Organisational culture: Variation across hospitals and connection to patient safety climate

Department of Medicine, Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
Quality and Safety in Health Care (Impact Factor: 2.16). 12/2010; 19(6):592-6. DOI: 10.1136/qshc.2009.039511
Source: PubMed


Bureaucratic organisational culture is less favourable to quality improvement, whereas organisations with group (teamwork) culture are better aligned for quality improvement.
To determine if an organisational group culture shows better alignment with patient safety climate.
Cross-sectional administration of questionnaires. Setting 40 Hospital Corporation of America hospitals.
1406 nurses, ancillary staff, allied staff and physicians.
Competing Values Measure of Organisational Culture, Safety Attitudes Questionnaire (SAQ), Safety Climate Survey (SCSc) and Information and Analysis (IA).
The Cronbach alpha was 0.81 for the group culture scale and 0.72 for the hierarchical culture scale. Group culture was positively correlated with SAQ and its subscales (from correlation coefficient r = 0.44 to 0.55, except situational recognition), ScSc (r = 0.47) and IA (r = 0.33). Hierarchical culture was negatively correlated with the SAQ scales, SCSc and IA. Among the 40 hospitals, 37.5% had a hierarchical dominant culture, 37.5% a dominant group culture and 25% a balanced culture. Group culture hospitals had significantly higher safety climate scores than hierarchical culture hospitals. The magnitude of these relationships was not affected after adjusting for provider job type and hospital characteristics.
Hospitals vary in organisational culture, and the type of culture relates to the safety climate within the hospital. In combination with prior studies, these results suggest that a healthcare organisation's culture is a critical factor in the development of its patient safety climate and in the successful implementation of quality improvement initiatives.

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    • "Subscales within the SAQ include Teamwork, Safety Climate, Job Satisfaction, Perceptions of Management, Working Conditions, and Stress Recognition. The SAQ has been used to assess opportunities for quality improvement in obstetrical settings [4], intensive care units [5,6], within single institutions [7-9], in multicentre studies [10-12], children’s hospitals [13], the Veteran’s Administration [14] and increasingly in international settings [8,15]. The SAQ has been well-described [16-18]. "
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