Organizational culture and climate in step-down units

Introduction

The purpose of this study was to examine organizational culture and climate (OCC) in step-down units (SDUs). Organizational culture is defined as the norms, values, beliefs and expectations shared by those who work in a given unit. Organizational climate is the perception of unit culture by its workers. In ICUs, organizational culture is an important determinant of the quality of care delivered. In an attempt to alleviate ICU demand and expenditures, many centers have opted to provide graded levels of critical care with the creation of SDUs. There is a paucity of literature specifically examining OCC in SDUs.

Methods

A prospective descriptive analysis of OCC in four SDUs (18 beds) with an open model of care in a tertiary regional referral centre. We administered a modified version of the previously validated Shortell ICU nurse–physician questionnaire to all healthcare professionals (HCPs) and physicians caring for patients in the SDUs in May 2006. We measured opinion regarding patient safety culture, organizational practices, perceived effectiveness of practice, and job satisfaction. Responses were converted to item scores, which reflect negative to positive opinion (0–100). Scores were aggregated for each survey construct and for an overall SDU rating.

Results

Surveys were completed by 68 HCPs and 69 physicians. Aggregated mean ± standard deviation item scores of HCP and physician opinions were (presented as assessment area, HCPs, physicians, P value): overall OCC in SDUs, 54.8 ± 19.9, 57.0 ± 20.3, P = 0.52; patient safety culture, 52.2 ± 21.2, 50.9 ± 21.0, P = 0.72; within-group relationships, 66.5 ± 16.0, 63.7 ± 18.2, P = 0.33; between-group relationships, 53.8 ± 22.2, 62.4 ± 21.7, P = 0.02; overall leadership, 52.2 ± 19.6, 54.8 ± 18.7, P = 0.42; conflict management, 55.2 ± 20.1, 61.3 ± 20.1, P = 0.08; effectiveness of care, 54.7 ± 16.8, 55.8 ± 19.3, P = 0.72; and job satisfaction, 67.5 ± 19.0, 77.9 ± 20.3, P = 0.002. The overall OCC score and most subcategory scores were similar between HCPs and physicians. Physicians had a better opinion of their relationships with other groups and a higher job satisfaction than HCPs.

Conclusion

Overall scores of OCC were poor and did not differ between HCPs and physicians with the exception of between-group relationships and job satisfaction. More research is needed to determine the correlation between clinical outcomes and OCC in SDUs and whether improvements in OCC result in better clinical outcomes and job satisfaction.