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Authors

  1. Gershon, Robyn R.M. DrPH, MHS, MT
  2. Stone, Patricia W. PhD, RN, MPH
  3. Bakken, Suzanne DNSc, RN
  4. Larson, Elaine PhD, RN, CIC

Abstract

Although there is increasing interest in the relationship between organizational constructs and health services outcomes, information on the reliability and validity of the instruments measuring these constructs is sparse.

 

Twelve instruments were identified that may have applicability in measuring organizational constructs in the healthcare setting. The authors describe and characterize these instruments and discuss the implications for nurse administrators.

 

Although the concepts of organizational culture and organizational climate were first developed in the early 1930s as part of the human relations movement, they did not become widely known in the healthcare field until the 1980s, when managed care initiatives resulted in unprecedented industry-wide organizational changes. 1,2 These initiatives, which included reduced length of hospital stay, capitated payment plans, and managed care systems, led not only to impressive savings in healthcare-related costs but also to widespread reports of employee and patient dissatisfaction. 3 Healthcare workers, especially nurses, reported high levels of work stress and a perceived decrease in their ability to supervise support staff and/or to provide quality care to patients. 4-6 Increasingly, both researchers and front-line workers hypothesized that rapid organizational change was to blame for the deteriorating morale and quality of care. 7-10 By the late 1990s, numerous and well-documented reports of poor patient care, coupled with well-publicized anecdotal reports of medical errors, heightened the public's concern about the quality of healthcare. 2,11-16

 

In response to these concerns, the Institute of Medicine formed a Quality of Healthcare Committee to develop strategies to improve the overall quality of patient care in the United States. The committee's report on patient safety, To Err is Human, played an important role in focusing the nation's attention on this issue and led, in part, to the creation of a Federal Quality Interagency Coordination Task Force, which included representatives from the Agency for Healthcare Research and Quality (AHRQ). 11,16,17 This task force cosponsored 2 conferences that highlighted the effect of healthcare working conditions on patient safety and concluded that interventions designed to improve the healthcare workplace would also likely improve the overall quality of healthcare. The specific working conditions identified included: (1) the physical work environment, (2) work hours and staffing levels, and (3) organizational culture and climate. In 2001, the AHRQ funded 21 studies examining these factors as one of the first steps in its patient safety initiative. Fourteen of these studies (66%) involve some measure of organizational culture and climate, further emphasizing the need for well-defined, well-characterized, and psychometrically valid measures of organizational constructs for the healthcare setting. 11

 

The goal of this review was to identify potentially useful instruments to measure these constructs in healthcare to assist those who wish to design a study, assess a proposed study, or evaluate the findings of studies that incorporate these measures. To accomplish this, we conducted a systematic review of the biomedical literature with the following 2 objectives: (1) to clarify the definition of organizational culture and climate and to begin the process of standardization of the terminology and (2) to identify instruments that measure the constructs of organizational culture and organizational climate.