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What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use.
Health Care Manage Rev. 2014 Apr-Jun; 39(2):154-63.HC

Abstract

BACKGROUND

Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There is substantial evidence that physician assistance to smokers can produce significant reductions in tobacco use. However, this evidence has not been well translated into practice, as only a small proportion of smokers receive recommended treatment during medical visits.

PURPOSE

This study examines organizational culture as a contextual feature of primary care clinics and its impact on adherence to evidence-based guidelines for treating tobacco use.

METHODOLOGY

Cross-sectional survey data were collected from 500 primary care providers in 60 community clinics located in New York City. Relationships between provider adherence to "5A" clinical guidelines, as recommended by the U.S. Public Health Service, and both provider and organizational covariates were described. We used hierarchical linear modeling to examine the associations between clinic culture and provider treatment patterns.

FINDINGS

Providers in clinics with stronger "group/clan," "hierarchical," and "rational" culture types, as compared with a "developmental" culture, reported greater adherence to 5A guidelines (p < .05). System-level structures and care processes were positively associated (p < .01), whereas number of ongoing quality initiatives was negatively associated with 5A delivery (p < .05). Provider familiarity with guidelines (p < .01), confidence with cessation counseling (p < .05), and perceived effectiveness in helping smokers quit were associated with more frequent 5A intervention (p < .01).

PRACTICE IMPLICATIONS

Findings suggest that organizational culture can influence provider adherence to cessation treatment guidelines, even when controlling for other factors known to affect practice patterns. Specifically, cultures that emphasize human resources and performance standards are conducive to integrating 5A guidelines into routine practice. Understanding the role of organizational culture enables healthcare managers and practitioners to be strategic when implementing, and also sustaining, use of evidence-based guidelines.

Authors+Show Affiliations

Dorothy Y. Hung, PhD, MA, MPH, is Assistant Investigator, Department of Health Policy Research, Palo Alto Medical Foundation Research Institute, Mountain View, California, and Institute for Health Policy Studies, University of California, San Francisco. E-mail: hungd@pamfri.org. Robynn Leidig, MPH, is Research Fellow, Department of Health Policy Research, Palo Alto Medical Foundation Research Institute, Mountain View, California. E-mail: leidigr@pamfri.org. Donna R. Shelley, MD, MPH, is Associate Professor, Division of General Internal Medicine, New York University Medical Center. E-mail: donna.shelley@nyumc.org.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23636103

Citation

Hung, Dorothy Y., et al. "What's in a Setting?: Influence of Organizational Culture On Provider Adherence to Clinical Guidelines for Treating Tobacco Use." Health Care Management Review, vol. 39, no. 2, 2014, pp. 154-63.
Hung DY, Leidig R, Shelley DR. What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use. Health Care Manage Rev. 2014;39(2):154-63.
Hung, D. Y., Leidig, R., & Shelley, D. R. (2014). What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use. Health Care Management Review, 39(2), 154-63. https://doi.org/10.1097/HMR.0b013e3182914d11
Hung DY, Leidig R, Shelley DR. What's in a Setting?: Influence of Organizational Culture On Provider Adherence to Clinical Guidelines for Treating Tobacco Use. Health Care Manage Rev. 2014 Apr-Jun;39(2):154-63. PubMed PMID: 23636103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use. AU - Hung,Dorothy Y, AU - Leidig,Robynn, AU - Shelley,Donna R, PY - 2013/5/3/entrez PY - 2013/5/3/pubmed PY - 2014/12/15/medline SP - 154 EP - 63 JF - Health care management review JO - Health Care Manage Rev VL - 39 IS - 2 N2 - BACKGROUND: Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There is substantial evidence that physician assistance to smokers can produce significant reductions in tobacco use. However, this evidence has not been well translated into practice, as only a small proportion of smokers receive recommended treatment during medical visits. PURPOSE: This study examines organizational culture as a contextual feature of primary care clinics and its impact on adherence to evidence-based guidelines for treating tobacco use. METHODOLOGY: Cross-sectional survey data were collected from 500 primary care providers in 60 community clinics located in New York City. Relationships between provider adherence to "5A" clinical guidelines, as recommended by the U.S. Public Health Service, and both provider and organizational covariates were described. We used hierarchical linear modeling to examine the associations between clinic culture and provider treatment patterns. FINDINGS: Providers in clinics with stronger "group/clan," "hierarchical," and "rational" culture types, as compared with a "developmental" culture, reported greater adherence to 5A guidelines (p < .05). System-level structures and care processes were positively associated (p < .01), whereas number of ongoing quality initiatives was negatively associated with 5A delivery (p < .05). Provider familiarity with guidelines (p < .01), confidence with cessation counseling (p < .05), and perceived effectiveness in helping smokers quit were associated with more frequent 5A intervention (p < .01). PRACTICE IMPLICATIONS: Findings suggest that organizational culture can influence provider adherence to cessation treatment guidelines, even when controlling for other factors known to affect practice patterns. Specifically, cultures that emphasize human resources and performance standards are conducive to integrating 5A guidelines into routine practice. Understanding the role of organizational culture enables healthcare managers and practitioners to be strategic when implementing, and also sustaining, use of evidence-based guidelines. SN - 1550-5030 UR - https://www.unboundmedicine.com/medline/citation/23636103/What's_in_a_setting:_Influence_of_organizational_culture_on_provider_adherence_to_clinical_guidelines_for_treating_tobacco_use_ L2 - https://doi.org/10.1097/HMR.0b013e3182914d11 DB - PRIME DP - Unbound Medicine ER -