Organizational culture, team climate and diabetes care in small office-based practices

Marije Bosch,Rob Dijkstra,Richard Grol,Trudy Van Der Weijden,Michel Wensing

doi:10.1186/1472-6963-8-180

Abstract

BackgroundRedesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices.MethodsWe conducted cross-sectional analyses of data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory) and organizational culture (Competing Values Framework), and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering.ResultsA strong group culture was negatively associated to the quality of diabetes care provided to patients (β = -0.04; p = 0.04), whereas a more 'balanced culture' was positively associated to diabetes care quality (β = 5.97; p = 0.03). No associations were found between organizational culture, team climate and clinical patient outcomes.ConclusionAlthough some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea that aspects of redesigning care such as teamwork and culture can contribute to higher quality of care. Future research should preferably combine quantitative and qualitative methods, focus on possible mediating or moderating factors and explore the use of instruments more sensitive to measure such complex constructs in small office-based practices.

Highlights

Redesigning care has been proposed as a lever for improving chronic illness care
The analysis on organizational culture and team climate was restricted to the practices in which at least two practice members returned the questionnaires
We found that high group culture scores were negatively correlated with adherence to diabetes guidelines in primary care practice (β = -0.04), whereas maintaining a balance among the different types of culture on the other hand was positively correlated to managing diabetes care well (β = 5.97)

Summary

Introduction

Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices. Redesigning primary care by separating acute care from planned management of chronic conditions has been proposed to close the quality chasm between current practices and optimal standards [3]. Key elements of teamwork, such as sharing clear goals, division of labour, training and communication [8] are suspected to potentially improve care for these patients [7,9]. A related construct that is increasingly described in quality improvement research is organizational culture. Some studies showed that organizational cultures that support teamwork and quality improvement may contribute to achieving high quality care [17,18,19,20]. It has been shown that a mix of cultures was associated with higher levels of team effectiveness [21], whereas several other studies failed to find associations between culture and performance [22,23]

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