title: Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.
abstract: This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation.
authors.affiliation: Philadelphia VA Medical Center, Philadelphia, PA University of Pennsylvania, Philadelphia, PA.
authors.forename: Danijela
authors.initials: D
authors.lastname: Korom-Djakovic
authors.affiliation: Philadelphia VA Medical Center, Philadelphia, PA.
authors.forename: Anne
authors.initials: A
authors.lastname: Canamucio
authors.affiliation: Philadelphia VA Medical Center, Philadelphia, PA.
authors.forename: Michele
authors.initials: M
authors.lastname: Lempa
authors.affiliation: VA Greater Los Angeles Healthcare System, Sepulveda, CA UCLA Fielding School of Public Health, Los Angeles, CA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.affiliation: Philadelphia VA Medical Center, Philadelphia, PA University of Pennsylvania, Philadelphia, PA jalong@mail.med.upenn.edu.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
mesh_terms: D003142:Communication; D003151:Community Health Centers / Q000458:organization & administration; D003299:Cooperative Behavior; D007857:Leadership; D015279:Organizational Culture; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D018802:Patient-Centered Care / Q000458:organization & administration; D010465:Perception; D010561:Personnel Staffing and Scheduling; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000592:standards
keywords: Veterans Affairs; culture; organizational complexity; primary care; quality improvement