CoE Project 6

Organizational culture is defined as "the values, beliefs, and norms of an organization that shape its behavior." In health care, organizational culture is identified as an important factor in implementing continuous quality improvement and total quality management and in promoting integration in health care systems. Organizational culture has also been identified as an important factor in promoting patient safety and error reduction in health care organizations. The pressing need to increase the reliability of health care systems to reduce frequency of adverse events--both negligent and other types--has placed a renewed focus on the role of organizational culture in promoting patient safety.

This project aims to improve the measurement of and characterize the role of organizational culture in increasing the reliability of patient care systems to reduce adverse events in health care organizations. Organizational culture may promote patient safety by influencing and supporting progressive attitudes towards patient safety among staff and employees in health care organizations. We are interested in characterizing the overall organizational culture in health care organizations (e.g., hospitals) as well as the organizational culture within specific patient care units (e.g., operating rooms, intensive care units, and ambulatory practices). In addition, given the focus of the Center of Excellence on reducing medication errors, we are interested in characterizing the organizational culture within pharmacy services in hospitals. Special attention will be devoted to understanding the implications of organizational culture and prevailing staff attitudes about patient safety on medication administration.

The specific aims of this project are:

1. We will develop a survey instrument that characterizes staff attitudes about patient safety.
2. We will establish the psychometric properties of the survey instrument developed in Aim 1.
3. We will administer the survey to a stratified random sample of staff in Partners HealthCare System (PHCS).
4. We will assess the associations between staff attitudes about patient safety and organizational culture in: (1) the large health care entities in Partners HealthCare System; (2) patient care units within hospitals in PHCS; and (3) the pharmacy services in the hospitals within PHCS.
5. We will disseminate the results of these assessments to appropriate and constituents in the integrated delivery system as it promotes patient safety as well as in the academic literature.

Our hypotheses in this study include that staff attitudes about patient safety will vary:

1. Among the major organizational components of Partners HealthCare System.
2. Among specific patient care units in Partners.
3. As a function of respondents' perceptions of the dominant culture of their hospital.
4. As a function of respondents' perceptions of the dominant culture of the patient care unit in which they work.
5. Knowledge about this variation will prove useful in designing interventions.