BACKGROUND: Medical research continues to focus overwhelmingly on biomedical interventions, such as drugs, devices, and procedures. The dysfunctional health care cultures and systems need more attention for quality of care to improve further. PURPOSE: The existing health services management research has not used a systematic theoretical framework to predict the effects of organizational variables on clinical outcomes. This study tests the theoretical model proposed by N. Khatri, A. Baveja, S. Boren, and A. Mammo (2006). METHODOLOGY: This study surveyed employees from hospitals in Missouri. The sample consisted of 77 respondents from 16 hospitals. FINDINGS: The control-based management approach (Management Control and Silos) was found to be positively associated with Culture of Blame and negatively with Learning From Mistakes. In contrast, the commitment-based approach (Fair Management Practices and Employee Participation) was negatively associated with Culture of Blame and positively with Learning From Mistakes, Camaraderie, and Motivation. Mediating variables of Learning From Mistakes and Camaraderie showed a significant negative relationship with Medical Errors. Learning From Mistakes, Camaraderie, and Motivation all showed a significant positive relationship with Quality of Patient Care. The mediating variables had much stronger relationships with Medical Errors and Quality of Patient Care than did the independent variables, lending support to the proposed mediation. IMPLICATIONS FOR PRACTICE: Health care organizations can improve the quality of care and reduce medical errors significantly by enhancing learning from mistakes and boosting camaraderie and morale of their employees. They can do so by breaking down silos in their structures, implementing just and fair management practices, and involving employees in decision making.
BACKGROUND: Medical research continues to focus overwhelmingly on biomedical interventions, such as drugs, devices, and procedures. The dysfunctional health care cultures and systems need more attention for quality of care to improve further. PURPOSE: The existing health services management research has not used a systematic theoretical framework to predict the effects of organizational variables on clinical outcomes. This study tests the theoretical model proposed by N. Khatri, A. Baveja, S. Boren, and A. Mammo (2006). METHODOLOGY: This study surveyed employees from hospitals in Missouri. The sample consisted of 77 respondents from 16 hospitals. FINDINGS: The control-based management approach (Management Control and Silos) was found to be positively associated with Culture of Blame and negatively with Learning From Mistakes. In contrast, the commitment-based approach (Fair Management Practices and Employee Participation) was negatively associated with Culture of Blame and positively with Learning From Mistakes, Camaraderie, and Motivation. Mediating variables of Learning From Mistakes and Camaraderie showed a significant negative relationship with Medical Errors. Learning From Mistakes, Camaraderie, and Motivation all showed a significant positive relationship with Quality of Patient Care. The mediating variables had much stronger relationships with Medical Errors and Quality of Patient Care than did the independent variables, lending support to the proposed mediation. IMPLICATIONS FOR PRACTICE: Health care organizations can improve the quality of care and reduce medical errors significantly by enhancing learning from mistakes and boosting camaraderie and morale of their employees. They can do so by breaking down silos in their structures, implementing just and fair management practices, and involving employees in decision making.
Authors: Sigall K Bell; Peter B Smulowitz; Alan C Woodward; Michelle M Mello; Anjali Mitter Duva; Richard C Boothman; Kenneth Sands Journal: Milbank Q Date: 2012-12 Impact factor: 4.911