title: The relationship between voice climate and patients' experience of timely care in primary care clinics.
abstract: BACKGROUND
  Aspects of the patient care experience, despite being central to quality care, are often problematic. In particular, patients frequently report problems with timeliness of care. As yet, research offers little insight on setting characteristics that contribute to patients' experience of timely care.
  
  
  OBJECTIVE
  The aims of this study were to assess the relationship between organizational climate and patients' reports of timely care in primary care clinics and to broadly examine the link between staff's work environment and patient care experiences. We test hypotheses about the relationship between voice climate--staff feeling safe to speak up about issues--and reported timeliness of care, consistency in reported voice climate across professions, and how climate differences for various professions relate to timely care.
  
  
  METHODS
  We conducted a cross-sectional study of employees (n = 1,121) and patients (n = 8,164) affiliated with 37 clinics participating in a statewide reporting initiative. Employees were surveyed about clinics' voice climate, and patients were surveyed about the timeliness of care. Hypotheses were tested using analysis of variance and generalized estimating equations.
  
  
  RESULTS
  Clinical and administrative staff (e.g., nurses and office assistants) reported clinics' climates to be significantly less supportive of voice than did clinical leaders (e.g., physicians). The greater the difference in reported support for voice between professional groups, the less patients reported experiencing timely care in three respects: obtaining an appointment, seeing the doctor within 15 minutes of appointment time, and receiving test results. In clinics where staff reported climates supportive of voice, patients indicated receiving more timely care. Clinical leaders' reports of voice climate had no relationship to reported timeliness of care.
  
  
  CONCLUSIONS
  Our findings suggest the importance of clinics developing a strong climate for voice, particularly for clinical and administrative staff, to support better service quality for patients.
authors.affiliation: Ingrid M. Nembhard, PhD, MS, is Associate Professor, Yale School of Public Health and Yale School of Management, New Haven, Connecticut. E-mail: ingrid.nembhard@yale.edu. Christina T. Yuan, MPH, MPhil, is PhD Candidate, Yale School of Public Health, New Haven, Connecticut. E-mail: christina.yuan@yale.edu. Veronika Shabanova, MPH, is PhD Candidate, Yale School of Public Health and Yale Center for Analytical Sciences, New Haven, Connecticut. E-mail: veronika.shabanova@yale.edu. Paul D. Cleary, PhD, is Anna M. R. Lauder Professor of Public Health and Dean, Yale School of Public Health, New Haven, Connecticut. E-mail: paul.cleary@yale.edu.
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Nembhard
authors.forename: Christina T
authors.initials: CT
authors.lastname: Yuan
authors.forename: Veronika
authors.initials: V
authors.lastname: Shabanova
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000458:organization & administration / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors; D055815:Young Adult