title: Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers.
abstract: BACKGROUND
  Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent.
  
  
  OBJECTIVE
  To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level.
  
  
  METHODS
  In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ≤ 18) and preventive quality management at ward level.
  
  
  RESULTS
  No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. β 0.32; p < 0.001).
  
  
  CONCLUSIONS
  Although the prevalence of nosocomial pressure ulcers varied considerably across wards, it did not relate to organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Bosch@iq.umcn.nl
authors.forename: Marije
authors.initials: M
authors.lastname: Bosch
authors.forename: Ruud J G
authors.initials: RJ
authors.lastname: Halfens
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Reinier
authors.initials: R
authors.lastname: Akkermans
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055318:Evidence-Based Nursing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009745:Nursing, Supervisory / Q000458:organization & administration / Q000592:standards; D009746:Nursing, Team / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D016134:Organizational Policy; D003668:Pressure Ulcer / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000379:methods*; D017751:Safety Management / Q000458:organization & administration