OrganizatiOnal and managerial COntexts Of HOspital units: results Of CrOss-seCtiOnal desCriptive survey witH 36 mediCine units by COmet© questiOnnaire

Abstract

At the care units level, organizational and managerial dimensions of local context are one way to explain success or failure of the quality improvement in hospitals. Like current quantitative research about organizational climate and culture, we measure the multi-dimensionality of organizational and managerial context, from perceptions of professionals on the management style, hierarchical support and their own work attitudes in return. Objective: To verify the existence of organizational and managerial profiles, consolidating services into homogeneous classes and to highlight contexts perceived by professionals as more favourable and optimist than others. methodology: We use our questionnaire COMEt © and its validation data, collected from a sample of 861 professionals – doctors, nurses, auxiliary nurses – of 36 medicine units in 33 pub lic or private hospitals, selected according to a stratified cluster sample from five french administrative regions. For data analysis, we operate a hierarchical ascending classification from dimensional COMEt © scores. results: We determine two profiles of care units, with organizational and managerial dimensions quasi-opposed in all points and significantly different according to the test-value (the difference between average score of all services and average score of the class). These results demonstrate the presence of an organizational and managerial spiral, virtuous for 9 units, and vicious for 13 units. Conclusion: Results open interesting perspectives to modelize interactions between organizational, managerial and attitudinal dimensions of these local contexts of care units, and to make the link between the optimists (or pessimists) profiles and the quality of care.