Carney Marie
School of Nursing, Royal College of Surgeons in Ireland, Dublin, Ireland.
Int J Health Care Qual Assur. 2011;24(7):523-39. doi: 10.1108/09526861111160562.
The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery.
DESIGN/METHODOLOGY/APPROACH: Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study.
Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery.
RESEARCH LIMITATIONS/IMPLICATIONS: Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions.
ORIGINALITY/VALUE: Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.
本文旨在确定组织文化的各个方面是否可能揭示文化影响与优质医疗关系中的一个新领域。这项研究源于作者的信念，即认为部门负责人或主任的角色对医疗管理至关重要，这对医疗规划和优质医疗服务的提供至关重要。
设计/方法/途径：对爱尔兰急症医院中担任部门负责人的50名专业临床医生和非临床管理人员进行了访谈。样本取自先前一项调查研究中使用的850名管理人员的总体。
组织文化比以前认为的更为复杂。研究发现，诸如卓越的护理服务、道德价值观、参与度、专业精神、性价比、护理成本、对质量的承诺和战略思维等多种文化影响因素是优质护理服务的关键文化决定因素。
研究局限性/启示：医疗管理人员认为，为了提供以质量为重点的护理服务，他们需要以专业、尽责的方式行事，并将卓越置于护理服务的首位，同时能够应对成本效益与护理质量之间存在的紧张关系。这些紧张关系需要进一步研究，以确定护理质量是否会受到这些紧张关系的负面影响。
原创性/价值：原创性在于本文提出的新文化领域，该领域认识到卫生服务管理人员有潜力影响组织文化，并通过这种影响在确保为患者提供优质医疗服务方面发挥更大作用。将性价比视为提供医疗服务的一种道德方式，而不是质量与成本之间的冲突，这似乎也很重要。
