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MeasurementOfOrganizational PDF
MeasurementOfOrganizational PDF
Although there is increasing interest in the relation- workers hypothesized that rapid organizational
ship between organizational constructs and health change was to blame for the deteriorating morale
services outcomes, information on the reliability and quality of care.'"" By the late 1990s, numerous
and validity of the instruments measuring these and well-documented reports of poor patient care,
constructs is sparse. coupled with well-publicized anecdotal reports of
Twelve instruments were identified that may have medical errors, heightened the public's concern
applicability in measuring organizational constructs about the quality of healthcare.~u.16
in the healthcare setting. The authors describe and In response to these concerns, the Institute of
characterize these instruments and discuss the im- Medicine formed a Quality of Healthcare Commit-
plications for nurse administrators. tee to develop strategies to improve the overall
quality of patient care in the United States. The
Although the concepts of organizational culture and committee's report on patient safety, To Err is
organizational climate were first developed in the Human, played an important role in focusing the
early 1930s as part of the human relations move- nation's attention on this issue and led, in part, to
ment, they did not become widely known in the the creation of a Federal Quality Interagency Coor-
healthcare field until the 1980s, when managed care dination Task Force, which included representatives
initiatives resulted in unprecedented industry-wide from the Agency for Healthcare Research and
organizational changes. I ,2These initiatives, which in- Quality (AHRQ). n,"." This task force cosponsored
cluded reduced length of hospital stay, capitated 2 conferences that highlighted the effect of health-
payment plans, and managed care systems, led not care working conditions on patient safety and con-
only to impressive savings in healthcare-related cluded that interventions designed to improve the
costs but also to widespread reports of employee healthcare workplace would also likely improve the
and patient dissatisfaction.' Healthcare workers, es- overall quality of healthcare. The specific working
pecially nurses, reported high levels of work stress conditions identified included: (1) the physical
and a perceived decrease in their ability to supervise work environment, (2) work hours and staffing lev-
support staff andlor to provide quality care to pa- els, and (3) organizational culture and climate. In
tients." Increasingly, both researchers and front-line 2001, the AHRQ funded 21 studies examining
these factors as one of the first steps in its patient
safety initiative. Fourteen of these studies (66%) in-
Authors' affiliation: Associate Professor (Dr Gershon), Mailman volve some measure of organizational culture and
School of Public Health; Assistant Professor (Dr Stone), Alumni Pro- climate, further emphasizing the need for well-de-
fessor (:br Bakken), Professor (Dr Larson), School of Nursing, Co- fined, well-characterized, and psychometrically
lumbia University, New York. NY.
Corresponding author: Dr Gershon, Columbia University, Mail- valid measures of organizational constructs for the
man School of Public Health, Department of Sociomedical Sciences, healthcare setting. U
600 West 168th St, 4th Floor, New York, NY 10032 (rg405@ The goal of this review was to identify poten-
columbia.edu).
This article was funded, in pan, by AHRQ (lROIHS013114) tially useful instruments to measure these constructs
and CDCiNIOSH (520722) and N1NR (P20NR07799). in healthcare to assist those who wish to design a
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