Measures of Organizational Culture and Climate in Primary Care: a Systematic Review

Influence of patient-oriented organizational climate on physicians' patient-centered behavior: The mediating role of patient-centeredness self-efficacy

OBJECTIVE

Existing literature highlights the benefits of organizational climate, but research gaps exist regarding how a patient-oriented organizational climate captures the sub-dimensions of physicians' patient-centered behavior. We explored the mediating role of patient-centeredness self-efficacy between them.

METHODS

Utilizing the Patient-Oriented Organizational Climate Scale, Self-efficacy in Patient-Centeredness Questionnaire, and Doctor Interaction Behavior Evaluation Scale, we surveyed 1394 physicians from grade ⅢA general hospitals in Guangdong Province, China from July to September 2022, employing stratified proportional sampling.

RESULTS

Patient-oriented organizational climate was positively associated with patient-centered behavior. Patient-centeredness self-efficacy partially mediated their relationship, with varying effects on different dimensions of patient-centered behavior; further, it could partially mediate the association between patient-oriented organizational climate and dialogue and transparency dimensions, but played a full mediating role between patient-oriented organizational climate and access and risk assessment dimensions.

CONCLUSION

These findings underscore the importance of establishing a patient-oriented organizational climate and fostering patient-centeredness self-efficacy in shaping patient-centered behavior, as they differ in impact on the dimensions of patient-centered behavior.

PRACTICE IMPLICATIONS

Targeted interventions are necessary to clarify the definitions of patient-centered behavior and consider it as a multidimensional construct.

An Exploratory Study to Understand the Climate That Creates Opportunities (Ba) for Physiotherapists to Develop Professionally: A Workplace Climate That Enhances the Sense of Self-Growth

OBJECTIVE

This study aimed to understand the climate that creates opportunities for physiotherapists to develop professionally by conducting an exploratory analysis of the workplace climate factors that enhance the sense of self-growth among them.

METHODS

We recruited participants from March to May 2023 through physiotherapists' networks and social media. Participants were sent a URL to access the study survey. A total of 357 Japanese physiotherapists who had provided their consent to participate in the survey engaged in the study. The questionnaire measured physiotherapists' subjective perception of their current workplace across three aspects: a sense of self-growth, satisfaction level, and stress level. Further, they were asked to rate three aspects of their workplace: climate, human relationships, and the learning environment. The respondents were also asked to rate their subjective impression of the climate at their current workplace on 10 four-point scales, each with antonymous adjectives at the ends of the scale: (1) bright-dark, (2) exciting-boring, (3) warm-cold, (4) strict-loose, (5) honest-dishonest, (6) open-closed, (7) diligent-lazy, (8) passionate-apathetic, (9) cooperative-uncooperative, and (10) autonomous-heteronomous. Exploratory analysis was conducted to examine the relationship between each item and physiotherapists' sense of self-growth. We formatted the scale responses as a 0-1 binary prior to analysis to minimize ambiguity in the response data. Binary logistic regression was performed, with the cutoff for statistical significance set at 5%.

RESULTS

Sense of self-growth was significantly associated with a positive learning environment (β=0.41, OR=2.28, p<0.01). The learning environment was significantly associated with strictness (β=0.28, OR=1.89, p<0.05) and diligence (β=0.78, OR=4.90, p<0.01). The results suggest that a positive learning environment is essential for enhancing physiotherapists' sense of self-growth; to create such an environment, fostering a climate that is perceived as strict and diligent is important.

CONCLUSIONS

A positive learning environment is essential for the development of physiotherapists' sense of self-growth; to create such an environment, fostering a culture that is recognized as strict and diligent is crucial. Therefore, when developing workplace policies and training strategies, the following aspects must be considered: it is important to create a management and guidance system that fosters a workplace environment where it is easier to learn and that recognizes the importance of strictness and diligence in work.

Using an organizational framework to drive change in nursing education: An action plan for nurse leaders

BACKGROUND

Organizational change within nursing schools that supports growth of students, faculty, and staff from underrepresented groups occurs through purposeful strategies and commitments to building capacity for the spectra and richness of diverse perspectives.

PURPOSE

To evaluate framework-guided initiatives, our organization implemented to advance diversity, equity, and inclusion to achieve inclusive excellence in nursing education and leadership.

METHODS

Framework-guided initiatives include a standardized diversity education model, hiring bias mitigation strategies, equitable spending, partnerships for student and faculty recruitment, and restructuring committees to include diverse perspectives. Metrics were ascertained over 3years following framework implementation.

DISCUSSION

The findings indicate the framework provides an intentional, actionable, and scalable approach for leaders driving change toward inclusivity that can be measured to promote accountability.

Junior doctors' workplace well-being and the determinants based on ability-motivation-opportunity (AMO) theory: Educational and managerial implications from a three-year longitudinal observation after graduation

PURPOSE

Junior doctors function as trainees from an educational perspective and as employees from a human resource management perspective. Employing the ability-motivation-opportunity (AMO) theory as a conceptual framework, this study longitudinally investigated the factors affecting the workplace well-being and career progression of junior doctors over a 3-year period following their graduation from medical schools.

MATERIALS AND METHODS

This 3-year prospective cohort study enrolled junior doctors who graduated from 2 medical schools in June 2019 in Taiwan. This study collected data by implementing web-based, self-administered structured questionnaires at 3-month intervals between September 2019 and July 2022. The collected data encompassed ability indicators (i.e. academic performance and perceived preparedness for clinical practice), motivation indicators (i.e. educational and clinical supervision), opportunity indicators (i.e. clinical unit cultures), and workplace well-being indicators (i.e. burnout, compassion satisfaction, and job performance). A total of 107 junior doctors participated, providing 926 total responses. The data were analysed using univariate analyses and structural equation modelling with path analysis.

RESULTS

Over the 3-year period following graduation, the junior doctors' confidence in their preparedness for clinical practice and the educational and clinical supervision had varying degrees of influence on the junior doctors' workplace well-being. The influence of clinical unit cultures, which can provide opportunities for junior doctors, became evident starting from the second year postgraduation; notably, unit cultures that emphasised flexibility and discretion played positive and critical roles in enhancing the junior doctors' workplace well-being lasted to the third year.

CONCLUSIONS

Our findings provide insights into the distinct critical factors that affect the socialisation of junior doctors within workplace environments over 3 consecutive years. These findings can provide guidance for medical educators and healthcare managers, helping them understand and support the progressive integration of junior doctors into their work environments.

Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation

Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.

Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients

BACKGROUND

Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases.

METHODS

Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores.

RESULTS

After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23).

CONCLUSIONS

As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.

Implementation of an Enculturation Toolkit for New Nurses During Unit Onboarding

OBJECTIVE

This quality improvement project targeted an enculturation gap among new nurses by assembling and piloting an Enculturation Toolkit.

BACKGROUND

Enculturation of new nurses contributes to engagement, performance, sense of belonging, and retention. During the COVID-19 pandemic, orientation was shortened, virtual, and asynchronous, creating a gap in enculturation.

METHODS

New nurses and their preceptors were surveyed at baseline, 2 to 3 months, and 4 to 5 months to measure engagement and enculturation using the Meaning and Joy in Work Questionnaire (MJWQ) and questions about the history and values of the organization.

RESULTS

Initial MJWQ responses were high and sustained throughout the study period. Participants demonstrated increased knowledge of the organization's mission statement and logo. New nurses rated the toolkit activities favorably, with an average score of 4.6 out of 5.

CONCLUSIONS

An Enculturation Toolkit was effective in improving knowledge about the organization and sustaining engagement and belonging.

Dynamics of organizational climate and job satisfaction in healthcare service practice and research: a protocol for a systematic review

Organizational climate and job satisfaction have been established as fundamental pillars of research and practice in organizational behavior and organizational psychology, inspiring many explanations and operationalizations over time. In most sectors, global trends such as labor shortages, high rates of turnover and absenteeism, the need to increase productivity, and the interest in new work models concur to keep climate and job satisfaction on top of the research agenda. The situation is particularly acute in the healthcare sector, where related factors have the capacity to influence all aspects of care provision, including patient safety and the physical and mental health of care providers. Nevertheless, a gap in knowledge persists regarding climate, job satisfaction, and their relationships in healthcare services. This protocol describes a study that aims to examine the dynamics of climate and job satisfaction in healthcare organizations from the practice and research perspectives. The protocol complies with PRISMA-P. PRISMA will be used to report the results of the study. Databases will be searched for published studies in May 2023, and we expect to complete the study by December 2024. A framework based on a multi-dimensional concept of quality in research will be used to examine the quality of any studies before inclusion. The results will be disseminated in two systematic reviews. We will describe proposed models depicting the dynamics of climate and job satisfaction in healthcare organizations. We will systematize and discuss available evidence regarding the outcomes of climate and job satisfaction in healthcare work environments. We will synthesize information on research designs and methodological options of included studies. We will identify measures of climate and job satisfaction used in healthcare settings, assess their psychometric properties, and appraise the overall quality of underlying studies. Finally, we expect to identify areas in need of further research.

Creating an Organizational Culture and Climate of Meaningful Recognition for Nurse Managers

OBJECTIVES

To examine the current nurse manager (NM) recognition culture and climate in organizations and to develop a theoretical foundation for meaningful recognition.

BACKGROUND

Nurse managers call for wider recognition, but the theoretical conceptualization and underpinnings of meaningful recognition are sparse in the literature.

METHODS

A qualitative descriptive design was used utilizing individual interviews. The study participants included 30 individuals consisting of NMs, chief nursing officers, and chief nursing executives. Content analysis was conducted.

RESULTS

A theoretical model with super-categories and supportive quotes was created to operationalize a culture and climate of meaningful recognition in the organizations represented by the sample.

CONCLUSION

This qualitative descriptive study highlights the importance of recognizing the value of NMs for their contributions to nursing leadership and patient care. Implications of recognizing NMs are counteracting the feeling of being invisible and mitigating issues within the work environment.

Measuring Organizational Culture in Ethiopia's Primary Care System: Validation of a Practical Survey Tool for Managers

BACKGROUND

Organizational culture has been widely recognized as predictive of health system performance and improved outcomes across various healthcare settings. Research on organizational culture in healthcare has been largely conducted in high-income settings, and validated scales to measure this concept in primary healthcare systems in low- and middle-income country (LMIC) settings are lacking. Our study aimed to validate a tool to measure organizational culture in the context of the Ethiopian Primary Healthcare Transformation Initiative (PTI), a collaborative of the Federal Ministry of Health (FMoH) and the Yale Global Health Leadership Initiative to strengthen primary healthcare system performance in Ethiopia.

METHODS

Following established survey development and adaptation guidelines, we adapted a 31-item US-based organizational culture scale using (1) cognitive interviewing, (2) testing with 1176 district and zonal health officials from four regions in Ethiopia, and (3) exploratory factor analysis (EFA).

RESULTS

Based on the results of cognitive interviewing, an adapted 30-item survey was piloted. The factor analyses of 1034 complete surveys (88% complete responses) identified five constructs of the scale which demonstrated strong validity and internal consistency: learning and problem solving, psychological safety, resistance to change, time for improvement, and commitment to the organization. Of the 30 a priori items, 26 items loaded well on the five constructs (loading values 0.40-0.86), and 4 items failed to load. Cronbach alpha coefficients were 0.86 for the scale as a whole and ranged from 0.65 to 0.90 for the subscales. The five-factor solution accounted for 62% of total variance in culture scores across respondents.

CONCLUSION

Through validation and factor analyses, we generated a 26-item scale for measuring organizational culture in public primary healthcare systems in LMIC settings. This validated tool can be useful for managers, implementers, policy-makers, and researchers to assess and improve organizational culture in support of improved primary healthcare system performance.

Association Between Availability of Women's Health Services and Women Veterans' Care Experiences

INTRODUCTION

Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences.

METHODS

In a cross-sectional analysis, we linked Fiscal Year 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Health care Experiences of Patients-Patient Centered Medical Home (2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient-provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics.

RESULTS

A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01-1.10), provider communication (AOR, 1.08; 95% CI, 1.002-1.16), and primary care provider (AOR, 1.07; 95% CI, 1.02-1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88-0.99).

CONCLUSION

For the most part, routine availability of women's health services in VA primary care clinics enhanced women's health care experiences. These empirical findings offer health care leaders evidence-based approaches for improving women's care experiences.

Primary Care Nurse Practitioner Work Environments and Hospitalizations and ED Use Among Chronically Ill Medicare Beneficiaries

BACKGROUND

Nurse practitioners (NPs) play a critical role in delivering primary care, particularly to chronically ill elderly. Yet, many NPs practice in poor work environments which may affect patient outcomes.

OBJECTIVE

We investigated the relationship between NP work environments in primary care practices and hospitalizations and emergency department (ED) use among chronically ill elderly.

RESEARCH DESIGN

We used a cross-sectional design to collect survey data from NPs about their practices. The survey data were merged with Medicare claims data.

SUBJECTS

In total, 979 primary care practices employing NPs and delivering care to chronically ill Medicare beneficiaries (n=452,931) from 6 US states were included.

MEASURES

NPs completed the Nurse Practitioner-Primary Care Organizational Climate Questionnaire-a valid and reliable measure for work environment. Data on hospitalizations and ED use was obtained from Medicare claims. We used Cox regression models to estimate risk ratios.

RESULTS

After controlling for covariates, we found statistically significant associations between practice-level NP work environment and 3 outcomes: Ambulatory Care Sensitive (ACS) ED visits, all-cause ED visits, and all-cause hospitalizations. With a 1-unit increase in the work environment score, the risk of an ACS-ED visit decreased by 4.4% [risk ratio (RR)=0.956; 99% confidence interval (CI): 0.918-0.995; P=0.004], an ED visit by 3.5% (RR=0.965; 99% CI: 0.933-0.997; P=0.005), and a hospitalization by 4.0% (RR=0.960;99% CI: 0.928-0.993; P=0.002). There was no relationship between NP work environment and ACS hospitalizations.

CONCLUSION

Favorable NP work environments are associated with lower hospital and ED utilization. Practice managers should focus on NP work environments in quality improvement strategies.