Organizational culture, team climate and diabetes care in small office-based practices.
BACKGROUND
Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices.


METHODS
We conducted cross-sectional analyses of data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory) and organizational culture (Competing Values Framework), and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering.


RESULTS
A strong group culture was negatively associated to the quality of diabetes care provided to patients (beta = -0.04; p = 0.04), whereas a more 'balanced culture' was positively associated to diabetes care quality (beta = 5.97; p = 0.03). No associations were found between organizational culture, team climate and clinical patient outcomes.


CONCLUSIONS
Although some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea that aspects of redesigning care such as teamwork and culture can contribute to higher quality of care. Future research should preferably combine quantitative and qualitative methods, focus on possible mediating or moderating factors and explore the use of instruments more sensitive to measure such complex constructs in small office-based practices.
Bosch
Marije
M
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.bosch@iq.umcn.nl
Dijkstra
Rob
R
Wensing
Michel
M
van der Weijden
Trudy
T
Grol
Richard
R
D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006276:Health Facility Size; D006801:Humans; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011216:Practice Management, Medical / Q000592:standards*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000078329:Workforce