Organizational culture, team climate and diabetes care in small office-based practices
Organizational culture, team climate and diabetes care in small office-based practices
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DOI：
10.1186/1472-6963-8-180
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发表时间：
2008-08-21
影响因子：
2.8
通讯作者：
Grol, Richard
中科院分区：
文献类型：
--
作者：
Bosch, Marije;Dijkstra, Rob;Grol, Richard
背景：重新设计护理已被提议作为改善慢性病护理的杠杆。在初级保健中，糖尿病护理是重组综合护理的最广泛的例子。我们的目标是评估在多大程度上，重组护理的重要方面，如多学科团队合作和不同类型的组织文化与小型办公室为基础的全科诊所的高质量糖尿病护理相关。方法：我们对来自荷兰30个初级保健机构的83名参与糖尿病护理的卫生保健专业人员的数据进行了横断面分析，共有752名II型糖尿病患者参与了改善研究。我们使用了自我报告的团队气氛（团队气氛清单）和组织文化（竞争价值观框架）的措施，以及糖尿病护理质量和来自医疗记录和自我报告的临床患者特征的措施。我们对文化、气候和HbA 1c、总胆固醇、收缩压以及糖尿病护理质量过程指标的总分之间的关系进行了多变量分析，调整了潜在的患者和实践水平混杂因素以及实践水平聚类。结果：强大的群体文化与为患者提供的糖尿病护理质量呈负相关（beta= -0.04; p = 0.04），而更“平衡的文化”与糖尿病护理质量呈正相关（beta = 5.97; p = 0.03）。组织文化，团队气氛和临床patient outcomes.Conclusion之间没有发现关联：虽然一些显着的协会之间发现高质量的糖尿病护理在一般的做法和不同的组织文化，关系是相当边缘。临床患者结局的变化不能归因于组织文化或团队合作。因此，这项研究有助于讨论的合法性的广泛的想法，重新设计的照顾，如团队合作和文化的方面，可以有助于更高质量的护理。今后的研究最好将联合收割机的定量和定性方法结合起来，重点放在可能的中介或调节因素上，并探讨如何使用更敏感的工具来衡量小型办事处做法中的这种复杂结构。
Background: 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.Methods: We 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.Results: A strong group culture was negatively associated to the quality of diabetes care provided to patients (beta= -0.04; p = 0.04), whereas a more 'balanced culture' was positively associated to diabetes care quality (beta = 5.97; p = 0.03). No associations were found between organizational culture, team climate and clinical patient outcomes.Conclusion: Although 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.