Influence of organizational culture on quality healthcare delivery.
OBJECTIVE
The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery.


METHODS
Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study.


RESULTS
Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery.


CONCLUSIONS
Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions.


CONCLUSIONS
Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.
School of Nursing, Royal College of Surgeons in Ireland, Dublin, Ireland. mariecarney@rcsi.ie
Marie
M
Carney
D003363:Cost Control; D006302:Health Services Research; D006739:Hospital Administration; D006801:Humans; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*