Organizational climate related to quality of chronic care
MedWire News: The organizational climate of a primary care clinic is positively associated with the delivery of quality chronic care, US research shows.
Effective interactions between providers and support staff were predictive of quality diabetes care, such as annual foot inspections and hemoglobin A1c (HbA1c) tests, report Justin Benzer (Veteran Affairs Boston Healthcare System, Massachusetts, USA) and colleagues in the journal of Health Services Research.
The observed effect sizes were small, add the authors, but the data suggest that "patient behavior can be influenced by provider and system-level factors."
In their analysis, the researchers focused on the organizational climate of the primary care clinic. They applied a framework in which human perceptions and behavior were organized under task and relational dimensions.
The task climate is management based and focused on achievement and improvement goals. The relational climate, on the other hand, refers to a management focus on mutual support and respect.
The researchers tested the ability of their two-dimensional model - including task and relational dimensions - to explain possible variations in diabetes care between primary care centers.
Data were obtained from 223 clinics in the US Veteran Affairs Healthcare system. Included in the analysis were hospital-based and outpatient clinics involving more than 4500 patients.
In a statistical model that analyzed the incremental effects of different variables, the relational climate was positively associated with an increased likelihood that patients would receive annual foot exams and HbA1c tests.
There was a smaller effect of the relationship climate on maintaining blood pressure at guideline-recommended levels, but no effect on maintaining low-density lipoprotein LDL cholesterol levels at target.
"Relational climate was observed to be a robust predictor of high-quality diabetes care across process measures," write Benzer and colleagues. "The documented benefits of positive relational climates are broad, and now include objectively measured diabetes care in addition to employee satisfaction and well-being."
When task climate was added to the statistical model, there was an "unexpected negative relationship" with HbA1c exams, report investigators. In models without relationship dimensions, the task-climate variables were not significantly related to process or intermediate-outcome measures.
The researchers add that a lack of significant findings for task climate suggests that a management emphasis on performance goals and rewards is not effective for improving care for chronic conditions such as diabetes.
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