title: Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.
abstract: OBJECTIVE
  The objective of this work was to elucidate aspects of organizational culture associated with hospital performance in perioperative antibiotic prophylaxis using quantitative data in a multicenter and multidimensional study.
  
  
  METHODS
  Cross-sectional retrospective study using a survey data and administrative data.
  
  
  METHODS
  Eighty-three acute hospitals in Japan.
  
  
  METHODS
  A total of 4856 respondents in the organizational culture study, and 23 172 patients for the quality indicator analysis.
  
  
  METHODS
  Multilevel models of various cultural dimensions were used to analyze the association between hospital organizational culture and guideline adherence. The dependent variable was adherence or non-adherence to Japanese and CDC guidelines at the patient level and main independent variable was hospital groups categorized according to organizational culture score. Other control variables included hospital characteristics such as ownership, bed capacity, region and urbanization level of location.
  
  
  RESULTS
  The multilevel analysis showed that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals. In particular, the hospital group with high scores in the 'collaboration' and 'professional growth' dimensions had three times the odds for Japanese guideline adherence in comparison with low-scoring hospitals.
  
  
  CONCLUSIONS
  Our study revealed that various aspects of organizational culture were associated with adherence to guidelines for perioperative antibiotic use. Hospital managers aiming to improve quality of care may benefit from improving hospital organizational culture.
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Ukawa
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Morishima
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D019072:Antibiotic Prophylaxis; D003142:Communication; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006739:Hospital Administration / Q000592:standards*; D006742:Hospital Bed Capacity; D006801:Humans; D007588:Job Satisfaction; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care; D010067:Ownership; D019990:Perioperative Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012111:Residence Characteristics; D012189:Retrospective Studies
keywords: antibiotic use; health-care-associated infections; multilevel model; quality culture; quality indicators