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Deng Q, Wang Y, Liu W. Using Multilevel Structural Equation Modeling (MSEM) to Identify the Predictors and Influencing Mechanism of Technology Use Among Chinese Physicians: An Example from Des-Gamma-Carboxy Prothrombin (DCP). Healthc Policy 2022; 15:59-70. [PMID: 35082541 PMCID: PMC8785222 DOI: 10.2147/rmhp.s344923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Since expanding the use of appropriate and effective health technologies will greatly benefit the diagnosis and treatment of some major diseases at an early stage, understanding the mechanism of technology use is crucial for its successful implementation. Few previous studies focused on the healthcare providers and involved multi-facets factors at individual, technical, organizational, and environmental levels. Purpose To examine the influencing mechanism of technology use among Chinese physicians by integrating multilevel factors, Des-gamma-Carboxy Prothrombin (DCP) was taken as an example. Methods Through multistage random sampling, a cross-sectional questionnaire survey was conducted among physicians in charge of direct use of DCP of sampled secondary and tertiary hospitals. Since the sample data comprised two hierarchical levels (physicians and hospitals), multilevel structural equation modeling was used to link five aspects of factors with physicians’ technology use and estimate the effects. Results Totally, 229 physicians completed the investigation. The use of DCP appears to be at a relatively low level. Intra-class coefficients of the null model (unadjusted baseline model) suggested that physicians’ DCP use has a significant variation between hospitals. The final model identified that value cognition (B = 0.447, P < 0.01), experienced organizational practice (B = 0.203, P < 0.05), and perceived organizational atmosphere (B = −0.237, P < 0.01) contributed directly to physicians’ DCP use. Additionally, technical assessment, perceived organizational atmosphere, and perceived environmental pressure had indirect impacts on physicians’ DCP use that were mediated by value cognition and experienced organizational practice (P < 0.05). Conclusion This study incorporated and determined the significant direct or indirect role of value cognition, technical assessment, experienced organizational practice, perceived organizational atmosphere, and perceived environmental pressure. This influencing mechanism with integrated multilevel factors could serve as a theoretical basis for tailoring interventions to promote technology use among Chinese physicians.
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Affiliation(s)
- Qingwen Deng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Yueqin Wang
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
| | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- Correspondence: Wenbin Liu, Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China, Tel +86 13799983766, Email
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Perez H, Neubauer N, Marshall S, Philip S, Miguel-Cruz A, Liu L. Barriers and Benefits of Information Communication Technologies Used by Health Care Aides. Appl Clin Inform 2022; 13:270-286. [PMID: 35263800 PMCID: PMC8906996 DOI: 10.1055/s-0042-1743238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although information and communication technologies (ICT) are becoming more common among health care providers, there is little evidence on how ICT can support health care aides. Health care aides, also known as personal care workers, are unlicensed service providers who encompass the second largest workforce, next to nurses, that provide care to older adults in Canada. OBJECTIVE The purpose of this literature review is to examine the range and extent of barriers and benefits of ICT used by health care workers to manage and coordinate the care-delivery workflow for their clients. METHODS We conducted a literature review to examine the range and extent of ICT used by health care aides to manage and coordinate their care delivery, workflow, and activities. We identified 8,958 studies of which 40 were included for descriptive analyses. RESULTS We distinguished the following five different purposes for the use and implementation of ICT by health care aides: (1) improve everyday work, (2) access electronic health records for home care, (3) facilitate client assessment and care planning, (4) enhance communication, and (5) provide care remotely. We identified 128 barriers and 130 benefits related to adopting ICT. Most of the barriers referred to incomplete hardware and software features, time-consuming ICT adoption, heavy or increased workloads, perceived lack of usefulness of ICT, cost or budget restrictions, security and privacy concerns, and lack of integration with technologies. The benefits for health care aides' adoption of ICT were improvements in communication, support to workflows and processes, improvements in resource planning and health care aides' services, and improvements in access to information and documentation. CONCLUSION Health care aides are an essential part of the health care system. They provide one-on-one care to their clients in everyday tasks. Despite the scarce information related to health care aides, we identified many benefits of ICT adoption.
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Affiliation(s)
- Hector Perez
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Noelannah Neubauer
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Samantha Marshall
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Serrina Philip
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Antonio Miguel-Cruz
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada.,Glenrose Rehabilitation Hospital, Edmonton (AB), Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton (AB), Canada
| | - Lili Liu
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
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Allen JD, Shelton RC, Kephart L, Tom LS, Leyva B, Ospino H, Cuevas AG. Examining the external validity of the CRUZA study, a randomized trial to promote implementation of evidence-based cancer control programs by faith-based organizations. Transl Behav Med 2021; 10:213-222. [PMID: 30496532 DOI: 10.1093/tbm/iby099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The CRUZA trial tested the efficacy of an organizational-level intervention to increase capacity among Catholic parishes to implement evidence-based interventions (EBIs) for cancer control. This paper examines the external generalizability of the CRUZA study findings by comparing characteristics of parishes that agreed to participate in the intervention trial versus those that declined participation. Sixty-five Roman Catholic parishes that offered Spanish-language mass in Massachusetts were invited to complete a four-part survey assessing organization-level characteristics that, based on the Consolidated Framework for Implementation Research (CFIR), may be associated with EBI implementation. Forty-nine parishes (75%) completed the survey and were invited to participate in the CRUZA trial, which randomized parishes to either a "capacity enhancement intervention" or a "standard dissemination" group. Of these 49 parishes, 31 (63%) agreed to participate in the trial, whereas 18 parishes (37%) declined participation. Parishes that participated in the CRUZA intervention trial were similar to those that did not participate with respect to "inner organizational setting" characteristics of the CFIR, including innovation and values fit, implementation climate, and organizational culture. Change commitment, a submeasure of organizational readiness that reflects the shared resolve of organizational members to implement an innovation, was significantly higher among the participating parishes (mean = 3.93, SD = 1.08) as compared to nonparticipating parishes (mean = 3.27, SD = 1.08) (Z = -2.16, p = .03). Parishes that agreed to participate in the CRUZA intervention trial were similar to those that declined participation with regard to organizational characteristics that may predict implementation of EBIs. Pragmatic tools to assess external generalizability in community-based implementation trials and to promote readiness among faith-based organizations to implement EBIs are needed to enhance the reach and impact of public health research. Clinical Trial information: The CRUZA trial identifier number with clinicaltrials.gov is NCT01740219.
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Affiliation(s)
| | | | | | - Laura S Tom
- Community Health, Tufts University, Medford, MA
| | - Bryan Leyva
- Community Health, Tufts University, Medford, MA
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Nagaraj S, Harish V, McCoy LG, Morgado F, Stedman I, Lu S, Drysdale E, Brudno M, Singh D. From Clinic to Computer and Back Again: Practical Considerations When Designing and Implementing Machine Learning Solutions for Pediatrics. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:336-349. [PMID: 38624409 PMCID: PMC7490206 DOI: 10.1007/s40746-020-00205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of review Machine learning (ML), a branch of artificial intelligence, is influencing all fields in medicine, with an abundance of work describing its application to adult practice. ML in pediatrics is distinctly unique with clinical, technical, and ethical nuances limiting the direct translation of ML tools developed for adults to pediatric populations. To our knowledge, no work has yet focused on outlining the unique considerations that need to be taken into account when designing and implementing ML in pediatrics. Recent findings The nature of varying developmental stages and the prominence of family-centered care lead to vastly different data-generating processes in pediatrics. Data heterogeneity and a lack of high-quality pediatric databases further complicate ML research. In order to address some of these nuances, we provide a common pipeline for clinicians and computer scientists to use as a foundation for structuring ML projects, and a framework for the translation of a developed model into clinical practice in pediatrics. Throughout these pathways, we also highlight ethical and legal considerations that must be taken into account when working with pediatric populations and data. Summary Here, we describe a comprehensive outline of special considerations required of ML in pediatrics from project ideation to implementation. We hope this review can serve as a high-level guideline for ML scientists and clinicians alike to identify applications in the pediatric setting, generate effective ML solutions, and subsequently deliver them to patients, families, and providers.
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Affiliation(s)
- Sujay Nagaraj
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario Canada
| | - Vinyas Harish
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Liam G. McCoy
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Felipe Morgado
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - Ian Stedman
- School of Public Policy and Administration, York University, Toronto, Ontario Canada
| | - Stephen Lu
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Erik Drysdale
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, Ontario Canada
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
- University Health Network, Toronto, Ontario Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario Canada
| | - Devin Singh
- Department of Computer Science, University of Toronto, Toronto, Ontario Canada
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
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A systematic literature review of healthcare supply chain and implications of future research. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2019. [DOI: 10.1108/ijphm-05-2018-0028] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to review the healthcare supply chain (HSC) literature along various areas and to find out the gap in it.
Design/methodology/approach
In total, 143 research papers were reviewed during 1996-2017. A critical review was carried out in various dimensions such as research methodologies/data collection method (empirical, case study and literature review) and inquiry mode of research methodology (qualitative, quantitative and mixed), country-specific, targeted area, research aim and year of publication.
Findings
Supply chain (SC) operations, performance measurement, inventory management, lean and agile operation, and use of information technology were well studied and analyzed, however, employee and customer training, tracking and visibility of medicines, cold chain management, human resource practices, risk management and waste management are felt to be important areas but not much attention were made in this direction.
Research limitations/implications
Mainly drug and vaccine SC were considered in current study of HSC while SC along healthcare equipment and machine, hospitality and drug manufacturing related papers were excluded in this study.
Practical implications
This literature review has recognized and analyzed various issues relevant to HSC and shows the direction for future research to develop an efficient and effective HSC.
Originality/value
The insight of various aspects of HSC was explored in general for better and deeper understanding of it for designing of an efficient and competent HSC. The outcomes of the study may form a basis to decide direction of future research.
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Montezeli JH, Haddad MDCFL, Garanhani ML, Peres AM. Improving social skills in care management provided by nurses: intervention research. Rev Bras Enferm 2019; 72:49-57. [PMID: 30942344 DOI: 10.1590/0034-7167-2017-0918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/15/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the process of introducing an educational intervention for the improvement of social skills in care management provided by nurses. METHOD intervention research, according to its complexity, carried out in a South-Brazilian public university hospital. To identify learning needs, 11 nurses were interviewed and educational meetings were held with 20 participants, who evaluated with open-ended questions: what they would stop doing; what they would continue doing; and what they would start doing on the issues addressed. The data was analyzed comprehensively. RESULTS we developed 30 educational hours on social skills of communication, work, assertiveness, and other themes inherent in care management mentioned by the participants as deficient. The evaluation revealed intentions of advances in: self-monitoring, communication, empathy, assertiveness, leadership and search for knowledge. Monthly meetings on care management were formally requested by the institution. FINAL CONSIDERATIONS social skills are intertwined in care management relationships and their improvement has proved to be dialogical, recursive and hologrammatic.
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Xiang LL, Hua ZY. [Application of the Evidence-based Practice for Improving Quality method in neonatal intensive care units]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:686-690. [PMID: 30111481 PMCID: PMC7389753 DOI: 10.7499/j.issn.1008-8830.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/24/2018] [Indexed: 06/08/2023]
Abstract
The Evidence-based Practice for Improving Quality (EPIQ) method was proposed by Canadian Neonatal Network for high quality health care. The method is characterized by evidence-based, targeted, collaborative and continuous concept. At present it is applied in neonatal intensive care units (NICUs). This review article focuses on the application of the method in NICUs.
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Affiliation(s)
- Ling-Ling Xiang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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Khatri N, Gupta V. Effective implementation of health information technologies in U.S. hospitals. Health Care Manage Rev 2016; 41:11-21. [PMID: 25120194 DOI: 10.1097/hmr.0000000000000039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better--a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated. STUDY DESIGN/DATA COLLECTION The data on type of HIT system and IT expertise/capabilities were collected from a national sample of senior executives of U.S. hospitals. The data on quality of patient care were gathered from the Hospital Compare Web site. FINDINGS The quality of patient care was significantly higher in hospitals deploying a homegrown HIT system than hospitals deploying an outsourced HIT system. Furthermore, the professional competence and compelling vision of the chief information officer was found to be a major driver of another key IT capability of hospitals-professionalism of IT staff. The positive relationship of professionalism of IT staff with quality of patient care was mediated by proactive employee behavior. CONCLUSION A homegrown HIT system achieves better quality of patient care than an outsourced one. The chief information officer's IT vision and the professional expertise and professionalism of IT staff are important IT capabilities in U.S. hospitals.
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Affiliation(s)
- Naresh Khatri
- Naresh Khatri, PhD, is Associate Professor, Health Management and Informatics, University of Missouri School of Medicine, Columbia. E-mail: . Vishal Gupta, PhD, is Assistant Professor, Organizational Behavior, Indian Institute of Management Ahmedabad, Vastrapura, India
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Vegro TC, Rocha FLR, Camelo SHH, Garcia AB. Organizational culture of a private hospital. Rev Gaucha Enferm 2016; 37:e49776. [PMID: 27253589 DOI: 10.1590/1983-1447.2016.02.49776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/27/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To assess the values and practices that characterize the organizational culture of a private hospital in the state of São Paulo in the perspective of nursing professionals. Methods Quantitative, descriptive, cross-sectional study. Data collection was conducted between January and March 2013 using the Brazilian Instrument for Assessing Organizational Culture. Twenty-one nurses and sixty-two nursing aides and technicians participated in the study. The responses of the participants were coded into numerical categories, generating an electronic database to be analyzed by means of the software Statistical Package for the Social Sciences. Results Scores of cooperative professionalism values (3.24); hierarchical strictness values (2.83); individual professionalism values (2.69); well-being values (2.71); external integration practices (3.73); reward and training practices (2.56); and relationship promotion practices (2.83). Conclusion In the perception of workers, despite the existence of hierarchical strictness there is cooperation at work and the institution pursues customer satisfaction and good interpersonal relationships.
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Affiliation(s)
- Thamiris Cavazzani Vegro
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Fernanda Ludmilla Rossi Rocha
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Silvia Helena Henriques Camelo
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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Seeking high reliability in primary care: Leadership, tools, and organization. Health Care Manage Rev 2016; 40:183-92. [PMID: 24787749 DOI: 10.1097/hmr.0000000000000022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Leaders in health care increasingly recognize that improving health care quality and safety requires developing an organizational culture that fosters high reliability and continuous process improvement. For various reasons, a reliability-seeking culture is lacking in most health care settings. Developing a reliability-seeking culture requires leaders' sustained commitment to reliability principles using key mechanisms to embed those principles widely in the organization. PURPOSE The aim of this study was to examine how key mechanisms used by a primary care practice (PCP) might foster a reliability-seeking, system-oriented organizational culture. METHODOLOGY A case study approach was used to investigate the PCP's reliability culture. The study examined four cultural artifacts used to embed reliability-seeking principles across the organization: leadership statements, decision support tools, and two organizational processes. To decipher their effects on reliability, the study relied on observations of work patterns and the tools' use, interactions during morning huddles and process improvement meetings, interviews with clinical and office staff, and a "collective mindfulness" questionnaire. The five reliability principles framed the data analysis. FINDINGS Leadership statements articulated principles that oriented the PCP toward a reliability-seeking culture of care. Reliability principles became embedded in the everyday discourse and actions through the use of "problem knowledge coupler" decision support tools and daily "huddles." Practitioners and staff were encouraged to report unexpected events or close calls that arose and which often initiated a formal "process change" used to adjust routines and prevent adverse events from recurring. Activities that foster reliable patient care became part of the taken-for-granted routine at the PCP. PRACTICE IMPLICATIONS The analysis illustrates the role leadership, tools, and organizational processes play in developing and embedding a reliable-seeking culture across an organization. Progress toward a reliability-seeking, system-oriented approach to care remains ongoing, and movement in that direction requires deliberate and sustained effort by committed leaders in health care.
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Khatri N. Effective implementation of electronic medical records and health information technologies. MISSOURI MEDICINE 2015; 112:41-45. [PMID: 25812274 PMCID: PMC6170095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Information technology (IT) capabilities are necessary for realizing the full promise of health information technologies in improving health care delivery process. In this study, three key IT capabilities for health care organizations are identified and their relationship with 30-day mortality rate from heart attack examined in a national sample of U.S. hospitals. The findings indicate that the negative relationship of IT capabilities with mortality rate from heart attack is mediated by effort/flexibility putforth by health care workers.
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Rocha FLR, Marziale MHP, de Carvalho MC, Cardeal Id SDF, de Campos MCT. [The organizational culture of a Brazilian public hospital]. Rev Esc Enferm USP 2014; 48:308-14. [PMID: 24918891 DOI: 10.1590/s0080-6234201400002000016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 02/07/2014] [Indexed: 11/21/2022] Open
Abstract
The objective of this research was to analyze the organizational culture of a Brazilian public hospital. It is a descriptive study with quantitative approach of data, developed in a public hospital of São Paulo State, Brazil. The sample was composed by 52 nurses and 146 nursing technicians and auxiliaries. Data were collected from January to June 2011 using the Brazilian Instrument for Assessing Organizational Culture - IBACO. The analysis of the organizational values showed the existence of hierarchical rigidity and centralization of power within the institution, as well as individualism and competition, which hinders teamwork. The values concerning workers' well-being, satisfaction and motivation were not highly valued. In regard to organizational practices, the promotion of interpersonal relationship, continuous education, and rewarding practices were not valued either. It becomes apparent that traditional models of work organization support work practices and determine the organizational culture of the hospital.
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