various culture types existed in the studied institution, with the Clan culture (A) being dominant. In the Hierarchy culture, the analysis of the components Dominant Characteristics, Organizational Leadership, Strategic Emphases, and Criteria of Success revealed that significantly greater differences between the Preferred and Now mean evaluations were in the neonatal departments. Conclusion. According to the nursing staff, the Hierarchy culture type was predominant in the studied healthcare institution that provides services in the fields of obstetrics-gynecology and neonatology. However, the respondents also would prefer a trend towards a friendlier (the Clan culture) and more creative (the Adhocracy culture) work environment.
... Due to the impact of the organizational culture on the quality of health services, organizational performance and job satisfaction of the employees, it has gained an increasing importance in the health sector, and studies have started to be carried out to determine the relationship between job satisfaction and organizational culture and their influence on each other (Brazil et al., 2010;Rovithis et al., 2016). ...
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The chapter is about benefits of breastfeeding for infant and maternal health.
... Za pomocą OCI przeanalizowano odpowiedzi 1700 pracowników z 42 oddziałów intensywnej terapii. Celem była ocena związku kultury organizacyjnej z efektywnością pracy zespołowej powiązanej z następującymi determinantami: przywództwem, komunikacją, koordynacją, rozwiązywaniem konfliktów oraz spójnością zespołu 25,26 . We Francji przeprowadzono badanie oceniające kulturę organizacyjną i zarządzanie na oddziałach szpitalnych. ...
... In our study, nurses assess their involvement level as unsatisfactory. A previous study in the same hospitals showed that the aggressive and defensive culture that nurses adopt, causes them to behave competitively, with a controlling and superior attitude to maintain status and to feel safe (Rovithis et al., 2016). ...
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Purpose: The purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience. Design/methodology/approach: In total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data. Findings: Nurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse-physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage. Practical implications: Hospital managers do not provide sufficient support for Greek nurses in their working environments. Originality/value: The authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses' working in these hospitals.
... US non-Magnet environments typically return a positive score for Nurse Manager Ability, Leadership and Support of Nurses (mean 2.68), whereas the Greek nurses in this study returned a mean score of 2.19 for this trait. In a previous study, Greek nurses felt that leaders should intervene in organisational changes with educational programmes, construct culture styles, and minimise aggressive or defensive behaviours (Rovithis et al., 2016). ...
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Background The organisational characteristics of the nursing practice environment play a crucial role in nurses’ job satisfaction, job retention, quality-of-care service provision and patient outcomes. The widely used Practice Environment Scale of the Nursing Work Index assesses the favourability of these traits, showing the grade of magnetism of these factors in the workplace. Aims and methods This study aims to assess the nurse working environment at five public hospitals in Greece, and to compare these data with those of Magnet and non-Magnet hospitals. The Practice Environment Scale of the Nursing Work Index was completed by 532 nurses. Results Findings have shown that all five hospitals were assessed by nurses as unfavourable working environments. Four of five subscales were identified as unfavourable by the participants and only Collegial Nurse-Physician Relations were evaluated as a positive organisational trait. The mean scores in all five subscales of favourability were significantly lower than the corresponding scores of non-Magnet hospitals in the US. Conclusions The present study shows the favourability grade of Greek hospitals. When compared with Magnet and non-Magnet hospitals in the US, Greek hospitals were perceived as more unfavourable than non-Magnet hospitals. Action to improve the current situation must be taken by hospital management, supporting nurse involvement, continuous education, changing human resources management and adopting evaluation procedures.
... [21][22][23] The Greek National Health System depends on the willingness and commitment of the employees to contribute to the effective and quality performance of the health facilities. 24 For this reason, it is important to study role ambiguity and conflict, mainly because of their multifaceted effects on the shaping of professional relations and the satisfaction drawn from them. The well-regulated and effective performance of health care organizations can be achieved when conflict and ambiguity are handled with appropriate administrative interventions. ...
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Role conflict and ambiguity among physicians and nurses in the public health care sector in Crete OBJECTIVE To identify role conflict and role ambiguity in the public health care facilities in Crete, as perceived by physicians and nurses. METHOD A descriptive comparative study was conducted in the 5 public general hospitals, one university hospital and 7 of the 14 health centers in Crete, randomly selected. A sample of 75 physicians and 81 nurses completed anonymously the Greek version of the Role Ambiguity and Role Conflict Scales. Their responses were analyzed using multivariate methods. RESULTS The total score was 3.20±1.30 for role ambiguity and 4.75±1.19 for role conflict. Women presented a higher mean ambiguity score (r=0.203, p<0.05), as did participants in the younger age group (p<0.001). Nurses presented a higher mean ambiguity score (3.48±0.14) and physicians a higher mean conflict score (4.91±0.16). Analysis by health care level reveals statistically significant difference, with staff in the primary care health centers recording a higher mean ambiguity score (3.29 vs 2.14, p<0.001). A statistically significant difference was also found between physicians and nurses (p<0.001), with nurses presenting a higher mean ambiguity score than physicians (3.48 vs 2.90, p=0.020). CONCLUSIONS Role ambiguity and role conflict in doctors and nurses can lead to lowered health service performance and efficiency. Awareness of the degree of role conflict and role ambiguity among health personnel has implications for future research and efficient management. To reduce role ambiguity and conflict, managers of health care facilities should introduce interdisciplinary projects aimed at improving job satisfaction and providing quality patient-centered care.
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280 εργαζόμε-νοι όλων των ειδικοτήτων και εκπαιδευτικών επιπέδων που απασχολούνταν στα δύο ελληνικά δημόσια νοσοκομεία (Γενικό Νοσοκομείο [ΓΝ] Βόλου και Πανεπιστημιακό Γενικό Νοσοκομείο [ΠΓΝ] Λάρισας). Ως εργαλείο μέτρησης του οργανωσιακού κλίματος της κλινικής διακυβέρνησης χρησιμοποιήθηκε το ερωτηματολόγιο κλίματος της κλινικής διακυβέρνησης (Clinical Gover-nance Climate Questionnaire, CGCQ). Το ερωτηματολόγιο αποτελείται από 60 ερωτήσεις κλίμακας Likert 5 σημείων (1=συμφωνώ απόλυτα, 5=διαφωνώ απόλυτα). Η μελέτη διεξήχθη κατά το χρονικό διάστημα Ιανουαρίου-Μαρτίου του 2017. Για την επεξεργασία και ανάλυση των δεδομένων χρησιμοποιήθηκε το λογισμικό πρόγραμμα Statistical Package for the Social Sciences (SPSS), έκδοση 21.0. Το επίπεδο στατιστικής σημαντικότητας τέθηκε στο 5%. ΑΠΟ-ΤΕΛΕΣΜΑΤΑ Το υφιστάμενο οργανωσιακό κλίμα και των δύο υπό μελέτη νοσοκομείων ως προς τα γνωρίσματα της κλινικής διακυβέρνησης δεν ήταν ιδιαίτερα υποστηρικτικό, καθώς οι περισσότερες πτυχές του κλίματος αξιο-λογήθηκαν από μέτριες έως ελαφρώς θετικές. Συγκεκριμένα, οι εργαζόμενοι του ΠΓΝ Λάρισας και ειδικότερα οι γυναίκες, αντιλαμβάνονταν τον παράγοντα «διαχείριση κλινικών κινδύνων» σε μετριότερο επίπεδο σε σχέση με τους εργαζόμενους του ΓΝ Βόλου. Επί πλέον, οι ιατροί του ΠΓΝ Λάρισας δήλωσαν χαμηλότερη μέση τιμή στους παράγοντες «διαχείριση κλινικών κινδύνων», «δίκαιη επιβολή ποινών» και «συναδελφική συνεργασία», σε αντίθεση με τους ιατρούς του ΓΝ Βόλου που παρουσίασαν σχετικά περισσότερο ικανοποιημένη στάση στις εν λόγω παραμέτρους κλινικής διακυβέρνησης. Οι εργαζόμενοι μεγαλύτερης ηλικίας αντιλαμβάνονταν πιο θετικά τους παράγοντες «δίκαιη επιβολή ποινών», «συναδελφική συνεργασία» και «ευκαιρίες για εκπαίδευση και ανάπτυξη». ΣΥΜΠΕΡΑΣΜΑΤΑ Η εφαρμοζόμενη πολιτική υγείας οφείλει να περιλαμβάνει δράσεις με τη συμμετοχή όλων των επαγγελματιών υγείας. Η συνεχής εκπαίδευση και οι ευκαιρίες για ανάπτυξη αποτελούν κρίσιμο μέσο τόσο για τον εντοπισμό ελλείψεων όσο και για την ανάπτυξη στρατηγικών κατάλληλων για τη λήψη πρωτοβουλιών. Η κλινική διακυβέρνηση θα μπορούσε να αποτελέσει την ασφαλιστική δικλείδα για τη διατήρηση ποιοτικών και βιώσιμων υπηρεσιών υγείας στη χώρα μας. 1 Η κλινική δια-κυβέρνηση έχει αναδειχθεί ως μια από τις μεγαλύτερες και σημαντικότερες μεταρρυθμίσεις που συντελέστηκαν στον χώρο της υγείας τα τελευταία έτη. 2 Είναι «ένα σύστημα μέσω του οποίου οι οργανισμοί του Εθνικού Συστήματος Υγείας (ΕΣΥ) είναι υπεύθυνοι για τη συνεχή βελτίωση των υπηρεσιών τους και τη διασφάλιση υψηλών προτύπων περίθαλψης για τη δημι-ουργία ενός περιβάλλοντος, στο οποίο η αριστεία της κλινικής φροντίδας θα ανθίσει». 3 Είναι ένας σχετικά πρόσφατος όρος για την πρακτική της υγειονομικής περίθαλψης και συνιστά το μεθοδολογικό πλαίσιο όλων εκείνων των δραστηριοτή-των που απαιτούνται για τη βελτίωση και την αξιολόγηση της κλινικής ποιότητας φροντίδας. 4 Η κλινική διακυβέρνηση θα μπορούσε να βελτιώσει την ποιότητα φροντίδας και να
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OBJECTIVE To investigate possible differences in relation to health behaviors among police academy cadets, in relation to (a) smoking and (b) exercise. METHOD The survey was conducted using the “Theory of Planned Behavior” questionnaire, with 202 police cadets, 118 men and 84 women, aged 18–24 years. RESULTS Analysis of variance revealed that there were differences between smokers and non-smokers in exercise and health behaviors. Older cadets exhibited more positive exercise behavior, and the older the individual, the greater his(her) involvement in and knowledgeabout sport activities in his(her) free time. CONCLUSIONS Behavior recording is an important tool for future information and for future modification, if necessary, of the attitudes and intentions of professional police officers.
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COVID-19 salgını, modern dünyanın şimdiye kadar gördüğü en önemli tehditlerden biri haline gelmiştir. Ülkeler COVID-19’un daha fazla yayılmasını önlemek için çalışırken süreçten en çok etkilenen grup sağlık çalışanları olmuştur (Catton, 2020). Dünya Sağlık Örgütü (DSÖ) 2020 yılını hemşire ve ebe yılı olarak ilan etmiştir. Bu şaşırtıcı bir seçim değildir, çünkü 2 milyon ebe ve 22 milyon hemşire dünyadaki sağlık iş gücünün yarısını oluşturmakta ve tüm dünyada sağlık hizmetlerinin merkezinde yer almaktadır. COVID- 19 salgını sırasında ebelerin ve hemşirelerin, küresel sağlık bakım sistemleri için temel olduğunun ve özellikle ebelerin annelik bakım sistemleri için kilit önemde olduğunun farkına varılmıştır. Ebeler ve hemşireler olmadan, çoğu ülke ne Sürdürülebilir Kalkınma Hedeflerine ne de Evrensel Sağlık Kapsamına ulaşması mümkün olmayacaktır (Cadee & Wiklund, 2020). Pandemi sürecinde gerekli olmadıkça hastane ortamına gidilmemesi tavsiye edilmektedir (Rocca-Ihenacho & Alonso, 2020). Ancak bu tavsiye gebe ve doğumu başlayan kadınlar için geçerliliğini yitirmektedir (Thaels, 2020). Çünkü kadınlar hala gebe kalmaya ve doğum yapmaya, gebeler ve aileleri ebelik desteğine ve bakımına ihtiyaç duymaya devam etmektedir (Bick, 2020 ). Ebeler, dünyada her yıl gerçekleşen 130 milyon doğumun çoğuna yardımcı olmaktadır. Kadınlarla ve bebekleriyle olan temasları, bakımın sürekliliği, sağlıklı gebelik doğum ve doğum sonu dönem, yaşama sağlıklı bir başlangıç oluşturmak için hayati önem taşımaktadır (Carballo, Guidotti, Gudumac, Gagliardi, Hartmann, & Cadée, 2020). Ebeler pandemi sürecinde enfekte olmadan ve hizmet sundukları kadınları enfekte etmeden nasıl çalışmaları gerektiği konusunda endişe duymaktadır (Colonna, 2020). Çünkü bilimsel bir gerçek, COVID-19’un insanlar arasında kolayca yayıldığını, asemptomatik sağlık çalışanlarının en yaygın vektörler olabileceğini ve enfekte olma ve hastalığa yakalanma olasılıklarının yüksek olduğunu göstermektedir (Kennedy, 2020). Ebeler dünya genelinde yetersiz kaynakların bulunduğu ortamlardan, aşırı tıbbileşmiş annelik bakım sistemlerinin bulunduğu ortamlara kadar kadınların ihtiyaçlarını karşılamada savunucu bir rol oynamaktadır. Özellikle pandeminin yaygın olduğu bölgelerde doğum öncesi bakım, aile planlaması ve küretaj hizmetleri kadınlar üzerinde yıkıcı etki göstermektedir (Cadee & Wiklund, 2020).
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That organizational culture influences firm effectiveness is an assumption implicitly held by many managers and management researchers, although few empirical studies have provided detailed insight into the relationship. This manuscript addresses this dearth of research by examining employee attitudes as a potential mediator of the relationship between organizational culture, as operationalized by the competing values framework [Quinn, R.E., Beyond Rational Management. San Francisco: Josey-Bass; 1988.], and diverse measures of organizational effectiveness. Results of this study, which was conducted in 99 healthcare facilities across the US, provide evidence that suggests that employee attitudes mediate the culture–effectiveness relationship.
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Safety climate refers to shared perceptions of what an organization is like with regard to safety, whereas safety culture refers to employees' fundamental ideology and orientation and explains why safety is pursued in the manner exhibited within a particular organization. Although research has sought to identify opportunities for improving safety outcomes by studying patterns of variation in safety climate, few empirical studies have examined the impact of organizational characteristics such as culture on hospital safety climate. This study explored how aspects of general organizational culture relate to hospital patient safety climate. In a stratified sample of 92 U.S. hospitals, we sampled 100% of senior managers and physicians and 10% of other hospital workers. The Patient Safety Climate in Healthcare Organizations and the Zammuto and Krakower organizational culture surveys measured safety climate and group, entrepreneurial, hierarchical, and production orientation of hospitals' culture, respectively. We administered safety climate surveys to 18,361 personnel and organizational culture surveys to a 5,894 random subsample between March 2004 and May 2005. Secondary data came from the 2004 American Hospital Association Annual Hospital Survey and Dun & Bradstreet. Hierarchical linear regressions assessed relationships between organizational culture and safety climate measures. Aspects of general organizational culture were strongly related to safety climate. A higher level of group culture correlated with a higher level of safety climate, but more hierarchical culture was associated with lower safety climate. Aspects of organizational culture accounted for more than threefold improvement in measures of model fit compared with models with controls alone. A mix of culture types, emphasizing group culture, seemed optimal for safety climate. Safety climate and organizational culture are positively related. Results support strategies that promote group orientation and reduced hierarchy, including use of multidisciplinary team training, continuous quality improvement tools, and human resource practices and policies.
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The purpose of this survey is the measurement of the Organizational Culture which defines Ηealth Centers of Crete Island as well as to measure the role conflict and role ambiguity among personnel of the Health Centers of Crete. Five Health Centers were randomly selected out of a total of 11 Health Centers which are located in the prefectures of Heraklion and Rethimnon. The sample consisted of 98 employees out of a total of 117 employees. A percentage of 44.8 (N= 44) were men and 55.1% (N= 54) were women. For the measurement of organizational culture a self – administered questionnaire was chosen which is a translated edition of the organizational culture inventory (OCI). Additionally, two scales translated into Greek were used for the measurement of role conflict and role ambiguity among personnel of Health Centers. The findings reveal that the main cultural type of the 5 Health Centers is a combination of both aggressive – defensive and pathetic – defensive organizational culture. The highest percentile scores to the overall profile of Health Centers was found to avoidance culture (78th percentile), and to power culture (73th percentile). While the approval culture as well as the competitive culture are ranked at 70th percentile. The behavioral norms that constitute the constructive culture and define a healthy organization are ranked in medium percentile scores. Differences are also found in the degree of behavioral norms at each Health Center. In regard to the measurement of role ambiguity and role conflict the findings reveal an average score among personnel of 2.9 and 4.4 for the role ambiguity and role conflict respectfully. Moreover, a statistically significant positive correlation was found among the total average scores of aggressive - defensive and pathetic - defensive culture of all five Centers and a total average score of role conflict (p = 0.001 & p = 0.020). The current research is the first that has measured the organizational culture and the degree of role conflict and role ambiguity of health personnel in health organizations in Greece. However, further research of the measurement of organizational culture should be conducted in a larger scale and perhaps a combination of qualitative and quantitative analysis that will permit a profound measurement of organizational culture in health organizations.
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This study investigated "thinking and behavioral" styles that are used to measure the concept of organizational culture among registered nurses (RNs) and unlicensed assistive personnel (UAPs) in acute care hospitals. The Organizational Culture Inventory has been used in numerous industries, including hospitals, to describe aspects of organizational culture in order to better understand and manage change. Evidence shows that nursing unit and hospital culture tends to be "constructive" but little evidence indicates whether workers in different job categories influence the culture differently. This survey was conducted in five tertiary care hospitals on the west coast of the United States. The design is cross-sectional and analytic. A convenience sample was recruited from staff members working at least 20 hours per week in the adult medical-surgical and specialty nursing units. Analyses include descriptive statistics and multiple regression. Staff members of color, regardless of position, scored higher on the thinking and behavioral styles of approval, avoidance, and competitiveness. Unlicensed assistive personnel, regardless of race or ethnicity, scored higher on the thinking and behavioral styles dependence and opposition. Nurse administrators and managers should be aware of how the addition of unlicensed assistive personnel or people of color can change the culture of the nursing unit or hospital. Explicit management strategies may be necessary to promote employee behaviors that are desirable for patient care and for the organization.
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The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.
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Drawing from both theory and case-study data, the role of nurse leaders in implementing constructive organizational cultures is discussed. Constructive cultures create high-performance work environments, increasing both employee and patient satisfaction, and ultimately affecting economic performance. Nursing administrators aspiring to implement a constructive culture should emphasize people-centered values through a collective mission, strategic human resource management practices, and a patient service-oriented philosophy. Furthermore, constructive organizational cultures create successful high-performance work environments when nurses have positive colleague interactions and approach tasks in a manner that helps them experience self-actualization, while at the same time achieving organizational goals.
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This critical review focuses on the 12 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2000 and 2004. Although these new studies indicate further evidence of positive clinical and cost outcomes, the quantity and quality of such research continue to decline. When corporations and health plans are demanding more evidence-based outcomes, this decline in rigorous research marks a serious challenge to the field of health promotion and disease management.
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The purpose of this study was to explore relationships between senior management team culture and organizational performance in English hospital organizations (NHS trusts [National Health Service]). We used an established culture-rating instrument, the Competing Values Framework, to assess senior management team culture. Organizational performance was assessed using a wide variety of routinely collected measures. Data were gathered from all English NHS acute hospital trusts, a total of 197 organizations. Multivariate econometric analyses were used to explore the associations between measures of culture and measures of performance using regressions, ANOVA, multinomial logit, and ordered probit. Organizational culture varied across hospital organizations, and at least some of this variation was associated in consistent and predictable ways with a variety of organizational characteristics and measures of performance. The findings provide particular support for a contingent relationship between culture and performance.
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As the nation's hospitals face increasing demands to participate in a wide range of quality improvement activities, the role and influence of nurses in these efforts is also increasing, according to a new study by the Center for Studying Health System Change (HSC). Hospital organizational cultures set the stage for quality improvement and nurses' roles in those activities. Hospitals with supportive leadership, a philosophy of quality as everyone's responsibility, individual accountability, physician and nurse champions, and effective feedback reportedly offer greater promise for successful staff engagement in improvement activities. Yet hospitals confront challenges with regard to nursing involvement, including: scarcity of nursing resources; difficulty engaging nurses at all levels--from bedside to management; growing demands to participate in more, often duplicative, quality improvement activities; the burdensome nature of data collection and reporting; and shortcomings of traditional nursing education in preparing nurses for their evolving role in today's contemporary hospital setting. Because nurses are the key caregivers in hospitals, they can significantly influence the quality of care provided and, ultimately, treatment and patient outcomes. Consequently, hospitals' pursuit of high-quality patient care is dependent, at least in part, on their ability to engage and use nursing resources effectively, which will likely become more challenging as these resources become increasingly limited.
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