Improving Organizational Climate for Quality and Quality of Care Does Membership in a Collaborative Help?

摘要

Background: The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown.Objective: To evaluate the impact of collaborative membership on organizational climate for quality and service quality.Subjects: Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement.Research Design: Pre-post design. Reassessments occurred 2 months before the collaborative began in January 2009. Postassess-ments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality.Measures: Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality.Results: There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison climes. Conclusion: Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.