title: Organizational culture influences health care workers' influenza immunization behavior.
abstract: OBJECTIVE
  Low rates of influenza immunization among health care workers (HCWs) pose a potential health risk to patients in primary care practices. Despite previous educational efforts and programs to reduce financial barriers, HCW influenza immunization rates remain low. Variation in practice-level organizational culture may affect immunization rates. To explore this relationship, we examined organizational cultures and HCWs' influenza immunization behaviors in three family medicine practices.
  
  
  METHODS
  We used a multi-method comparative case study. A field researcher used participant observation, in-depth interviews, and key informant interviews to collect data in each practice in November-December 2003. A diverse team used grounded theory to analyze text data.
  
  
  RESULTS
  Organizational culture varied among practices and differing HCW immunization rates were observed. The most structured and business-like practice achieved immunization of all HCWs, while the other two practices exhibited greater variation in HCW immunization rates. Physicians in the practices characterized as chaotic/disorganized or divided were immunized at higher rates than other members of the practices.
  
  
  CONCLUSIONS
  In these practices, organizational culture was associated with varying rates of influenza immunization for HCWs, especially among nonphysicians. Addressing elements of organizational culture such as beliefs regarding influenza immunization and office policies may facilitate the immunization of all staff members.
authors.affiliation: Research Division, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, Somerset, NJ, USA. nisaacso@echo.rutgers.edu
authors.forename: Nicole
authors.initials: N
authors.lastname: Isaacson
authors.forename: Beatrix
authors.initials: B
authors.lastname: Roemheld-Hamm
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: Barbara
authors.initials: B
authors.lastname: Dicicco-Bloom
authors.forename: Carla A
authors.initials: CA
authors.lastname: Winston
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D017598:Efficiency, Organizational; D015438:Health Behavior; D006282:Health Personnel; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007251:Influenza, Human / Q000517:prevention & control*; D015279:Organizational Culture