Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
Implement Sci. 2011 Apr 3;6:33. doi: 10.1186/1748-5908-6-33.
Organisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. In recent years, increasing emphasis has been placed on the need to change organisational culture in order to improve healthcare performance. However, the precise function of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted have been called into question. The objective of this review was to determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance.
We searched the following electronic databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies (controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) analyses). Studies could be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome.
The search strategy yielded 4,239 records. After the full text assessment, two CBA studies were included in the review. They both assessed the impact of interventions aimed at changing organisational culture, but one evaluated the impact on work-related and personal outcomes while the other measured clinical outcomes. Both were at high risk of bias. Both reported positive results.
Current available evidence does not identify any effective, generalisable strategies to change organisational culture. Healthcare organisations considering implementing interventions aimed at changing culture should seriously consider conducting an evaluation (using a robust design, e.g., ITS) to strengthen the evidence about this topic.
组织文化是一个用于为研究和咨询提供信息并解释组织环境的人类学隐喻。近年来，越来越强调需要改变组织文化以提高医疗保健绩效。然而，组织文化在医疗保健政策中的具体作用往往仍未得到明确规定，并且所采用策略的可取性和可行性也受到了质疑。本综述的目的是确定改变组织文化以提高医疗保健绩效的策略的有效性。
我们搜索了以下电子数据库： Cochrane 对照试验中心注册库、MEDLINE、EMBASE、CINAHL、社会学文摘、Web of Knowledge、PsycINFO、商业与管理、ETHOS、论文索引、Intute、HMIC、SIGLE 和 Scopus，截至 2009 年 10 月。还对疗效评价数据库（DARE）进行了相关综述的搜索。我们还搜索了所有确定的论文和相关综述的参考文献，并就进一步的潜在研究向该领域的专家征求了意见。我们考虑了随机对照试验（RCTs）或设计良好的准实验研究（对照临床试验（CCTs）、对照前后研究（CBA）和中断时间序列（ITS）分析）。研究可以在任何类型的医疗保健组织中进行，以实施旨在改变组织文化以提高医疗保健绩效的策略。我们的主要结果是专业绩效和患者结果的客观测量。
搜索策略产生了 4239 条记录。经过全文评估，有两项 CBA 研究被纳入综述。它们都评估了旨在改变组织文化的干预措施的影响，但一项评估了对工作相关和个人结果的影响，而另一项则衡量了临床结果。两者都存在较高的偏倚风险。两者都报告了积极的结果。
目前可用的证据并未确定任何有效的、可推广的改变组织文化的策略。考虑实施旨在改变文化的干预措施的医疗保健组织应认真考虑进行评估（使用稳健的设计，例如 ITS），以加强有关这一主题的证据。
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