Shortell S M, O'Brien J L, Carman J M, Foster R W, Hughes E F, Boerstler H, O'Connor E J
J.L. Kellogg Graduate School of Management, Northwestern University KGSM/HSM, Evanston, IL 60208-2007, USA.
Health Serv Res. 1995 Jun;30(2):377-401.
This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals.
Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions.
The study involved cross-sectional examination of the named relationships.
DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care.
A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation.
What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.
本研究调查了多达61家美国医院样本中组织文化、质量改进过程与选定结果之间的关系。
主要数据来自61家美国医院（主要位于中西部和西部），涉及与持续质量改进/全面质量管理（CQI/TQM）、组织文化、实施方法以及基于鲍德里奇奖标准的质量改进实施程度相关的指标。这些数据与独立收集的关于六种临床病症的感知影响和临床效率客观指标（即费用和住院时间）的数据相结合。
该研究对上述关系进行了横断面调查。
数据收集/提取方法：基于61家医院7000多名个体的回复，开发了可靠且有效的组织文化和质量改进实施指标量表，总体完成率为72%。关于感知影响的独立数据来自一项全国性调查，关于临床效率的独立数据来自一项配套的管理式医疗研究。
一种参与性、灵活性、敢于冒险的组织文化与质量改进实施显著相关。质量改进实施反过来又与更高的患者感知结果和人力资源发展呈正相关。规模较大的医院在费用和住院时间方面临床效率较低，部分原因是其拥有更多官僚化和层级化的文化，这对质量改进实施形成了障碍。
真正重要的是医院是否拥有支持质量改进工作的文化以及鼓励灵活实施的方法。规模较大的医院在这方面面临更艰巨的挑战。
