Organisational culture: variation across hospitals and connection to patient safety climate.
BACKGROUND
Bureaucratic organisational culture is less favourable to quality improvement, whereas organisations with group (teamwork) culture are better aligned for quality improvement.


OBJECTIVE
To determine if an organisational group culture shows better alignment with patient safety climate.


METHODS
Cross-sectional administration of questionnaires. Setting 40 Hospital Corporation of America hospitals.


METHODS
1406 nurses, ancillary staff, allied staff and physicians.


METHODS
Competing Values Measure of Organisational Culture, Safety Attitudes Questionnaire (SAQ), Safety Climate Survey (SCSc) and Information and Analysis (IA).


RESULTS
The Cronbach alpha was 0.81 for the group culture scale and 0.72 for the hierarchical culture scale. Group culture was positively correlated with SAQ and its subscales (from correlation coefficient r = 0.44 to 0.55, except situational recognition), ScSc (r = 0.47) and IA (r = 0.33). Hierarchical culture was negatively correlated with the SAQ scales, SCSc and IA. Among the 40 hospitals, 37.5% had a hierarchical dominant culture, 37.5% a dominant group culture and 25% a balanced culture. Group culture hospitals had significantly higher safety climate scores than hierarchical culture hospitals. The magnitude of these relationships was not affected after adjusting for provider job type and hospital characteristics.


CONCLUSIONS
Hospitals vary in organisational culture, and the type of culture relates to the safety climate within the hospital. In combination with prior studies, these results suggest that a healthcare organisation's culture is a critical factor in the development of its patient safety climate and in the successful implementation of quality improvement initiatives.
Department of Medicine, Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA. ted.speroff@vanderbilt.edu
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Speroff
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Nwosu
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Greevy
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Weinger
T R
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Talbot
R J
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Wall
J K
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Deshpande
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France
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Ely
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Burgess
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Englebright
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Williams
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Dittus
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D015279:Organizational Culture; D010564:Personnel, Hospital; D010818:Practice Patterns, Physicians'; D017751:Safety Management / Q000379:methods; D014481:United States