Skip to main content
Top
Published in: BMC Health Services Research 1/2015

Open Access 01-06-2015 | Research article

Organizational culture in cardiovascular care in Chinese hospitals: a descriptive cross-sectional study

Authors: Emily S. Yin, Nicholas S. Downing, Xi Li, Sara J. Singer, Leslie A. Curry, Jing Li, Harlan M. Krumholz, Lixin Jiang

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

Organizational learning, the process by which a group changes its behavior in response to newly acquired knowledge, is critical to outstanding organizational performance. In hospitals, strong organizational learning culture is linked with improved health outcomes for patients. This study characterizes the organizational learning culture of hospitals in China from the perspective of a cardiology service.

Methods

Using a modified Abbreviated Learning Organization Survey (27 questions), we characterized organizational learning culture in a nationally representative sample of 162 Chinese hospitals, selecting 2 individuals involved with cardiovascular care at each hospital. Responses were analyzed at the hospital level by calculating the average of the two responses to each question. Responses were categorized as positive if they were 5+ on a 7-point scale or 4+ on a 5-point scale. Univariate and multiple regression analyses were used to assess the relationship between selected hospital characteristics and perceptions of organizational learning culture.

Results

Of the 324 participants invited to take the survey, 316 responded (98 % response rate). Perceptions of organizational learning culture varied among items, among domains, and both among and within hospitals. Overall, the median proportion of positive responses was 82 % (interquartile range = 59 % to 93 %). “Training,” “Performance Monitoring,” and “Leadership that Reinforces Learning” were characterized as the most favorable domains, while “Time for Reflection” was the least favorable. Multiple regression analyses showed that region was the only factor significantly correlated with overall positive response rate.

Conclusions

This nationally representative survey demonstrated variation in hospital organizational learning culture among hospitals in China. The variation was not substantially explained by hospital characteristics. Organizational learning culture domains with lower positive response rates reveal important areas for improvement.
Appendix
Available only for authorised users
Literature
1.
go back to reference Garvin DA. Learning in action: a guide to putting the learning organization to work. Boston: Harvard Business School Press; 2000. Garvin DA. Learning in action: a guide to putting the learning organization to work. Boston: Harvard Business School Press; 2000.
2.
go back to reference Crossan MM, Lane HW, White RE. An organizational learning framework: From intuition to institution. Acad Manage Rev. 1999;24(3):522–37. Crossan MM, Lane HW, White RE. An organizational learning framework: From intuition to institution. Acad Manage Rev. 1999;24(3):522–37.
3.
go back to reference March JG. Exploration and exploitation in organizational learning. Organ Sci. 1991;2(1):71–87.CrossRef March JG. Exploration and exploitation in organizational learning. Organ Sci. 1991;2(1):71–87.CrossRef
4.
go back to reference Garvin DA, Edmondson AC, Gino F. Is yours a learning organization? Harvard Bus Rev. 2008;86(3):109–16. 34. Garvin DA, Edmondson AC, Gino F. Is yours a learning organization? Harvard Bus Rev. 2008;86(3):109–16. 34.
5.
go back to reference Edmondson A. Psychological safety and learning behavior in work teams. Admin Sci Q. 1999;44(2):350–83.CrossRef Edmondson A. Psychological safety and learning behavior in work teams. Admin Sci Q. 1999;44(2):350–83.CrossRef
6.
go back to reference Keller S, Price C. Beyond performances: how great organizations build ultimate competitive advantage. Hoboken, N.J.: Wiley; 2011. Keller S, Price C. Beyond performances: how great organizations build ultimate competitive advantage. Hoboken, N.J.: Wiley; 2011.
7.
go back to reference Singer SJ, Hayes JE, Gray GC, Kiang MV. Making time for learning-oriented leadership in multidisciplinary hospital management groups. Health Care Manage Rev. 2014;40(4):300-12. Singer SJ, Hayes JE, Gray GC, Kiang MV. Making time for learning-oriented leadership in multidisciplinary hospital management groups. Health Care Manage Rev. 2014;40(4):300-12.
8.
go back to reference McLaughlin CP, Kaluzny AD. Continuous quality improvement in health care. 3rd ed. Sudbury: Jones and Bartlett; 2006. McLaughlin CP, Kaluzny AD. Continuous quality improvement in health care. 3rd ed. Sudbury: Jones and Bartlett; 2006.
9.
go back to reference Weerawardena J, O’Cass A, Julian C. Does industry matter? Examining the role of industry structure and organizational learning in innovation and brand performance. J Bus Res. 2006;59(1):37–45.CrossRef Weerawardena J, O’Cass A, Julian C. Does industry matter? Examining the role of industry structure and organizational learning in innovation and brand performance. J Bus Res. 2006;59(1):37–45.CrossRef
10.
go back to reference van Solingen R, Bergout E, Kusters R, Trienekens J. From process improvement to people improvement: enabling learning in software development. Inform Software Tech. 2000;42(14):965–71.CrossRef van Solingen R, Bergout E, Kusters R, Trienekens J. From process improvement to people improvement: enabling learning in software development. Inform Software Tech. 2000;42(14):965–71.CrossRef
11.
go back to reference Lapre MA, Tsikriktsis N. Organizational learning curves for customer dissatisfaction: Heterogeneity across airlines. Manag Sci. 2006;52(3):352–66.CrossRef Lapre MA, Tsikriktsis N. Organizational learning curves for customer dissatisfaction: Heterogeneity across airlines. Manag Sci. 2006;52(3):352–66.CrossRef
12.
go back to reference Nicolay CR, Purkayastha S, Greenhalgh A, Benn J, Chaturvedi S, Phillips N, et al. Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare. Br J Surg. 2012;99(3):324–35.CrossRefPubMed Nicolay CR, Purkayastha S, Greenhalgh A, Benn J, Chaturvedi S, Phillips N, et al. Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare. Br J Surg. 2012;99(3):324–35.CrossRefPubMed
13.
go back to reference Scott T, Mannion R, Davies H, Marshall M. The quantitative measurement of organizational culture in health care: a review of the available instruments. Health Serv Res. 2003;38(3):923–45.CrossRefPubMedPubMedCentral Scott T, Mannion R, Davies H, Marshall M. The quantitative measurement of organizational culture in health care: a review of the available instruments. Health Serv Res. 2003;38(3):923–45.CrossRefPubMedPubMedCentral
14.
go back to reference Argote L. Organizational learning : creating, retaining, and transferring knowledge. Boston: Kluwer; 1999. Argote L. Organizational learning : creating, retaining, and transferring knowledge. Boston: Kluwer; 1999.
15.
go back to reference Dodgson M. Organizational learning—A review of some literatures. Organ Stud. 1993;14(3):375–94.CrossRef Dodgson M. Organizational learning—A review of some literatures. Organ Stud. 1993;14(3):375–94.CrossRef
16.
go back to reference McConnell KJ, Chang AM, Maddox TM, Wholey DR, Lindrooth RC. An exploration of management practices in hospitals. Healthc (Amst). 2014;2(2):121–9.CrossRef McConnell KJ, Chang AM, Maddox TM, Wholey DR, Lindrooth RC. An exploration of management practices in hospitals. Healthc (Amst). 2014;2(2):121–9.CrossRef
17.
go back to reference McConnell KJ, Lindrooth RC, Wholey DR, Maddox TM, Bloom N. Management practices and the quality of care in cardiac units. JAMA Intern Med. 2013;173(8):684–92.CrossRefPubMed McConnell KJ, Lindrooth RC, Wholey DR, Maddox TM, Bloom N. Management practices and the quality of care in cardiac units. JAMA Intern Med. 2013;173(8):684–92.CrossRefPubMed
18.
go back to reference James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122–8.CrossRefPubMed James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122–8.CrossRefPubMed
19.
go back to reference Edmondson AC, Bohmer RM, Pisano GP. Disrupted routines: team learning and new technology implementation in hospitals. Admin Sci Q. 2001;46(4):685–716.CrossRef Edmondson AC, Bohmer RM, Pisano GP. Disrupted routines: team learning and new technology implementation in hospitals. Admin Sci Q. 2001;46(4):685–716.CrossRef
20.
go back to reference Johnson DS, Perlow R, Pieper KF. Differences in task performance as a function of type of feedback: learning-oriented versus performance-oriented feedback. J Appl Soc Psychol. 1993;23(4):303–20.CrossRef Johnson DS, Perlow R, Pieper KF. Differences in task performance as a function of type of feedback: learning-oriented versus performance-oriented feedback. J Appl Soc Psychol. 1993;23(4):303–20.CrossRef
21.
go back to reference Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM, et al. Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration. Health Serv Res. 2012;47(4):1541–60.CrossRefPubMedPubMedCentral Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM, et al. Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration. Health Serv Res. 2012;47(4):1541–60.CrossRefPubMedPubMedCentral
22.
go back to reference Tucker AL, Nembhard IM, Edmondson AC. Implementing new practices: an empirical study of organizational learning in hospital intensive care units. Manage Sci. 2007;53(6):894–907.CrossRef Tucker AL, Nembhard IM, Edmondson AC. Implementing new practices: an empirical study of organizational learning in hospital intensive care units. Manage Sci. 2007;53(6):894–907.CrossRef
23.
go back to reference Bradley EH, Curry L, Horwitz LI, Sipsma H, Wang Y, Walsh MN, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;6(4):444–50.CrossRefPubMedPubMedCentral Bradley EH, Curry L, Horwitz LI, Sipsma H, Wang Y, Walsh MN, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;6(4):444–50.CrossRefPubMedPubMedCentral
24.
go back to reference Wang X, Liu K, You LM, Xiang JG, Hu HG, Zhang LF, et al. The relationship between patient safety culture and adverse events: a questionnaire survey. Int J Nurs Stud. 2013;51(8):1114–22.CrossRefPubMed Wang X, Liu K, You LM, Xiang JG, Hu HG, Zhang LF, et al. The relationship between patient safety culture and adverse events: a questionnaire survey. Int J Nurs Stud. 2013;51(8):1114–22.CrossRefPubMed
25.
go back to reference Garner P, Kale R, Dickson R, Dans T, Salinas R. Getting research findings into practice: implementing research findings in developing countries. BMJ. 1998;317(7157):531–5.CrossRefPubMedPubMedCentral Garner P, Kale R, Dickson R, Dans T, Salinas R. Getting research findings into practice: implementing research findings in developing countries. BMJ. 1998;317(7157):531–5.CrossRefPubMedPubMedCentral
26.
go back to reference Rondeau KV, Wagar TH. Organizational learning and continuous quality improvement: examining the impact on nursing home performance. Healthc Manage Forum. 2002;15(2):17–23.CrossRefPubMed Rondeau KV, Wagar TH. Organizational learning and continuous quality improvement: examining the impact on nursing home performance. Healthc Manage Forum. 2002;15(2):17–23.CrossRefPubMed
27.
go back to reference Reich MR, Takemi K, Roberts MJ, Hsiao WC. Global action on health systems: a proposal for the Toyako G8 summit. Lancet. 2008;371(9615):865–9.CrossRefPubMed Reich MR, Takemi K, Roberts MJ, Hsiao WC. Global action on health systems: a proposal for the Toyako G8 summit. Lancet. 2008;371(9615):865–9.CrossRefPubMed
28.
go back to reference Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27(5):1235–45.CrossRef Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27(5):1235–45.CrossRef
30.
go back to reference Yip WC, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet. 2012;379(9818):833–42.CrossRefPubMed Yip WC, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet. 2012;379(9818):833–42.CrossRefPubMed
31.
go back to reference Cao RG. Medical quality and patient safety in China. Chinese Hospitals. 2007;11(11):1–4. Cao RG. Medical quality and patient safety in China. Chinese Hospitals. 2007;11(11):1–4.
33.
go back to reference Institute of Medicine (US), Olsen L, Saunders R, McGinnis J. Patients Charting the Course: Citizen Engagement and the Learning Health System: Workshop Summary. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC): National Academies Press; 2011. p. 187-196. Institute of Medicine (US), Olsen L, Saunders R, McGinnis J. Patients Charting the Course: Citizen Engagement and the Learning Health System: Workshop Summary. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC): National Academies Press; 2011. p. 187-196.
35.
go back to reference Zhu J, Li L, Li Y, Shi M, Lu H, Garnick DW, et al. What constitutes patient safety culture in Chinese hospitals? Int J Qual Health Care. 2012;24(3):250–7.CrossRefPubMed Zhu J, Li L, Li Y, Shi M, Lu H, Garnick DW, et al. What constitutes patient safety culture in Chinese hospitals? Int J Qual Health Care. 2012;24(3):250–7.CrossRefPubMed
36.
go back to reference Xue D, Zhou P, Bundorf MK, Huang JX, Chang JL. The association of strategic group and organizational culture with hospital performance in China. Health Care Manage R. 2013;38(3):258–70.CrossRef Xue D, Zhou P, Bundorf MK, Huang JX, Chang JL. The association of strategic group and organizational culture with hospital performance in China. Health Care Manage R. 2013;38(3):258–70.CrossRef
37.
go back to reference Zhou P, Bundorf K, Chang JL, Huang JX, Xue D. Organizational culture and its relationship with hospital performance in public hospitals in China. Health Serv Res. 2011;46(6):2139–60.CrossRefPubMedPubMedCentral Zhou P, Bundorf K, Chang JL, Huang JX, Xue D. Organizational culture and its relationship with hospital performance in public hospitals in China. Health Serv Res. 2011;46(6):2139–60.CrossRefPubMedPubMedCentral
38.
go back to reference Gaziano TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation. 2005;112(23):3547–53.CrossRefPubMed Gaziano TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation. 2005;112(23):3547–53.CrossRefPubMed
39.
go back to reference World Health Organization. The global burden of disease: 2004 update. Geneva, Switzerland: World Health Organization; 2008. World Health Organization. The global burden of disease: 2004 update. Geneva, Switzerland: World Health Organization; 2008.
40.
go back to reference Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746–53.CrossRefPubMed Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746–53.CrossRefPubMed
41.
go back to reference Singer SJ, Moore SC, Meterko M, Williams S. Development of a short-form Learning Organization Survey: the LOS-27. Med Care Res Rev. 2012;69(4):432–59.CrossRefPubMed Singer SJ, Moore SC, Meterko M, Williams S. Development of a short-form Learning Organization Survey: the LOS-27. Med Care Res Rev. 2012;69(4):432–59.CrossRefPubMed
42.
go back to reference Dharmarajan K, Li J, Li X, Lin Z, Krumholz HM, Jiang L. The China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective study of acute myocardial infarction: study design. Circ Cardiovasc Qual Outcomes. 2013;6(6):732–40.CrossRefPubMedPubMedCentral Dharmarajan K, Li J, Li X, Lin Z, Krumholz HM, Jiang L. The China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective study of acute myocardial infarction: study design. Circ Cardiovasc Qual Outcomes. 2013;6(6):732–40.CrossRefPubMedPubMedCentral
43.
go back to reference Ministry of Health of the People’s Republic of China. China public health statistical yearbook 2003. Beijing: Peking Union Medical College Publishing House; 2003. Ministry of Health of the People’s Republic of China. China public health statistical yearbook 2003. Beijing: Peking Union Medical College Publishing House; 2003.
44.
go back to reference Joinson A. Social desirability, anonymity, and internet-based questionnaires. Behav Res Meth Ins C. 1999;31(3):433–8.CrossRef Joinson A. Social desirability, anonymity, and internet-based questionnaires. Behav Res Meth Ins C. 1999;31(3):433–8.CrossRef
45.
go back to reference Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP, et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med. 2012;156(9):618–26.CrossRefPubMedPubMedCentral Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP, et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med. 2012;156(9):618–26.CrossRefPubMedPubMedCentral
46.
go back to reference Krumholz HM, Curry LA, Bradley EH. Survival after acute myocardial infarction (SAMI) study: the design and implementation of a positive deviance study. Am Heart J. 2011;162(6):981–7.CrossRefPubMedPubMedCentral Krumholz HM, Curry LA, Bradley EH. Survival after acute myocardial infarction (SAMI) study: the design and implementation of a positive deviance study. Am Heart J. 2011;162(6):981–7.CrossRefPubMedPubMedCentral
47.
go back to reference McGorry SY. Measurement in a cross-cultural environment: survey translation issues. Qual Market Res Int J. 2000;3(2):74–81.CrossRef McGorry SY. Measurement in a cross-cultural environment: survey translation issues. Qual Market Res Int J. 2000;3(2):74–81.CrossRef
48.
go back to reference Willis GB, Miller K. Cross-cultural cognitive interviewing: seeking comparability and enhancing understanding. Field Method. 2011;23(4):331–41.CrossRef Willis GB, Miller K. Cross-cultural cognitive interviewing: seeking comparability and enhancing understanding. Field Method. 2011;23(4):331–41.CrossRef
49.
go back to reference Zhang Y. Using the Internet for survey research: a case study. J Assoc Inf Sci Technol. 1999;51(1):57-68. Zhang Y. Using the Internet for survey research: a case study. J Assoc Inf Sci Technol. 1999;51(1):57-68.
50.
go back to reference Tucker AL, Edmondson AC. Why hospitals don’t learn from failures: Organizational and psychological dynamics that inhibit system change. Calif Manage Rev. 2003;45(2):55–72.CrossRef Tucker AL, Edmondson AC. Why hospitals don’t learn from failures: Organizational and psychological dynamics that inhibit system change. Calif Manage Rev. 2003;45(2):55–72.CrossRef
51.
go back to reference Arthur D, Pang S, Wong T, Alexander MF, Drury J, Eastwood, et al. Caring attributes, professional self concept and technological influences in a sample of Registered Nurses in eleven countries. Int J Nurs Stud. 1999;36(5):387–96.CrossRefPubMed Arthur D, Pang S, Wong T, Alexander MF, Drury J, Eastwood, et al. Caring attributes, professional self concept and technological influences in a sample of Registered Nurses in eleven countries. Int J Nurs Stud. 1999;36(5):387–96.CrossRefPubMed
53.
go back to reference Reeves R, West E, Barron D. Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial. BMC Health Serv Res. 2013;13:259.CrossRefPubMedPubMedCentral Reeves R, West E, Barron D. Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial. BMC Health Serv Res. 2013;13:259.CrossRefPubMedPubMedCentral
54.
go back to reference Jimenez-Jimenez D, Cegarra-Navarro JG. The performance effect of organizational learning and market orientation. Ind Market Manag. 2007;36(6):694–708.CrossRef Jimenez-Jimenez D, Cegarra-Navarro JG. The performance effect of organizational learning and market orientation. Ind Market Manag. 2007;36(6):694–708.CrossRef
55.
go back to reference Zhao YB, Li YA, Lee SH, Chen LB. Entrepreneurial orientation, organizational learning, and performance: evidence from China. Entrep Theory Pract. 2011;35(2):293–317.CrossRef Zhao YB, Li YA, Lee SH, Chen LB. Entrepreneurial orientation, organizational learning, and performance: evidence from China. Entrep Theory Pract. 2011;35(2):293–317.CrossRef
56.
go back to reference Singer SJ, Falwell A, Gaba DM, Baker LC. Patient safety climate in US hospitals: variation by management level. Med Care. 2008;46(11):1149–56.CrossRefPubMed Singer SJ, Falwell A, Gaba DM, Baker LC. Patient safety climate in US hospitals: variation by management level. Med Care. 2008;46(11):1149–56.CrossRefPubMed
Metadata
Title
Organizational culture in cardiovascular care in Chinese hospitals: a descriptive cross-sectional study
Authors
Emily S. Yin
Nicholas S. Downing
Xi Li
Sara J. Singer
Leslie A. Curry
Jing Li
Harlan M. Krumholz
Lixin Jiang
Publication date
01-06-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1211-7

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue