The association between culture, climate and quality of care in primary health care teams.
BACKGROUND
Culture and climate represent shared beliefs and values that may influence quality of care in health care teams, and which could be manipulated for quality improvement. However, there is a lack of agreement on the theoretical and empirical relationships between climate and culture, and their relative power as predictors of quality of care. This study sought to examine the association between self-report measures of climate and culture in primary care teams and comprehensive measures of quality of care.


METHODS
The data were derived from a cross-sectional survey of 492 professionals in 42 general practices in England. Self-report measures of culture (the Competing Values Framework) and climate (the Team Climate Inventory) were used, together with validated measures of quality of care from medical records and self-report.


RESULTS
The majority of practices could be characterized as 'clan' culture type. Practices with a dominant clan culture scored higher on climate for participation and teamwork. There were no associations between culture and quality of care, and only limited evidence of associations between climate and quality.


CONCLUSIONS
The current analysis would not support the hypothesis that culture and climate are important predictors of quality of care in primary care. Although larger studies are required to provide a definitive test, the results may suggest the need for a more complex model of the associations between culture, climate and outcomes, and further research may be required into the interaction between culture and climate with other determinants of behaviour such as internal and external incentives.
Hann
Mark
M
National Primary Care Research and Development Centre, 5th Floor - Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL.
Bower
Peter
P
Campbell
Stephen
S
Marshall
Martin
M
Reeves
David
D
D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice; D006801:Humans; D007400:Interprofessional Relations; D008485:Medical Audit; D015279:Organizational Culture; D010348:Patient Care Team; D011320:Primary Health Care; D011787:Quality of Health Care; D013222:State Medicine