NIVEL Netherlands Institute for Health Services Research, Utrecht, The NetherlandsDepartment of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
Health Services Management Centre, University of Birmingham, Birmingham B15 2RT, UK
Faculty of Human Science and Faculty of Medicine, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USAUCLA Center for Health Policy Research, Los Angeles, CA, USA
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, SpainRed de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
Objective To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals.
Design A multi-method, multi-level, cross-sectional observational study.
Setting and participants As 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 measures Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities.
Results Among 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.
Conclusion The 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.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.