Measures of Organizational Culture and Climate in Primary Care: a Systematic Review
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University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA; 3Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 4Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; 5Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA; 6UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA.
BACKGROUND: Primary care is increasingly contributing to improving the quality of patient care. This has imposed significant demands on clinicians with rising needs and limited resources. Organizational culture and climate have been found to be crucial in improving workforce well-being and hence quality of care. The objectives of this study are to identify organizational culture and climate measures used in primary care from 2008 to 2019 and evaluate their psychometric properties. METHODS: Data sources include PubMed, PsycINFO, HAPI, CINAHL, and Mental Measurements Yearbook. Bibliographies of relevant articles were reviewed and a cited reference search in Scopus was performed. Eligibility criteria include primary health care professionals, primary care settings, and use of measures representing the general concept of organizational culture and climate. Consensus-Based Standards for the selection of health Measurement Instruments (COSMIN) guidelines were followed to evaluate individual studies for methodological quality, rate results of measurement properties, qualitatively pool studies by measure, and grade evidence. RESULTS: Of 1745 initial studies, 42 studies met key study inclusion criteria, with 27 measures available for review (16 for organizational culture, 11 for organizational climate). There was considerable variability in measures, both conceptually and in psychometric quality. Many reported limited or no psychometric information. DISCUSSION: Notable measures selected for frequent use and strength and applicability of measurement properties include the Culture Questionnaire adapted for health care settings, Practice Culture Assessment, and Medical Group Practice Culture Assessment for organizational culture. Notable climate measures include the Nurse Practitioner Primary Care Organizational Climate Questionnaire, Practice Climate Survey, and Task and Relational Climate Scale. This synthesis and appraisal of organizational culture and climate measures can help investigators make informed decisions in choosing a
Supplementary Information The online version of this article (https:// doi.org/10.1007/s11606-020-06262-7) contains supplementary material, which is available to authorized users. Received May 20, 2020 Accepted September 21, 2020
measure or deciding to develop a new one. In terms of limitations, ratings should be considered conservative due to adaptations of the COSMIN protocol for clinician populations. P R O S P E R O R E G I S T R AT I O N N U M B E R : C R D 42019133117 KEY WORDS: organizational culture; or
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