title: Organizational culture in cardiovascular care in Chinese hospitals: a descriptive cross-sectional study.
abstract: BACKGROUND
  Organizational learning, the process by which a group changes its behavior in response to newly acquired knowledge, is critical to outstanding organizational performance. In hospitals, strong organizational learning culture is linked with improved health outcomes for patients. This study characterizes the organizational learning culture of hospitals in China from the perspective of a cardiology service.
  
  
  METHODS
  Using a modified Abbreviated Learning Organization Survey (27 questions), we characterized organizational learning culture in a nationally representative sample of 162 Chinese hospitals, selecting 2 individuals involved with cardiovascular care at each hospital. Responses were analyzed at the hospital level by calculating the average of the two responses to each question. Responses were categorized as positive if they were 5+ on a 7-point scale or 4+ on a 5-point scale. Univariate and multiple regression analyses were used to assess the relationship between selected hospital characteristics and perceptions of organizational learning culture.
  
  
  RESULTS
  Of the 324 participants invited to take the survey, 316 responded (98 % response rate). Perceptions of organizational learning culture varied among items, among domains, and both among and within hospitals. Overall, the median proportion of positive responses was 82 % (interquartile range = 59 % to 93 %). "Training," "Performance Monitoring," and "Leadership that Reinforces Learning" were characterized as the most favorable domains, while "Time for Reflection" was the least favorable. Multiple regression analyses showed that region was the only factor significantly correlated with overall positive response rate.
  
  
  CONCLUSIONS
  This nationally representative survey demonstrated variation in hospital organizational learning culture among hospitals in China. The variation was not substantially explained by hospital characteristics. Organizational learning culture domains with lower positive response rates reveal important areas for improvement.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. emily.yin@yale.edu.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Yin
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. nicholas.downing@yale.edu.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Downing
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. lixi@fuwai.com.
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA. ssinger@hsph.harvard.edu.|Department of Medicine, Harvard Medical School, and Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA. ssinger@hsph.harvard.edu.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. leslie.curry@yale.edu.|Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA. leslie.curry@yale.edu.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. lijing@fuwai.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. harlan.krumholz@yale.edu.|Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. harlan.krumholz@yale.edu.|Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA. harlan.krumholz@yale.edu.|Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. jianglixin@fuwai.com.
authors.forename: Lixin
authors.initials: L
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002300:Cardiac Care Facilities / Q000458:organization & administration* / Q000639:trends; D002318:Cardiovascular Diseases / Q000628:therapy*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004526:Efficiency; D005260:Female; D006761:Hospitals; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000639:trends; D058996:Quality Improvement; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires