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Observational Study
. 2014 Apr;26 Suppl 1(Suppl 1):74-80.
doi: 10.1093/intqhc/mzu027. Epub 2014 Mar 25.

The associations between organizational culture, organizational structure and quality management in European hospitals

C Wagner  1 , R Mannion, A Hammer, O Groene, O A Arah, M Dersarkissian, R Suñol; DUQuE Project Consortium
Affiliations
Observational Study

The associations between organizational culture, organizational structure and quality management in European hospitals

C Wagner et al. Int J Qual Health Care. 2014 Apr.

Abstract

Objective: To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals.

Design: A multi-method, multi-level, cross-sectional observational study.

Setting and participants: As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees.

Main outcome measures: Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities.

Results: Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems.

Conclusion: The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.

Keywords: DUQuE; hospital; organizational culture; organizational structure; quality improvement; quality management.

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Figures

Figure 1
Figure 1
DAG showing the relationships between the study variables. QMSI, Quality Management System Index; QMCI, Quality Management Compliance Index; CQII, Clinical Quality Implementation Index.
Box 1
Box 1
‘The Competing Values Framework’ for modelling organisational culture. See ref. [4].
See this image and copyright information in PMC

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