Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use

Abstract

Objective: The objective of this work was to elucidate aspects of organizational culture associated with hospital performance in perioperative antibiotic prophylaxis using quantitative data in a multicenter and multidimensional study.

Design: Cross-sectional retrospective study using a survey data and administrative data.

Setting: Eighty-three acute hospitals in Japan.

Participants: A total of 4856 respondents in the organizational culture study, and 23 172 patients for the quality indicator analysis.

Main outcome measure: Multilevel models of various cultural dimensions were used to analyze the association between hospital organizational culture and guideline adherence. The dependent variable was adherence or non-adherence to Japanese and CDC guidelines at the patient level and main independent variable was hospital groups categorized according to organizational culture score. Other control variables included hospital characteristics such as ownership, bed capacity, region and urbanization level of location.

Results: The multilevel analysis showed that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals. In particular, the hospital group with high scores in the 'collaboration' and 'professional growth' dimensions had three times the odds for Japanese guideline adherence in comparison with low-scoring hospitals.

Conclusions: Our study revealed that various aspects of organizational culture were associated with adherence to guidelines for perioperative antibiotic use. Hospital managers aiming to improve quality of care may benefit from improving hospital organizational culture.

Keywords: antibiotic use; health-care-associated infections; multilevel model; quality culture; quality indicators.