Hann Mark, Bower Peter, Campbell Stephen, Marshall Martin, Reeves David
National Primary Care Research and Development Centre, 5th Floor - Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL.
Fam Pract. 2007 Sep;24(4):323-9. doi: 10.1093/fampra/cmm020. Epub 2007 Jun 24.
Culture and climate represent shared beliefs and values that may influence quality of care in health care teams, and which could be manipulated for quality improvement. However, there is a lack of agreement on the theoretical and empirical relationships between climate and culture, and their relative power as predictors of quality of care. This study sought to examine the association between self-report measures of climate and culture in primary care teams and comprehensive measures of quality of care.
The data were derived from a cross-sectional survey of 492 professionals in 42 general practices in England. Self-report measures of culture (the Competing Values Framework) and climate (the Team Climate Inventory) were used, together with validated measures of quality of care from medical records and self-report.
The majority of practices could be characterized as 'clan' culture type. Practices with a dominant clan culture scored higher on climate for participation and teamwork. There were no associations between culture and quality of care, and only limited evidence of associations between climate and quality.
The current analysis would not support the hypothesis that culture and climate are important predictors of quality of care in primary care. Although larger studies are required to provide a definitive test, the results may suggest the need for a more complex model of the associations between culture, climate and outcomes, and further research may be required into the interaction between culture and climate with other determinants of behaviour such as internal and external incentives.
文化和氛围代表着共同的信念和价值观，可能会影响医疗团队的护理质量，并且可以通过调整来改善质量。然而，对于氛围和文化之间的理论及实证关系，以及它们作为护理质量预测指标的相对影响力，目前尚无定论。本研究旨在探讨基层医疗团队中自我报告的氛围和文化测量指标与综合护理质量测量指标之间的关联。
数据来源于对英格兰42家全科诊所的492名专业人员进行的横断面调查。使用了文化（竞争价值观框架）和氛围（团队氛围量表）的自我报告测量指标，以及来自病历和自我报告的经过验证的护理质量测量指标。
大多数诊所可被归类为“家族”文化类型。主导文化为家族文化的诊所在参与度和团队合作氛围方面得分更高。文化与护理质量之间没有关联，氛围与质量之间仅有有限的关联证据。
目前的分析不支持文化和氛围是基层医疗护理质量重要预测指标的假设。尽管需要更大规模的研究来进行确定性检验，但结果可能表明需要一个更复杂的模型来解释文化、氛围和结果之间的关联，并且可能需要进一步研究文化和氛围与其他行为决定因素（如内部和外部激励）之间的相互作用。
