title: Predictors of perceived health care quality for registered nurses during and after health care reform.
abstract: BACKGROUND
  Limited research has focused on the predictive nature of organizational culture and trust on registered nurses' perceived health care quality in reformed health care systems.
  
  
  OBJECTIVE
  The purpose of this article was to investigate nurses' perceptions of organizational culture factors, trust in employer, and perceived health care quality during and 5 years after major organizational reform in the acute care setting and to test a model linking culture to perceived health care quality.
  
  
  METHODS
  Survey data collected from two samples of nurses (N = 222,343) during and 5 years after major organizational reform in the acute care setting of one Canadian province were analyzed, and an exploratory model linking aspects of culture, trust, and quality was tested.
  
  
  RESULTS
  For both periods, most variable scores were in the low range and depicted moderately positive intercorrelations with each other. Support for the proposed model was mixed. Select culture variables predicted health care quality at both periods, but trust emerged as a significant predictor in 2000 only. The findings support the negative impact of system transformation on nurses and the link between culture and health care quality.
  
  
  CONCLUSIONS
  The study findings suggest that managers and policy makers must develop and implement supportive and nurturing strategies that will enhance the organizational culture (emotional climate, collaborative relations), which should result in more positive perceptions of health care quality. However, further research is required to gain a better understanding of the relationships among trust, organizational culture, and perceptions of health care quality and what implications this may or may not have for nursing practice.
authors.affiliation: Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, Canada. dgregory@mun.ca
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Gregory
authors.forename: Christine Y
authors.initials: CY
authors.lastname: Way
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Barrett
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Parfrey
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D002170:Canada; D003299:Cooperative Behavior; D003625:Data Collection; D005544:Forecasting; D018166:Health Care Reform / Q000592:standards*; D006306:Health Surveys; D006761:Hospitals; D006801:Humans; D007400:Interprofessional Relations; D017146:Models, Organizational; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D015279:Organizational Culture; D009936:Organizational Innovation; D016134:Organizational Policy; D011787:Quality of Health Care