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Relationships Between Organizational Climate and Diabetes Quality of Care

Benzer JK, Young GJ, Stolzman KL, Osatuke K, White RA, Mohr DC. Relationships Between Organizational Climate and Diabetes Quality of Care. Paper presented at: VA HSR&D National Meeting; 2011 Feb 23; Washington, DC.

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Objectives: Evidence supporting a relationship between the climate of healthcare organizations and performance has been accumulating. The goal of the present study was to test the utility of a two dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. Methods: The study involved secondary data from two sources. Organizational climate was measured by the aggregated perceptions of direct care providers using data from the 2007 All Employee Survey. Multi-item scale scores were computed representing two climate dimensions: task (management focus on achievement and improvement) and relational (management focus on mutual support and respect). Diabetes quality of care data were obtained for 4,539 patients seen in 223 primary care clinics from the 2007 External Peer Review Program, and included measures of both processes (foot inspections, regular HbA1c exams), and intermediate outcomes (control of HbA1c, blood pressure, and LDL-C). Hierarchical linear modeling was used to determine the relationship between the organizational-level climate and patient-level quality of diabetes care. Results: Quality of care variables demonstrated low inter-correlations (r < = .20). Relational climate was associated with all diabetes process measures as well as blood pressure and cholesterol control. Task climate was not significantly associated with diabetes quality of care, but results suggested a negative relationship with HbA1c exams and blood pressure control. Implications: This study demonstrates that administrative surveys can be used to reliably measure organization climate, and climate is related to guideline-based care. Relational climate was a robust predictor of diabetes quality of care. Given that patient-level outcomes are generally not highly correlated, the relationship between a relational clinic climate and improved patient care observed here, particularly for process measures, is noteworthy and warrants future study. A task-oriented climate, however, may not contribute much to quality improvement, at least not without other organizational arrangements in place such as strong relational strategies. Impacts: Relational climate may be particularly important given that VA is promoting collaborative Patient Aligned Care Teams (PACT) models of care. Identifying the limitations of task-oriented strategies is also important given the growing emphasis that healthcare managers and policy makers are placing on pay-for-performance programs to improve the quality of care.

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