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The influence of hospital accreditation: a longitudinal assessment of organisational culture.

ABSTRACT: BACKGROUND:A growing body of evidence supports the link between hospital organisational culture and health outcomes. Organisational culture is thus an essential consideration for hospital accreditation, a practice of systematically assessing the quality of hospital care against accepted standards. This study assesses the interplay between accreditation and hospital professional staff perception of organisational culture. METHODS:A prospective cohort study design was used to explore the influence of accreditation on organisational culture within a large, publicly-funded, university teaching hospital in Hong Kong. All full-time hospital and academic physicians, nurses and allied health professionals were invited to participate. Organisational culture was evaluated using the Competing Values Framework through the Quality Improvement Implementation Survey. Organisational culture was assessed longitudinally at 9 months prior to accreditation, 3 months following and 15?months after accreditation. To capture potential shifts in staff perception of organisational culture through the accreditation process, we conducted a between time-point comparison using a linear trend model. RESULTS:545 clinical staff completed the organisational culture survey pre-accreditation, 378 three- months post-accreditation and 141 15-months post-accreditation. Hierarchical culture was the dominant organisational culture domain pre-accreditation, followed by rational, developmental and group culture, respectively. Following accreditation, hierarchical culture declined but remained dominant, while group and developmental culture increased. However, the decline in hierarchical culture was U-shaped with scores increasing at 15-months post-accreditation, though not to pre-accreditation levels. When stratified by professional group, hierarchical culture declined following accreditation with corresponding increases in group culture and developmental culture among physicians and nurses, respectively. While allied health professionals did not perceive any significant cultural differences directly following accreditation, a significant increase in hierarchical culture and corresponding decrease in group culture was found 15-months post-accreditation. CONCLUSIONS:This study suggests the hospital accreditation process may contribute to shifts in staff perception of organisational culture. Our findings also indicate differential views of organisational culture across professional groups. Finally, we note the striking dominance of hierarchical culture in this Hong Kong hospital across all time points, far surpassing other studies, even those in which hierarchical culture prevailed.

SUBMITTER: Andres EB

PROVIDER: S-EPMC6617556 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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The influence of hospital accreditation: a longitudinal assessment of organisational culture.

Andres Ellie Bostwick EB Song Wei W Schooling Catherine Mary CM Johnston Janice Mary JM

BMC health services research 20190709 1

<h4>Background</h4>A growing body of evidence supports the link between hospital organisational culture and health outcomes. Organisational culture is thus an essential consideration for hospital accreditation, a practice of systematically assessing the quality of hospital care against accepted standards. This study assesses the interplay between accreditation and hospital professional staff perception of organisational culture.<h4>Methods</h4>A prospective cohort study design was used to explor ...[more]

PMID: 31288810

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Project description:BACKGROUND:Health systems, particularly in low- and middle-income countries, are commonly plagued by poor access, poor performance, inefficient use and inequitable distribution of resources. To improve health system efficiency, equity and effectiveness, the World Development Report of 1993 proposed a first wave of health sector reforms, which has been followed by further waves. Various authors, however, suggest that the early reforms did not lead to the anticipated improvements. They offer, as one plausible explanation for this gap, the limited consideration given to the influence over implementation of the software aspects of the health system, such as organisational culture - which has not previously been fully investigated. OBJECTIVE:To identify, interpret and synthesise existing literature for evidence on organisational culture and how it influences implementation of health sector reforms in low- and middle-income countries. METHODS:We conducted a systematic search of eight databases: PubMed; Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Econlit, PsycINFO, SocINDEX with full text, Emerald and Scopus. Eight papers were identified. We analysed and synthesised these papers using thematic synthesis. RESULTS:This review indicates the potential influence of dimensions of organisational culture such as power distance, uncertainty avoidance, and in-group and institutional collectivism over the implementation of health sector reforms. This influence is mediated through organisational practices such as communication and feedback, management styles, commitment and participation in decision-making. CONCLUSION:This interpretive review highlights the dearth of empirical literature around organisational culture and therefore its findings can only be tentative. There is a need for health policymakers and health system researchers to conduct further analysis of organisational culture and change within the health system.

Project description:The objective of the paper is to diagnose organisational culture of selected universities and analyse its impact on the innovation processes within them. The subject matter of the study was organisational culture and innovation at universities. The subjects were four selected universities in Poland, Austria, Germany, and Ukraine. The paper provided a definition of organisational culture and its typology. It further discussed the organisational culture of universities and the relationships between organisational culture and innovativeness. The literature review provided foundations for building a model for the formation of a type of organisational culture at universities that is innovation-friendly, which is the added value of the paper. It offers actions worth taking to shape innovation-friendly culture at universities. It is particularly important during difficult time of changing labour market, when universities greatly impact the attitudes of young people. The knowledge of how to shape innovation-friendly organisational culture at universities is necessary for academia to profile future employees in times of continuous changes. To investigate the relationship between organisational culture and the innovativeness of universities, we designed an original survey questionnaire [S1 File]. Organisational culture was diagnosed with the Organizational Culture Assessment Instrument by K.S. Cameron and R.E. Quinn. The analyses were conducted in Dell Statistica v. 13.1 (StatSoft Polska). We normalised data from the Likert rating scale using Kaufman's and Rousseeuw's formula. We used Spearman's correlation coefficient and Kendall's W to calculate correlations. The research shows that the investigated Polish and Austrian universities are dominated by hierarchy and market cultures. On the other hand, the German and Ukrainian universities host all cultures, but clan and adhocracy dominate there. Moreover, the analyses demonstrated that although the adhocracy culture was the least visible in the investigated organisations, it contributes to university innovativeness the most. The conclusions were used to build a model for promoting innovation-friendly organisational culture at universities. The model contains answers to the research questions. In addition, it offers guidelines for shaping organisational culture to bolster innovation at universities. The research identified relationships between organisational culture and university innovativeness and components that create innovation opportunities at universities as its contribution to management theory. When applied in practice, the guidelines can help form the university's organisational culture bottom-up.

Project description:ObjectiveTo evaluate the evidence upon which standards for hospital accreditation by The Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) are based.DesignCross sectional study.SettingUnited States.ParticipantsFour Joint Commission R3 (requirement, rationale, and reference) reports released by July 2018 and intended to become effective between 1 July 2018 and 1 July 2019.InterventionsFrom each R3 report the associated standard and its specific elements of performance (or actionable standards) were extracted. If an actionable standard enumerated multiple requirements, these were separated into distinct components. Two investigators reviewed full text references, and each actionable standard was classified as either completely supported, partly supported, or not supported; Oxford evidence quality ratings were assigned; and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of recommendations.Main outcome measureStrengths of recommendation for actionable standards.Results20 actionable standards with 76 distinct components were accompanied by 48 references. Of the 20 actionable standards, six (30%) were completely supported by cited references, six were partly supported (30%), and eight (40%) were not supported. Of the six directly supported actionable standards, one (17%) cited at least one reference of level 1 or 2 evidence, none cited at least one reference of level 3 evidence, and five (83%) cited references of level 4 or 5 evidence. Of the completely supported actionable standards, strength of recommendation in five was deemed GRADE D and in one was GRADE B.ConclusionsIn general, recent actionable standards issued by The Joint Commission are seldom supported by high quality data referenced within the issuing documents. The Joint Commission might consider being more transparent about the quality of evidence and underlying rationale supporting each of its recommendations, including clarifying when and why in certain instances it determines that lower level evidence is sufficient.

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The influence of hospital accreditation: a longitudinal assessment of organisational culture.

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The influence of hospital accreditation: a longitudinal assessment of organisational culture.

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