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Qual Saf Health Care 19:592-596 doi:10.1136/qshc.2009.039511
  • Error management

Organisational culture: variation across hospitals and connection to patient safety climate

  1. R S Dittus1,2,10
  1. 1Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Tennessee, USA
  2. 2Division of General Internal Medicine and Center for Health Services Research, Vanderbilt University School of Medicine, Tennessee, USA
  3. 3Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Tennessee, USA
  4. 4Department of Biostatistics, Vanderbilt University School of Medicine, Tennessee, USA
  5. 5Department of Anesthesiology, Vanderbilt University School of Medicine, Tennessee, USA
  6. 6Departments of Biomedical Informatics and Medical Education, Vanderbilt University School of Medicine, Tennessee, USA
  7. 7Division of Infectious Diseases, Departments of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Tennessee, USA
  8. 8Division of Paediatric Critical Care, Department of Pediatrics, Monroe Carell Jr Children's Hospital, Vanderbilt University School of Medicine, Tennessee, USA
  9. 9Center for Perioperative Research in Quality, Vanderbilt University School of Medicine, Tennessee, USA
  10. 10Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Tennessee, USA
  11. 11Pulmonary, Critical Care and Sleep Disorders Medicine, Southlake Clinic, Valley Medical Center, Washington, USA
  12. 12Department of Quality, Safety, and Performance Improvement, Hospital Corporation of America (HCA), Tennessee, USA
  13. 13Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Illinois, USA
  1. Correspondence to Dr Ted Speroff, Department of Medicine, Center for Health Services Research, 6000 Medical Center East, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; ted.speroff{at}vanderbilt.edu
  1. Contributors TS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TS, EWE, RG, MBW, TRT, JKD, DJF, RSD. Acquisition of data: TS, RG, DJF, HB, JE, MVW. Analysis and interpretation of data: TS, EWE, RG, MBW, TRT, RJW, JKD, DJF, SN, MVW. Drafting of the manuscript: TS. Critical revision of the manuscript for important intellectual content: EWE, RG, MBW, TRT, RJW, JKD, DJF, SN, HB, JE, MVW, RSD. Statistical analysis: TS, RG, SN. Obtained funding: TS, EWE, MBW, TRT, RJW, JKD, DJF, RSD. Administrative, technical or material support: EWE, MBW, TRT, RJW, JKD, DJF, HB, JE, MVW, RSD. Study supervision: TS, JE.

  • Accepted 19 July 2010

Abstract

Context Bureaucratic organisational culture is less favourable to quality improvement, whereas organisations with group (teamwork) culture are better aligned for quality improvement.

Objective To determine if an organisational group culture shows better alignment with patient safety climate.

Design Cross-sectional administration of questionnaires.

Setting 40 Hospital Corporation of America hospitals.

Participants 1406 nurses, ancillary staff, allied staff and physicians.

Main outcome measures Competing Values Measure of Organisational Culture, Safety Attitudes Questionnaire (SAQ), Safety Climate Survey (SCSc) and Information and Analysis (IA).

Results The Cronbach alpha was 0.81 for the group culture scale and 0.72 for the hierarchical culture scale. Group culture was positively correlated with SAQ and its subscales (from correlation coefficient r=0.44 to 0.55, except situational recognition), ScSc (r=0.47) and IA (r=0.33). Hierarchical culture was negatively correlated with the SAQ scales, SCSc and IA. Among the 40 hospitals, 37.5% had a hierarchical dominant culture, 37.5% a dominant group culture and 25% a balanced culture. Group culture hospitals had significantly higher safety climate scores than hierarchical culture hospitals. The magnitude of these relationships was not affected after adjusting for provider job type and hospital characteristics.

Conclusions Hospitals vary in organisational culture, and the type of culture relates to the safety climate within the hospital. In combination with prior studies, these results suggest that a healthcare organisation's culture is a critical factor in the development of its patient safety climate and in the successful implementation of quality improvement initiatives.

Footnotes

  • Funding This project was supported by Partnerships in Implementing Patient Safety (PIPS) from the Agency for Healthcare Research and Quality (AHRQ), Grant Award Number: U18 HS015934.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Vanderbilt University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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