Health Services Research & Development

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Director's Letter

David Atkins, M.D., M.P.H., Director, HSR&D

The late Senator (and former sociologist) Daniel Patrick Moynihan famously said, "The central conservative truth is that it is culture, not politics, that determines the success of a society. The central liberal truth is that politics can change a culture..." Health care systems and researchers are increasingly paying attention to organizational culture in health care settings and how to improve it. Patient safety events often reveal local breakdowns in communication, teamwork, and leadership that enable problematic practices to develop; positive culture as assessed by VA's All Employee Survey and other markers is correlated with better health care outcomes.

The role of health care culture is central to at least three important clinical initiatives in VA. First, team training developed by the SimLearn Center is targeting the critical role of team communication in reducing surgical errors. Second, the Patient Aligned Care Team (PACT) rollout is illustrating the importance and challenge of building functioning, collaborative teams that include physicians, nurses, and support staff. Finally, the Office of Patient Centered Care and Cultural Transformation is piloting programs to transform VA culture into one where patients, rather than providers, are at the center of care.

A 2003 review in the International Journal for Quality in Health Care identified key factors that impede culture change, including inadequate leadership; constraints imposed by external stakeholders and professional allegiances; perceived lack of ownership; and competing cultures within health care systems.1

Health services research has contributed in various ways to our understanding of health care culture and culture change. Both HSR&D and QUERI benefit from the presence of anthropologists on various research teams. Research has contributed practical tools to measure culture and can illuminate those aspects of culture that may serve to either facilitate or impede efforts to improve care. A big challenge for research and health care systems is to develop and test effective programs that can either promote a healthy culture or improve a dysfunctional one.

David Atkins, M.D., M.P.H., Director, HSR&D

1. Scott, T. et al. "Implementing Culture Change in Health Care: Theory and Practice," International Journal for Quality in Health Care 2003; 15(2):111-8.