title: The associations between organizational culture, organizational structure and quality management in European hospitals.
abstract: OBJECTIVE
  To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals.
  
  
  METHODS
  A multi-method, multi-level, cross-sectional observational study.
  
  
  METHODS
  As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees.
  
  
  METHODS
  Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities.
  
  
  RESULTS
  Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems.
  
  
  CONCLUSIONS
  The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.
authors.affiliation: * P.O. Box 1568, 3500 BN Utrecht, The Netherlands. c.wagner@nivel.nl.
authors.forename: C
authors.initials: C
authors.lastname: Wagner
authors.forename: R
authors.initials: R
authors.lastname: Mannion
authors.forename: A
authors.initials: A
authors.lastname: Hammer
authors.forename: O
authors.initials: O
authors.lastname: Groene
authors.forename: O A
authors.initials: OA
authors.lastname: Arah
authors.forename: M
authors.initials: M
authors.lastname: Dersarkissian
authors.forename: R
authors.initials: R
authors.lastname: Suñol
mesh_terms: D005060:Europe; D006739:Hospital Administration; D006740:Hospital Administrators; D006761:Hospitals / Q000592:standards; D006769:Hospitals, General / Q000592:standards*; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011786:Quality Control; D012044:Regression Analysis
keywords: DUQuE; hospital; organizational culture; organizational structure; quality improvement; quality management