Abstract
ObjectiveTo better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals.DesignA multi-method, multi-level, cross-sectional observational study.Setting and participantsAs part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees.Main outcome measuresExtent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities.ResultsAmong participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems.ConclusionThe type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.
Highlights
Many cultural aspects of health-care organizations are understood to be important in determining the quality of patient care—whether through fostering excellence or contributing to failure [1,2,3,4]
The final data set used for these analyses contains 158 hospitals for the analysis with the Quality Management System Index (QMSI) and 64 hospitals for analysis with Quality Management Compliance Index (QMCI) and Clinical Quality Implementation Index (CQII)
We found no associations between competing values framework (CVF) culture type and the implementation of quality management strategies as measured by the QMSI, QMCI and CQII (Tables 3–5)
Summary
Many cultural aspects of health-care organizations are understood to be important in determining the quality of patient care—whether through fostering excellence or contributing to failure [1,2,3,4]. Organizational culture (OC) represents the shared beliefs, values, attitudes, norms of behaviour of people in an organization and the established organizational routines, traditions, ceremonies and reward systems. OC defines legitimate and acceptable actions within an organization and encompasses the meanings that professionals and staff assign to their work. It is the social and normative ‘glue’ that binds people into collective enterprise; and it defines ‘the way things are done around here’. Previous research has found that a participative, flexible, risk-taking ‘developmental’ OC
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