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Primary Funding Source: AHRQ Organizational Culture and Hospital Performance in VHA David Mohr, Ph.D., Mark Meterko, Ph.D., Gary Young, Ph.D., Martin Charns, D.B.A. Presented by: David Mohr, Ph.D., Project Manager, Management Decision and Research Center, VA Boston Health Care System, 150 South Huntington Ave 152M ; , Boston, MA 02130, US; Tel: 617 ; 232-9500 x 5679; Fax: 617 ; 232-6140; Email: david.mohr2 med.va.gov Research Objective: As part of its transformation, VA has sought to move away from a bureaucratic culture to one that emphasizes entrepreneurship and teamwork. To date, no empirical studies have examined whether such a culture is associated with better performance at VA hospitals. This study capitalizes on a highly unique system-wide database that includes measures of culture and performance for VA hospitals. Based on a conceptual model drawn from management and organizational theory, we hypothesized that hospitals with greater emphasis on entrepreneurial and teamwork culture would perform better on patient satisfaction. Study Design: To measure culture, we conducted our own nationwide survey of all VA hospitals. Data for the analysis was derived from the national VA databases on patient satisfaction. The survey questionnaire included a culture scale that has demonstrated reliability and validity for healthcare settings and was designed to measure an organization's relative emphasis on each of four cultural attributes: entrepreneurship, teamwork, bureaucratic and rational. Employee-level responses to the national survey and patient satisfaction measures were aggregated for hospital-level scores. Multivariate analyses were used to test the direct and indirect relationships among the culture and patient satisfaction measures. Control variables in the analysis included: hospital size, teaching status, urban status, and geographical region. Population Studied: The unit of analysis was the VA hospital. At each facility, 125 employees were randomly sampled for a national survey on organizational culture. A total of 8, 454 employees responded 52% ; . We also examined inpatient and outpatient satisfaction ratings that were compiled from a national database. Principal Findings: Bureaucratic culture was allocated the most points 44 out of 100 ; of all four culture dimensions. The remaining culture dimensions were rated as follows: teamwork 19 out of 100 ; , entrepreneurial 13 out of 100 ; and rational 24 out of 100 ; . Higher scores for teamwork culture were significantly associated with better inpatient satisfaction scores Beta .29 ; while a higher bureaucratic culture score was significantly associated with lower inpatient satisfaction scores Beta -.24 ; . The top 25 percent highest scoring facilities on teamwork culture had significantly better inpatient satisfaction scores than either the middle 50 percent group or the bottom 25 percent group. Hospital size was negatively related to inpatient satisfaction across all four culture types Beta -.27 to -.31 ; . Northeastern region hospitals related positively to outpatient satisfaction Beta .22 to .24 ; and western region.

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Hong JE, Foster CS. Spirochetal Uveitis. Int Ophth Clin 2006; 46: 2: Kim, EC, Foster CS. Immunomodulatory Therapy for the Treatment of Ocular Inflammatory Disease: Evidence-based Medicine Recommendations for Use. Int Ophth Clin 2006; 46: 2: Yu EN, Jurkunas U, Rubin PA, Baltatzis S, Foster CS. Obliterative Microangiopathy Presenting as Chronic Conjunctivitis in a Patient With Relapsing Polychondritis. Cornea. 2006 Jun; 25 5 ; : 621-622. Kump LI, Castaneda RA, Androudi SN, Reed GF, Foster CS. Visual Outcomes in Children with Juvenile Idiopathic Arthritis-Associated Uveitis. Ophthalmology. 2006 ; Choi JY, Kafkala C, Foster CS. Primary intraocular lymphoma: a review. Semin Ophthalmol. 2006; 21 3 ; : 125-33. Khan N, Huang JJ, Foster CS. Cancer Associated Retinopathy CAR ; : An AutoimmuneMediated Paraneoplastic Syndrome. Semin Ophthalmol. 2006; 21 3 ; : 135-41. Ahmed M, Foster CS. Steroid Therapy for Ocular Inflammatory Disease. Focal Points, American Academy of Ophthalmology 2006; 24: 7: Foster CS. Cataract Surgery and Uveitis. Current Insight, American Academy of Ophthalmology, Summer 2006; Kafkala C, Choi JY, Choopong P, Foster CS. Octreotide as a Treatment for Uveitic Cystoid Macular Edema. Arch Ophthalmol 2006; 124 9 ; : 1353-5. Ocampo J, Yu E, Zhao TZ, Feroze K, Foster CS. Toxicity of 0.2% Chlorhexidine Gluconate to the Cornea and Adjacent Structures. Philippine Journal of Ophthalmology, 2006; 30 3 ; : 119-123. Fortuna ES, Hinkle D, Foster CS. Management of anterior uveitis: Immunomodulatory Therapy is gaining acceptance. Ophthalmology Management 2006; October; 61-101 Papadaki TG, Kafkala C, Zacharopoulos IP, Seyedahmadi B J, Dryja T, Foster CS. Conjunctival Non-Caseating Granulomas in a Human Immunodeficiency Virus HIV ; Positive Patient Attributed to Sarcoidosis. Ocul Immunol Inflamm. 2006; 14 5 ; : 309-11. Kafkala C, Choi J, Zafirakis P, Baltatzis S, Livir-Rallatos C, Rojas B, Foster CS. Mooren Ulcer: An Immunopathologic Study. Cornea. 2006 Jul; 25 6 ; : 667-673. Letko E, Bhol K, Anzaar F, Perez VL, Ahmed AR, Foster CS. Chronic Cicatrizing Conjunctivitis in a Patient With Epidermolysis Bullosa Acquisita.Arch Ophthalmol. 2006 Nov; 124 11 ; : 1615-1618. Papadaki TG, Zacharopoulos IP, Papaliodis G, Iaccheri B, Fiore T, Foster CS. Plasmapheresis for lupus retinal vasculitis. Arch Ophthalmol. 2006 Nov; 124 11 ; : 1654-6. The benefits getting avil online the rewards you get from acquiring your avil online via pills for stress are two-fold and imdur.

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The most recent death occurred in february 200 this is a significant number because canada has about one-tenth the population of the in the , only about one to 10 percent of serious adverse drug reactions are ever reported to the fda. Thomas JK, Forrest A, Bhavnani SM, et al. Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy. Antimicrob Agents Chemother 1998; 42: 521527. Trouillet JL, Chastre J, Vuagnat A, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. J Respir Crit Care Med 1998; 157: 531539. Tsay RW, Siu LK, Fung CP, Chang FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for communityacquired infection. Arch Intern Med 2002; 162: 10211027. Weinstein RA. Nosocomial infection update. Emerg Infect Dis 1998; 4: 416420. Weinstein MP, Towns ML, Quartey SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24: 584602. Wiener J, Quinn JP, Bradford PA, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999; 281: 517523 and vasodilan and monoket, for example, naproxen. A potential quality indicator pqi ; is any verbal complaint regarding suspected deviation in the quality of healthcare or the quality of healthcare service at the va community clinic. Q: what is the cost of shipping monomet and ketorolac. REFERENCE ARTICLE 12-18 1999 USPHS IDSA GUIDELINES FOR THE PREVENTION OF OPPORTUNISTIC INFECTIONS IN PERSONS INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS In August 1999, the US Public Health Service and the Infectious Disease Society of America published these updated guidelines. 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The following authors or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices in a study if they are not being evaluated as part of the investigation. Acted as a consultant within the last 2 years: Mark G. Kris, Aventis Pharmaceuticals, Bristol-Myers Squibb, GlaxoSmithKline, Merck and Company, MGI Pharma Inc, Pfizer Inc. Received more than $2, 000 a year from a company for either of the last 2 years: Mark G. Kris, Aventis Pharmaceuticals, Bristol-Myers Squibb, GlaxoSmithKline, Merck and Company, MGI Pharma Inc, Pfizer Inc. Ob gyn news - drug update: irritable bowel syndrome - clinical rounds august 15, 2003 - a few short years ago, even gastroenterologists cringed when a patient with irritable bowel syndrome walked in.
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