2033. Organizational Culture and Hospital Performance in VA
DC Mohr, Management Decision and Research Center, MM Meterko, Management Decision and Research Center, G Young, Management Decision and Research Center, MP Charns, Management Decision and Research Center

Objectives: As part of its transformation, VA has sought to move away from a bureaucratic culture to one that emphasizes entrepreneurship and teamwork.  To date, few empirical studies have examined whether such a culture is associated with better hospital performance. This study capitalized on a highly unique system-wide VA database to test the relationship between culture and hospital performance.

Methods: The unit of analysis was the VA hospital. Data for the analyses were drawn from several independent sources, including national VA databases on patient satisfaction and results from the national employee survey. The measures for teamwork and entrepreneurial culture were obtained through our own nationwide survey of VA hospitals. The survey questionnaire included a culture scale that has demonstrated reliability and validity for healthcare settings and was designed to measure an organizationís relative emphasis on each of four cultural attributes: entrepreneurship, teamwork, bureaucracy and task orientation. The survey questionnaire was distributed to a random sample of up to 125 employees at each VA hospital.  The employee-level responses were aggregated to arrive at a single culture score for each VA hospital. All other employee-level and patient-level measures were similarly aggregated to the hospital level, and all measures were 2000. Multivariate analyses were used to test direct and indirect relationships among the culture, employee satisfaction, and patient satisfaction measures.

Results:  Higher scores for teamwork as well as entrepreneurial culture were significantly associated with better patient satisfaction scores while a higher bureaucratic culture score was significantly associated with worse patient satisfaction scores. The same pattern of relationships held when employee satisfaction scores were related to the culture scores. Additional analyses indicated that teamwork and entrepreneurial culture affect patient satisfaction indirectly through their effect on employee satisfaction through a direct effect as well.

Conclusions: Organizational culture is relative to both employee and patient satisfaction.  An organization that is strong in teamwork and entrepreneurial culture may have better employee and patient satisfaction. Culture is also related to patient satisfaction in part through the underlying mechanism of employee satisfaction.

Impact: Study results suggested that VA managers should work to strengthen an organizational culture emphasizing teamwork and entrepreneurship as a means to improve employee and patient satisfaction.