Isaacson Nicole, Roemheld-Hamm Beatrix, Crosson Jesse C, Dicicco-Bloom Barbara, Winston Carla A
Research Division, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, Somerset, NJ, USA.
Fam Med. 2009 Mar;41(3):202-7.
Low rates of influenza immunization among health care workers (HCWs) pose a potential health risk to patients in primary care practices. Despite previous educational efforts and programs to reduce financial barriers, HCW influenza immunization rates remain low. Variation in practice-level organizational culture may affect immunization rates. To explore this relationship, we examined organizational cultures and HCWs' influenza immunization behaviors in three family medicine practices.
We used a multi-method comparative case study. A field researcher used participant observation, in-depth interviews, and key informant interviews to collect data in each practice in November-December 2003. A diverse team used grounded theory to analyze text data.
Organizational culture varied among practices and differing HCW immunization rates were observed. The most structured and business-like practice achieved immunization of all HCWs, while the other two practices exhibited greater variation in HCW immunization rates. Physicians in the practices characterized as chaotic/disorganized or divided were immunized at higher rates than other members of the practices.
In these practices, organizational culture was associated with varying rates of influenza immunization for HCWs, especially among nonphysicians. Addressing elements of organizational culture such as beliefs regarding influenza immunization and office policies may facilitate the immunization of all staff members.
医护人员中流感疫苗接种率较低，这对基层医疗实践中的患者构成了潜在的健康风险。尽管此前开展了教育活动并实施了相关计划以减少经济障碍，但医护人员的流感疫苗接种率仍然很低。实践层面的组织文化差异可能会影响接种率。为了探究这种关系，我们考察了三家家庭医学诊所的组织文化及医护人员的流感疫苗接种行为。
我们采用了多方法比较案例研究。2003年11月至12月期间，一名实地研究人员在每家诊所运用参与观察、深度访谈和关键信息人访谈来收集数据。一个多元化的团队运用扎根理论分析文本数据。
各诊所的组织文化存在差异，且观察到医护人员的接种率也有所不同。结构最严谨、最具商业氛围的诊所实现了所有医护人员的疫苗接种，而另外两家诊所医护人员的接种率差异较大。在被描述为混乱/无序或分化的诊所中，医生的接种率高于诊所的其他成员。
在这些诊所中，组织文化与医护人员尤其是非医生人员的流感疫苗接种率差异相关。解决组织文化中的一些因素，如对流感疫苗接种的看法和办公政策，可能会促进所有工作人员的疫苗接种。
