2033. Organizational Culture
and Hospital Performance in VA
DC Mohr, Management Decision and Research Center, MM Meterko,
Management Decision and Research Center, G Young, Management Decision and
Research Center, MP Charns, Management Decision and Research Center
Objectives: As part of
its transformation, VA has sought to move away from a bureaucratic culture to
one that emphasizes entrepreneurship and teamwork.
To date, few empirical studies have examined whether such a culture is
associated with better hospital performance. This study capitalized on a highly
unique system-wide VA database to test the relationship between culture and
hospital performance.
Methods: The unit of
analysis was the VA hospital. Data for the analyses were drawn from several
independent sources, including national VA databases on patient satisfaction and
results from the national employee survey. The measures for teamwork and
entrepreneurial culture were obtained through our own nationwide survey of VA
hospitals. The survey questionnaire included a culture scale that has
demonstrated reliability and validity for healthcare settings and was designed
to measure an organization’s relative emphasis on each of four cultural
attributes: entrepreneurship, teamwork, bureaucracy and task orientation. The
survey questionnaire was distributed to a random sample of up to 125 employees
at each VA hospital. The
employee-level responses were aggregated to arrive at a single culture score for
each VA hospital. All other employee-level and patient-level measures were
similarly aggregated to the hospital level, and all measures were 2000.
Multivariate analyses were used to test direct and indirect relationships among
the culture, employee satisfaction, and patient satisfaction measures.
Results: Higher
scores for teamwork as well as entrepreneurial culture were significantly
associated with better patient satisfaction scores while a higher bureaucratic
culture score was significantly associated with worse patient satisfaction
scores. The same pattern of relationships held when employee satisfaction scores
were related to the culture scores. Additional analyses indicated that teamwork
and entrepreneurial culture affect patient satisfaction indirectly through their
effect on employee satisfaction through a direct effect as well.
Impact: Study results suggested that VA managers should work to strengthen an organizational culture emphasizing teamwork and entrepreneurship as a means to improve employee and patient satisfaction.