Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, Canada.
Health Care Manage Rev. 2010 Oct-Dec;35(4):301-11. doi: 10.1097/HMR.0b013e3181edd992.
Limited research has focused on the predictive nature of organizational culture and trust on registered nurses' perceived health care quality in reformed health care systems.
The purpose of this article was to investigate nurses' perceptions of organizational culture factors, trust in employer, and perceived health care quality during and 5 years after major organizational reform in the acute care setting and to test a model linking culture to perceived health care quality.
Survey data collected from two samples of nurses (N = 222,343) during and 5 years after major organizational reform in the acute care setting of one Canadian province were analyzed, and an exploratory model linking aspects of culture, trust, and quality was tested.
For both periods, most variable scores were in the low range and depicted moderately positive intercorrelations with each other. Support for the proposed model was mixed. Select culture variables predicted health care quality at both periods, but trust emerged as a significant predictor in 2000 only. The findings support the negative impact of system transformation on nurses and the link between culture and health care quality.
The study findings suggest that managers and policy makers must develop and implement supportive and nurturing strategies that will enhance the organizational culture (emotional climate, collaborative relations), which should result in more positive perceptions of health care quality. However, further research is required to gain a better understanding of the relationships among trust, organizational culture, and perceptions of health care quality and what implications this may or may not have for nursing practice.
有限的研究集中在组织文化和信任对改革后医疗保健系统中注册护士感知的医疗保健质量的预测性质上。
本文的目的是调查护士在急性护理环境中重大组织改革期间和之后 5 年内对组织文化因素、对雇主的信任以及对医疗保健质量的看法，并检验将文化与感知医疗保健质量联系起来的模型。
对来自加拿大一个省急性护理环境中重大组织改革期间和之后 5 年内的两批护士（N=222343）的调查数据进行了分析，并测试了一个将文化与信任和质量联系起来的探索性模型。
对于这两个时期，大多数变量得分都处于较低范围，并彼此之间呈现出适度的正相关性。对所提出模型的支持是混合的。在两个时期，选择文化变量都预测了医疗保健质量，但只有在 2000 年信任才成为一个重要的预测因素。这些发现支持了系统转型对护士的负面影响以及文化与医疗保健质量之间的联系。
研究结果表明，管理人员和政策制定者必须制定和实施支持性和培养性策略，以增强组织文化（情感氛围、协作关系），这应导致对医疗保健质量的更积极看法。然而，需要进一步研究以更好地了解信任、组织文化和医疗保健质量感知之间的关系，以及这可能对护理实践产生的影响。
