title: Organizational culture: an important context for addressing and improving hospital to community patient discharge.
abstract: BACKGROUND
  Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown.
  
  
  OBJECTIVE
  To explore aspects of organizational culture to develop a deeper understanding of the discharge process.
  
  
  METHODS
  A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data.
  
  
  METHODS
  In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses.
  
  
  RESULTS
  Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices.
  
  
  CONCLUSIONS
  On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.hesselink@iq.umcn.nl
authors.forename: Gijs
authors.initials: G
authors.lastname: Hesselink
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: Loes
authors.initials: L
authors.lastname: Pijnenborg
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
authors.forename: Petra
authors.initials: P
authors.lastname: Gademan
authors.forename: Ewa
authors.initials: E
authors.lastname: Dudzik-Urbaniak
authors.forename: Maria
authors.initials: M
authors.lastname: Flink
authors.forename: Carola
authors.initials: C
authors.lastname: Orrego
authors.forename: Giulio
authors.initials: G
authors.lastname: Toccafondi
authors.forename: Julie K
authors.initials: JK
authors.lastname: Johnson
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D005060:Europe; D006739:Hospital Administration; D006801:Humans; D015279:Organizational Culture; D010351:Patient Discharge; D061214:Patient Safety; D011446:Prospective Studies; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*