2032. A Longitudinal Study of Culture and Hospital Performance in VA
MM Meterko, Management Decision and Research Center, D Mohr, Management Decision and Research Center, J Young, Management Decision and Research Center, MP Charns, Management Decision and Research Center

Objectives: One goal of the VA transformation was to move from a bureaucratic culture to one that emphasizes entrepreneurship and innovation. The present study addressed two questions: (a) to what extent has VA culture changed, and (b) if change has occurred, has this influenced performance in terms of patient satisfaction.

Methods: Culture was assessed using a five-item scale, which provides scores on four dimensions of culture: group, entrepreneurial, hierarchical, and task-oriented. This culture measure was part of the National VA Quality Improvement Survey (NQIS) conducted by the HSR&D Management Decision and Research Center (MDRC) in 1997, 1998 and 2000.  Patient satisfaction scores for those same years were obtained from the database of annual surveys conducted by the Performance Assessment Center of Excellence (PACE), a division of the Office of Quality and Performance (OQP). For this study, aggregate facility-level scores for culture and patient satisfaction were merged to create a unique longitudinal database. Univariate and multivariate analyses were used to address the study questions.

Results:  Contrary to expectation, facility-level scores for hierarchical culture increased over time while the scores for entrepreneurial culture declined.  However, considerable variation was observed each year and over time among facilities on the four culture dimensions.  For example, change in entrepreneurial culture ranged from a 56% decline to a 72% increase in 2000 relative to the 1997 baseline. Change in culture was not a significant predictor of change in either inpatient or outpatient satisfaction after controlling for baseline (1997) culture level.

Conclusions: Overall, VA culture appears to have become more bureaucratic and less entrepreneurial between 1997 and 2000.  Considerable variation in the amount of culture change was observed at the facility level, but this was unrelated to trends in patient satisfaction possibly because the magnitude of change in facility-level culture was insufficient to influence performance. Facilities with stronger entrepreneurial culture at baseline did experience greater improvement in patient satisfaction over time.  

Impact: VA officials should develop and evaluate strategies for strengthening entrepreneurial culture throughout the system and monitor whether changes in culture lead to better performance.