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Organizational Culture, Team Climate, and Quality Management in an Important Patient Safety Issue: Nosocomial Pressure Ulcers
Author(s) -
Bosch Marije,
Halfens Ruud J.G.,
Weijden Trudy van der,
Wensing Michel,
Akkermans Reinier,
Grol Richard
Publication year - 2011
Publication title -
worldviews on evidence‐based nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.052
H-Index - 49
eISSN - 1741-6787
pISSN - 1545-102X
DOI - 10.1111/j.1741-6787.2010.00187.x
Subject(s) - organizational culture , quality management , safety culture , quality (philosophy) , patient safety , business , safety climate , intensive care medicine , medicine , process management , environmental resource management , operations management , health care , public relations , political science , environmental science , engineering , management system , management , occupational safety and health , economics , pathology , law , philosophy , epistemology
Background: Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high‐quality care is inconsistent. Aims: To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. Methods: In this cross‐sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution‐level clustering. Data from 1,274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ≤ 18) and preventive quality management at ward level. Results: No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. β 0.32; p < 0.001). Conclusions and Implications: Although the prevalence of nosocomial pressure ulcers varied considerably across wards, it did not relate to organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross‐sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way.