Association between organisational and workplace cultures, and patient outcomes: systematic review

Abstract

Design and objectivesEvery organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes.SettingA variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts.ParticipantsThe articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review.Primary and secondary outcome measuresPatient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience.ResultsThe search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction.ConclusionsSynthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.

Advancing professionalism, attentive to culture, to improve health systems

“…Higher improvement implementation scores were strongly associated with cultures characterised (albeit separately) in terms of cohesion, inclusivity and employee morale, consistent with the characteristics of health care organisations associated with improved health outcomes, and lower scores were strongly associated with those emphasising hierarchy, rigidity and adherence to rules and procedures. Blouin notes that nine of the 11 schools demonstrated predominantly the latter, hierarchical, characteristics .…”

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Admission to intensive care: A qualitative study of triage and its determinants

“…Collaborative work outside the time‐pressured admission decision situation would foster patient‐centered teamwork . It represents a change in the hospital organizational culture which has the potential to facilitate the triage process …”

The goldilocks effect: the rhythms and pace of hospital life

“…A good culture, one that is productive, collegiate and supportive, is related to positive patient and organisational outcomes [5]. But busy-ness and the pace of hospital organisational life have not been measured (see Table 1, Glossary of terms).…”