Association between organisational and workplace cultures, and patient outcomes: systematic review.
Association between organisational and workplace cultures, and patient outcomes: systematic review.
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DOI：
10.1136/bmjopen-2017-017708
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发表时间：
2017-11-08
期刊：
影响因子：
2.9
通讯作者：
Lamprell G
中科院分区：
文献类型：
--
作者：
Braithwaite J;Herkes J;Ludlow K;Testa L;Lamprell G
每个组织都有自己独特的文化。人们普遍认为，积极的组织文化与积极的患者预后有关。根据系统评价和荟萃分析的首选报告项目声明，我们系统地审查和综合了组织和工作场所文化与患者预后相关程度的证据。各种保健设施，包括医院、全科诊所、药房、军事医院、老年护理设施、心理健康和其他保健环境。纳入的文章在参与者方面是异质的。这是预料之中的，因为我们允许在审查中纳入广泛的卫生背景。患者结果，包括具体结果，如疼痛程度，以及更广泛的结果，如患者的经验。搜索策略确定了2049篇相关文章。使用纳入标准对摘要进行审查，获得204篇符合全文审查条件的文章。最后的分析包括62篇文章。我们评估了研究的偏倚风险和证据质量。大多数研究（84%）来自北美或欧洲，并在医院环境中进行（89%）。它们主要是定量的（94%）和横断面的（81%）。该综述确定了四项干预性研究，没有随机对照试验，但有许多高质量的社会科学研究。我们发现，总体而言，积极的组织和工作场所文化始终与一系列患者结果相关，例如降低死亡率、跌倒、医院获得性感染和提高患者满意度。综合来看，尽管没有一级证据，但我们的综述发现，在多个研究、环境和国家中，文化与结果之间始终存在正相关。这支持有利于促进积极文化活动的论点，以提高医疗保健组织的成果。
Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes. A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts. The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review. Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience. The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction. Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.
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