The Role of Culture in the Perception of Planned Changes in the Emergency Department and Its Influence on Patient Satisfaction

Year 2020, Volume: 3 Issue: 1, 28 - 44, 29.06.2020

Fikret Efe

Abstract

ABSTRACT
The paper aims to determine the role of (sub)culture(s) in the perceptions of planned changes made to advance healthcare quality and patient satisfaction in a problematic emergency department (ED) between 2006-2010 by comparing the findings of two-period of time.
Both qualitative and quantitative designs were used. First qualitative data through observations and interviews were gathered in the Kocaeli State Hospital Emergency Department (KSHED), and then quantitative data through the two questionnaires we developed was collected. Five hundred ED patients in 2006 and 366 in 2010 responded to the surveys. Chi-square test for categorical data and paired samples t-test for ratio were used to analyze the relationships and differences between demographic characteristics and dimensions of satisfaction and perceived cultural changes of health quality by years.
Several planned changes implemented in the ED between 2006 and 2010 were perceived positively by the patients and contributed significantly (p<0.001) to overall patient satisfaction and healthcare quality in 2010. Among the perceived cultural changes, human to human interactional dimension of improvements were most drastically moved up (from 44.1% to 64.4%) and assessed satisfactorily.
KSHED hasa a unique cultture consistingg of two subcultures, institutional and organizational, through which patients and health staff interpret the meanings in their perceptions and expectations, and interact, accordingly determines the degree of their satisfaction and perceived healthcare quality, resulting in the successful management of organizational culture changes. The more the reciprocal expectations are overlapped; the more organizational culture changes are positively perceived and the more their relations satisfactorily function.

Keywords

Emergency department culture, organizational culture, perception of change, patient satisfaction

References

• REFERENCES 1. Tasso, K. H., and L. S. Behar-Horenstein. 2008. “Attributes of Patient-Physician Interactions in a Teaching Hospital.” Hospital Topics: Research and Perspectives on Healthcare 86:21-29. 2. Rahmqvist, M., and A. Bara. 2010. “Patient Characteristics and Quality Dimensions Related to Patient Satisfaction.” Int. Journal for Quality in Health Care 22:2: 86-92. 3. Romanow, R. J. 2002. Building Values on the Future of Health Care in Canada – Final Report. November. 4. Scott, T., R. Mannion, H. Davies, and M. Marshall. 2003b. “Implementing Culture Change in Health Care: Theory and Practice.” International Journal for Quality in Health Care. 15 (2): 111-118. 5. TUIK 2008. www.tuik.gov.tr. Accessed: September 03, 2015. 6. Zhou, P., K. Bundorf, J. Chang, J. X. Huang, and D. Xue. 2011. “Organizational Culture and Its Relationship with Hospital Performance in Public Hospitals in China.” Health Service Research 46(2): 2139. 7. Helfrich, C. D., Y. F. Li, D. C. Mohr, M. Meterko, and A. E. Sales. 2007. “Assessing an Organizational Culture Instrument Based on the Competing Values Framework: Exploratory and Confirmatory Factor Analyses.” Implementation Science 2(13): 1-14. 8. Pedersen, J. S., and F. Dobbin. 2006. “In Search of Identity and Ligitimation: Bridging Organizational Culture and Neoinstitutionalism.” Sepecial Issues of American Behavioral Scientist 49(7):897-907. 9. Oliver, C. 1992. “The antecedents of deinstitutionalization.” Organizational Studies 13(4): 563-588. 10. Kondra, A. Z., and D. C. Hurst. 2009. “Institutional Processes of Organizational Culture.” Culture and Organization 15: 39-58. 11. Greenwoods, R., and CR. Hinings. 1996. “Understanding Radical Organizational Change: Bringing together the Old and the New Institutionalism.” The Academy of Management Review 21(4): 1022-1054. 12. Olafsdottir, S., and B. A. Pescosolido. 2009. “Drawing the Line: The Cultural Cartography of Utilization Recommendations for Mental Health Problems.” Journal of Health and Social Behaviour 502: 2228-244. 13. Seltzer, T., E. Gardner, S. Bichard, and C. Callison. 2012. “Public Relations Review PR in the ER: Managing Internal Organization-Public Relationships in a Hospital Emergency Department.” Public Relations Review 38: 128–136. 14. Davies, H., S. Nutley, and R. Mannion.2000. “Organisational Culture and Quality of Health Care.” Quality in Health Care 9: 111-119. 15. Shortell, S. M., R. H. Jones, A. W. Rademaker, R. R. Gillies, et al. 2000. 16. Fakhoury, K. H. W. 1998. “Satisfaction with Palliative Care: What Should We Be Aware of?” Int. Journal of Nursing Studies. 353: 171-176. 17. Cockerham, W. J. 2001. “Medical Sociology and Sociological Theory”. in W. J. Cockerham (ed). The Blackwell Companion to Medical Sociology. Blackwell Publishers: Maiden, Massachusetts. “Assessing the Impact of Total Quality Management and Organizational Culture on Multiple Outcomes of Care for Coronary Artery Bypass Graft Surgery Patients.” Medical Care. 38(2): 207–17. 18. Schein, E. H. 1990. “Organizational Culture.” American Psychologist 45(2): 109-119. 19. Brown, A. 1995. Organizational Culture. London: Pitman. 20. Scott, T., R. Mannion, H. Davies, and M. Marshall. 2003a. “The Quantitative Measurement of Organizational Culture in Health Care: A Review of the Available Instruments.” HSR: Health Services Research 38 (3): 923-945. 21. Scott, T., R. Mannion, H. Davies, and M. Marshall. 2003c. Health Performance and Organizational Culture. Oxford: Radcliffe Medical Press. 22. Hatch, M, J., and A. L. Cunliffe. 2006. Organizational Theory. New York: Oxford University Press. 23. Denison, R. D. 1996. “What is the Difference between Organizational Culture and Organizational Climate? A Native's Point of View on a Decade of Paradigm Wars.” The Academy of Management Review. 21(3): 619-654. 24. Martin, J., and C. Seihl. 1983. “Organizational Culture and Counterculture: An Uneasy Symbiosis.” Organizational Dynamics 12(2): 52–64. 25. Jandt, F. E. 2003. The Disputes Over Defining of Culture. http://www.corwin.com/upm-data/5244_Jandt_Final_Pages_Chapter_1.pdf. Accessed June 12, 2015. 26. Vosk, A. and C. Milofsky. 2002. The Sociology of Emergency Medicine. Emergency Medicine News. Part I-II-III. 27. Person, J., L. Spiva, and P. Hart. 2013. “An Ethnographic Study: The Culture of an Emergency Department an Ethnographic Study: The Culture of an Emergency Department.” International Emergency Nursing 21: 222–227. 28. Turner, J. H. 1982. The Structure of Sociological Theory. The Dosey Press: USA. 29. Tichy, N. M. 1982. “Managing Change Strategically: The Technical, Political and Cultural Keys.” Organizational Dynamics 11: 59-80. 30. Linder-Pelz, S. U. 1982. “Toward a Theory of Patient Satisfaction. Social Science & Medicine. 165: 577-82. 31. Williams, B. 1994. “Patient Satisfaction: A Valid Concept?” Social Science and Medicine 384: 509-516. 32. Ulmer, J.T. and M.S. Wilson. 2003. The Potential Contributions of Quantitative Research to Symbolic Interactionism. Symbolic Interaction. 264:531-552. 33. Holm, L. and L. Fitzmaurice. 2008. Emergency Department Waiting Room Stress: Can Music or Aromatherapy Improve Anxiety Scores? Pediatric Emergency Care 2412: 836-8. 34. Umiker, W. 1999. “Organizational Culture: The Role of Management and Supervisors.” Health Care Supervisor 17 (4): 22-7. 35. Babbie, E. 1986. The Practice of Social Research. Belmont: California. 36. Young, J. T. 2004. “Illness Behaviour: A Selective Review and Synthesis.” Sociology of Health & Illness 261: 1-31. 37. Benzies, K. M., and M. N. Allen. 2001. “Symbolic Interactionism as a Theoretical Perspective for Multiple Method Research.” J Adv Nurs. 334: 541-7. 38. Mechanic, D. 1989. “Medical Sociology: Some Tensions among Theory, Method and Substance.” Journal of Health and Social Behaviour 302: 147-160. 39. www.haber7.com/haber/Doktor-gozuyle-cins-cins-refakatci.php. Accessed December 11, 2010. 40. ….. 2007. ………… 41. Larsson, W.B., Larsson, G. and Starrin, B. 1999. Patients views on quality of care: a comparison of men and women. Journal of Nursing Management 73:133-139. 42. Bostan, S., T. Acuner, and G. Yilmaz. 2007. “Patient Customer Expectations in Hospitals.” Health Policy 82: 62-70. 43. Yilmaz, M. 2000. Ameliyat Oncesi Ogretimin Ameliyat Sonrasi Komplikasyonlara ve Hasta Memnuniyetine Etkisi, Unpublished Doctoral Dissertation, Hacettepe Universitesi: Ankara. 44. Carr-Hill, A.R. 1992. “The Measurement of Patient Satisfaction.” Journal of Public Health Medicine 143: 236-249. 45. Yildirim, C., H. Kocoglu, S. Goksu, N. Gunay, and H. Savas. 2005. “Patient Satisfaction in a University Hospital Emergency Department in Turkey.” Acta Medica (Hradec Kralove). 481: 59-62. 46. Genc, M., M. Egri, E. Pehlivan, V. Kirimlioglu, and S.Yilmaz. 1999. “Acil Servise Basvuran Hastalarin Bekleme Zamanlari Uzerine Bir Calisma.” Turgut Ozal Tip Merkezi Dergisi 64: 338-339. 47. Bursch, B., J. Beezy, and R. Shaw. 1993. “Emergency Department Satisfaction: What Matters Most?” Annals of Emergency Medicine 22:586-91. 48. Franco, L. M., S. Bennett, and R. Kanfer. 2002. “Health Sector Reform and Public Sector Health Worker Motivation: A Conceptual Framework.” Social Science and Medicine. 548: 1255-66. 49. Choi, Y. F, T. W. Wong, C. C. Lau. 2006. “Triage Rapid initial Assessment by Doctor TRIAD Improves Waiting Time and Processing Time of the Emergency Department.” Emergency Med Journal 234: 262-5. 50. Kilic, T., F. Efe, Ş. Ergüney, Z. Niyaz, Çetin, M.A, et al. “Triaj ve Numara Sistemi Uygulamalarının Acil Hasta Bekleme Suresi ve Acil Hasta Memnuniyeti Uzerine Etkisi: Kocaeli Devlet Hastanesi Orneği.” In III. Uluslararasi Sağlikta Performans ve Kalite Kongresi Sozel Bildiriler Kitabi edited by: U. Beylik, O. Onder, H. Guler, and A. Ozturk. Kasım 2011. 51. Oktay, C., Y. Cete, O. Eray, M. Pekdemir, and A. Gunerli. 2003. “Appropriateness of Emergency Department Visits in a Turkish University Hospital.” Croat Med Journal. 445: 585-91. 52. Skar, P., A. Bruce, and D. Sheets. 2015. “The Organizational Culture of Emergency Departments and the Effect on Care of Older Adults: A Modified Scoping Study.” Int. Emergency Nursing 23(2): 174-8. 53. Skidmore, R. A., and M. G. Thackeray. 1976. Introduction to Social Work. Prentice-Hall: Englewood Cliffs. 54. Fişek, N. Türkiye’nin Sağlık Sorunları ve Çözüm Yolları, www.ttb.org.tr/n_fisek/kitap. Accessed: June 02, 2015. 55. Saz, E. U., S. Ozen, and B. Karapinar. 2009. “Pediatrik Acil Servisler Detriyaj Protokolleri.” Pediatry. 184: 289-96. 56. Fry, M., and C. Stainton. 2005. “An Educational Framework for Triage Nursing Based on Gatekeeping, Timekeeping and Decision-Making Processes.” Accident and Emergency Nursing. 13: 214-19.