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Organizational Culture, Continuous Quality Improvement, and Medication Administration Error Reporting

Iowa City VA Medical Center, Iowa, College of Nursing, University of Iowa, Iowa City, Iowa, bonnie.wakefield{at}med.va.gov

Mary A. Blegen, PhD, RN

College of Nursing, University of Colorado, Boulder, Colorado

Tanya Uden-Holman, PhD

Institute for Quality Healthcare, University of Iowa, College of Public Health, University of Iowa

Thomas Vaughn, PhD

College of Public Health, University of Iowa

Elizabeth Chrischilles, PhD

College of Public Health, University of Iowa

Douglas S. Wakefield, PhD

College of Public Health, University of Iowa

This study explores the relationships among measures of nurses' perceptions of organizational culture, continuous quality improvement (CQI) implementation, and medication administration error (MAE) reporting. Hospital-based nurses were surveyed using measures of organizational culture and CQI implementation. These data were combined with previously collected data on perceptions of MAE reporting. A group-oriented culture had a significant positive correlation with CQI implementation, whereas hierarchical and rational culture types were negatively correlated with CQI implementation. Higher barriers to reporting MAE were associated with lower perceived reporting rates. A group-oriented culture and a greater extent of CQI implementation were positively (but not significantly) associated with the estimated overall percentage of MAEs reported. We conclude that health care organizations have implemented CQI programs, yet barriers remain relative to MAE reporting. There is a need to assess the reliability, validity, and completeness of key quality assessment and risk management data.

Key Words: Adverse event reporting • continuous quality improvement • organizational culture • patient safety • risk management

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