What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use

• Published in: Health care management review Vol. 39; no. 2; p. 154
• Main Authors: Hung, Dorothy Y, Leidig, Robynn, Shelley, Donna R
• Format: Journal Article
• Language: English
• Published: United States 01.04.2014
• Subjects: Adult; Community Health Centers - organization & administration; Community Health Centers - statistics & numerical data; Cross-Sectional Studies; Female; Guideline Adherence - organization & administration; Guideline Adherence - statistics & numerical data; Health Care Surveys; Humans; Male; New York City - epidemiology; Organizational Culture; Primary Health Care - organization & administration; Primary Health Care - statistics & numerical data; Smoking Cessation - statistics & numerical data; New York City
• ISSN: 1550-5030
• DOI: 10.1097/HMR.0b013e3182914d11

Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There is substantial evidence that physician assistance to smokers can produce significant reductions in tobacco use. However, this evidence has not been well translated into practice, as only a small proportion of smokers receive recommended treatment during medical visits. This study examines organizational culture as a contextual feature of primary care clinics and its impact on adherence to evidence-based guidelines for treating tobacco use. Cross-sectional survey data were collected from 500 primary care providers in 60 community clinics located in New York City. Relationships between provider adherence to "5A" clinical guidelines, as recommended by the U.S. Public Health Service, and both provider and organizational covariates were described. We used hierarchical linear modeling to examine the associations between clinic culture and provider treatment patterns. Providers in clinics with stronger "group/clan," "hierarchical," and "rational" culture types, as compared with a "developmental" culture, reported greater adherence to 5A guidelines (p < .05). System-level structures and care processes were positively associated (p < .01), whereas number of ongoing quality initiatives was negatively associated with 5A delivery (p < .05). Provider familiarity with guidelines (p < .01), confidence with cessation counseling (p < .05), and perceived effectiveness in helping smokers quit were associated with more frequent 5A intervention (p < .01). Findings suggest that organizational culture can influence provider adherence to cessation treatment guidelines, even when controlling for other factors known to affect practice patterns. Specifically, cultures that emphasize human resources and performance standards are conducive to integrating 5A guidelines into routine practice. Understanding the role of organizational culture enables healthcare managers and practitioners to be strategic when implementing, and also sustaining, use of evidence-based guidelines.