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.
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.