title: Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.
abstract: OBJECTIVE
  We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations.
  
  
  METHODS
  We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model.
  
  
  CONCLUSIONS
  We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.
authors.affiliation: Department of Family Medicine, College Medicine, The Ohio State University, Columbus (Dr McAlearney); Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Switzerland (Dr McAlearney); Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus (Dr McAlearney); Center for Family Research, University of Georgia, Athens (Dr Terris); Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (Drs Terris and Baumgart); Warwick University, Warwick, United Kingdom (Drs Hardacre and Spurgeon); Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden (Drs Spurgeon, Brown, and Nyström); School of Public Health, Griffith University, Meadowbrook, Queensland, Australia (Dr Brown); Corporate Strategy and Development, Lucerne Canton Hospital, Lucerne, Switzerland (Dr Baumgart); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (Dr Nyström).
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
authors.forename: Darcey
authors.initials: D
authors.lastname: Terris
authors.forename: Jeanne
authors.initials: J
authors.lastname: Hardacre
authors.forename: Peter
authors.initials: P
authors.lastname: Spurgeon
authors.forename: Claire
authors.initials: C
authors.lastname: Brown
authors.forename: Andre
authors.initials: A
authors.lastname: Baumgart
authors.forename: Monica E
authors.initials: ME
authors.lastname: Nyström