Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.
Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.
复制标题
影响护理质量的组织文化：围手术期抗生素使用的指南依从性。
DOI：
10.1093/intqhc/mzu091
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发表时间：
2015
影响因子：
2.6
通讯作者：
Imanaka Y.
中科院分区：
文献类型：
--
作者：
Ukawa N;Tanaka M;Morishima T;Imanaka Y.
目的本工作的目的是利用多中心、多维研究中的定量数据，阐明与围手术期抗生素预防中医院表现相关的组织文化的各个方面。设计使用调查数据和管理数据的横断面回顾性研究。设置日本83家急症医院。参与者共有4856名受访者参加组织文化研究，23 172名患者进行质量指标分析。主要结果测量各种文化的多层次模型使用维度来分析医院组织文化与指南遵守之间的关联。因变量是患者层面是否遵守日本和 CDC 指南，主要自变量是根据组织文化评分分类的医院群体。其他控制变量包括医院特征，如所有权、床位容量、地区和所在地的城市化水平。结果多层次分析显示，与得分较低的医院相比，组织文化得分高的医院更有可能遵守日本和疾病预防控制中心的指南。特别是，与低分医院相比，在“合作”和“专业成长”维度得分高的医院集团遵守日本指南的几率是低分医院的三倍。结论我们的研究表明，组织文化的各个方面与遵守围手术期抗生素使用指南相关。旨在提高护理质量的医院管理者可能会受益于改善医院组织文化。
ObjectiveThe objective of this work was to elucidate aspects of organizational culture associated with hospital performance in perioperative antibiotic prophylaxis using quantitative data in a multicenter and multidimensional study.DesignCross-sectional retrospective study using a survey data and administrative data.SettingEighty-three acute hospitals in Japan.ParticipantsA total of 4856 respondents in the organizational culture study, and 23 172 patients for the quality indicator analysis.Main Outcome MeasureMultilevel models of various cultural dimensions were used to analyze the association between hospital organizational culture and guideline adherence. The dependent variable was adherence or non-adherence to Japanese and CDC guidelines at the patient level and main independent variable was hospital groups categorized according to organizational culture score. Other control variables included hospital characteristics such as ownership, bed capacity, region and urbanization level of location.ResultsThe multilevel analysis showed that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals. In particular, the hospital group with high scores in the ‘collaboration’ and ‘professional growth’ dimensions had three times the odds for Japanese guideline adherence in comparison with low-scoring hospitals.ConclusionsOur study revealed that various aspects of organizational culture were associated with adherence to guidelines for perioperative antibiotic use. Hospital managers aiming to improve quality of care may benefit from improving hospital organizational culture.