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Climatului organizational de lucru al serviciilor Organizational Climate of Staff
Working
Condiii i pentru Sigurana Un model integrativ Conditions and SafetyAn
Integrative Model
Patricia W. Stone, Michael I. Harrison, Feldman Penny, Patricia W. Stone, Michael I.
Harrison, Penny Feldman,
Linzer Mark, Peng Timotei, Douglas Roblin, Mark Linzer, Timothy Peng, Douglas
Roblin,
Jill Scott-Cawiezell, Nicholas Warren, Eric S. Williams Jill Scott-Cawiezell, Nicholas
Warren, Eric S. Williams
Abstract Abstract
Obiective: Acest proiect a ncercat s compare msurile de climatului organizational n
Objectives : This project sought to compare measures of organizational climate in
n curs de desfurare studii de sigurana pacienilor, s identifice asemnri i stabilirea
specifice ongoing patient safety studies, identify similarities and setting-specific
dimensiuni, dezvolta un model de domenii climatice, care sunt ipoteza de a afecta
dimensions, develop a model of climate domains that are hypothesized to affect
rezultate pe setrile, i de testare aspecte ale modelului:. Metode Anchetatorii outcomes
across settings, and test aspects of the model. Methods : Investigators
care au supravegheat "lucrtorii de ngrijire percepiile asupra sntii a climatului
organizational n who had surveyed health care workers' perceptions of organizational climate
in
ase studii finanate de ctre Agenia pentru Sntate i Cercetare Calitii (AHRQ) six
studies funded by the Agency for Healthcare Research and Quality (AHRQ)
au fost invitai s participe. were invited to participate. Ancheta elemente din fiecare studiu au
fost clasificate utiliznd Survey items from each study were classified using
patru domenii climatice gsite n literatura de specialitate o analiz prealabil. four climate
domains found in a prior literature review. Autorii discutat The authors discussed
subconstructs, a propus suplimentare construcii, a dezvoltat un model integrativ,
subconstructs, proposed additional constructs, developed an integrative model,
i testate independent anumite aspecte ale modelului:. Rezultate anchetatori and
independently tested selected aspects of the model. Results : The investigators
care au participat au studiat de ngrijire acut, domiciliu de ngrijire a sntii, ngrijire pe
termen lung, precum i who participated had studied acute care, home health care, long-term
care, and
mai multe setri; doi investigatori au studiat ngrijire medical primar. multiple settings; two
investigators had studied primary care. Mai mult de 80.000 More than 80,000
muncitori au fost chestionate. workers were surveyed. Modelul de baz domenii Clima inclus
conducere The model's core climate domains included leadership
(De exemplu, valori) i caracteristici structurale organizatorice (de exemplu, comunicare (eg,
values) and organizational structural characteristics (eg, communication
procesele i tehnologia informaiei), impactul care a fost mediat de patru processes and
information technology), the impact of which was mediated by four
variabilelor de proces: supravegherea, comportament de grup (de exemplu, colaborare), de
calitate process variables: supervision, group behavior (eg, collaboration), quality
accent (de exemplu, centrata in jurul pacientului), si design de munc (de exemplu, personal).
emphasis (eg, patient centeredness), and work design (eg, staffing). Aceste These

factori afecteaz sntatea lucrtor rezultatele de ngrijire (de exemplu, satisfacia, i intenia
de a factors affect health care worker outcomes (eg, satisfaction and intention to
concediu), precum i rezultatele pacient. leave) and patient outcomes. n general, modelul
complet explicat 24-65 la sut din Overall, the full model explained 24 to 65 percent of
variaia n satisfacia angajailor, dar nu a fost la fel de eficace la prezice the variance in
employee satisfaction, but was not as effective at predicting
intenia de a pleca:. Concluzii In timp ce unele din aceste domenii a aprut n prealabil
intention to leave. Conclusions: While some of these domains appeared in prior
modele, domenii-calitate accent noi, noi subconstructs, informaii models, new domains
quality emphasis, new subconstructs, information
tehnologie, precum i pacient centrarea-sunt n curs de dezvoltare. technology, and patient
centerednessare emerging. Modelul nostru invit dialog Our model invites dialogue
n rndul cercettorilor i informeaz stabilire a agendei pentru cercetri viitoare n among
researchers and informs agenda-setting for future research into
climatului organizaional i sigurana pacienilor i a angajailor de ngrijire a sntii.
organizational climate and the safety of patients and health care employees. Acest This
model integrativ va facilita-studiu cuantificarea cruce de asociaii ntre integrative model will
facilitate cross-study quantification of associations among
variabile n aceste domenii importante. variables in these important domains.
Introducere Introduction
Trei rapoarte recente de ctre Institutul de Medicina (IOM) majore identificate Three recent
reports by the Institute of Medicine (IOM) identified major
sigurana i probleme de calitate n sntate american i a atras atenia la sistemul de- safety
and quality problems in American health care and drew attention to systemsurse nivel de aceste probleme. level sources of these problems.
1-3 13
Ca autorii de trecere Chasm de calitate As the authors of Crossing the Quality Chasm
a declarat, "ameninrilor la adresa siguranei pacienilor sunt rezultatul final al cauze
complexe ... Modul stated, Threats to patient safety are the end result of complex causes
The way
pentru a mbunti sigurana este de a nva despre cauzele de eroare i de a folosi aceste
cunotine pentru a to improve safety is to learn about causes of error and use this knowledge
to
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Proiectarea sistemelor de ngrijire, astfel nct s ... face erori mai puin frecvente i mai puin
nocive design systems of care so as to make errors less common and less harmful
atunci cnd acestea apar. " when they do occur.
22
Ca rezultat, cercettorii, factorii de decizie politic, i de ngrijire a sntii As a result,
researchers, policymakers, and health care
Furnizorii au intensificat eforturile lor de a nelege i schimbarea organizaional providers
have intensified their efforts to understand and change organizational
condiii, componente, i procesele de sistemelor de sntate n care acestea se refer la
conditions, components, and processes of health care systems as they relate to
siguran. safety.
Studiile de cercetare n domeniul sntii, mpreun cu rezultatele de la alte industrii,
Research studies in health care, along with findings from other industries,

punct la o gam larg de condiii organizatorice i procese de lucru care pot point to a wide
range of organizational conditions and work processes that may
forma performana de practicieni de ngrijire a sntii i a organizaiilor furnizor. shape the
performance of health care practitioners and provider organizations.
4-10 410
n ciuda dificulti n punerea n aplicare de schimbare organizationala-ajunge departe, unele
Despite the difficulty in implementing far-reaching organizational change, some
furnizorii de servicii medicale au reuit n procesul de restructurare organizaiile lor n moduri
care health providers have succeeded in restructuring their organizations in ways that
promova asisten medical de calitate. promote quality health care.
11-14 1114
n cadrul acestui organism n cretere de dovezi, Within this growing body of evidence,
Cercettorii au cutat s neleag influena culturii organizaionale i researchers have sought
to understand the influence of organizational culture and
climatice asupra calitii de ngrijire a sntii. climate on health care quality.
climatului organizaional se refer la percepiile membru al organizaionale Organizational
climate refers to member perceptions of organizational
caracteristici cum ar fi luare a deciziilor, de conducere, i normele cu privire la locul de
munc. features like decisionmaking, leadership, and norms about work. De organizare
Organizational
cultur se refer n sens mai larg la norme, valori, convingeri i ipoteze mprtite culture
refers more broadly to the norms, values, beliefs, and assumptions shared
de ctre membrii unei organizaii sau a unei subculturi distinctiv ntr-un by members of an
organization or a distinctive subculture within an
organizaie. organization.
15, 16 15, 16
n ultimele dou decenii, multe studii ale culturii organizaionale In the past two decades,
many studies of organizational culture
au folosit chestionare standardizate i stocurilor culturale, care se bazeaz pe have used
standardized questionnaires and cultural inventories, which rely on
Membrii "percepiile i rapoartele de caracteristici culturale. members' perceptions and
reports of cultural features.
17-19 1719
Unele dintre aceste Some of these
cultura stocurilor standardizate sunt destul de aproape de instrumente iniial standardized
culture inventories are quite close to the instruments originally
dezvoltat pentru studii climatice. developed for climate studies. Mai mult dect att,
cercettorii au folosit uneori Moreover, researchers have sometimes used the
termenii de "cultur" i "clim" alternativ. terms culture and climate interchangeably.
Treptat, se acumuleaza dovezi ca cultura link-uri i climatice la comportament, Gradually,
evidence is accumulating that links culture and climate to behavior,
atitudini, i motivaiile intre clinicieni. attitudes, and motivations among clinicians. Aceste
comportamente i orientri poate, These behaviors and orientations can,
la rndul lor, afecta calitatea proceselor i a rezultatelor. in turn, affect quality processes and
outcomes. Multe studii n afara de ngrijire a sntii Many studies outside of health care
setrile i un numr tot mai mare de studii n domeniul ngrijirii sntii, arat c angajaii
settings and a growing number of studies in health care, show that employees
avea satisfacia de locuri de munc mai multe i experien puin stres i epuizare, atunci cnd
locul de munc have more job satisfaction and experience less stress and burnout when they
work

n culturi i climate, care au i mputernicirea de susinere i de conducere in cultures and


climates that have supportive and empowering leadership and
modalitile de organizare, mpreun cu mediile de grup pozitiv (de multe ori organizational
arrangements, along with positive group environments (often
reflectnd elemente de sprijin din partea grupului, colaborare, i consens). reflecting elements
of group support, collaboration, and consensus).
20-24 2024
Mai mult, satisfacia angajailor i de angajament au fost gsite n mod repetat Furthermore,
employee satisfaction and commitment have repeatedly been found
pentru a reduce si cifra de afaceri inteniile de absenteism. to reduce absenteeism and
turnover intentions.
20, 24-26 20, 2426
Aceste constatri conin These findings contain
implicaii importante pentru managementul de ngrijire a sntii. important implications for
health care management. De exemplu, personalul de asisten medical For example, nursing
staffs
sunt mai susceptibile de a fi ndeplinite, comise, i stabil n organizaii de ngrijire a sntii
are more likely to be satisfied, committed, and stable in health care organizations
care susin i s mputerniceasc asistente medicale. that support and empower nurses.
11
Un multumit stabil care alpteaz personal i mai poate A more satisfied and stable nursing
staff may
mai uor s contribuie la satisfacia pacientului, ajuta la reducerea erorilor, i s asiste n more
readily contribute to patient satisfaction, help reduce errors, and assist in the
punerea n aplicare de alte msuri pentru mbuntirea calitii de ngrijire a sntii.
implementation of other steps toward improving health care quality.
21, 27 21, 27
Studii Studies
ngrijire a sntii n afara link-ul, de asemenea, satisfacie i angajamentul de a individuale
outside health care also link satisfaction and commitment to individual
performan i alte forme de comportament constructive organizatoric. performance and other
forms of organizationally constructive behavior.
23, 24 23, 24
Un grup mai mic de studii exploreaz legturile directe ntre cultur sau climatice A smaller
group of studies explores direct links between culture or climate
i comportamente sau rezultate care sunt legate de calitate. and behaviors or outcomes that
are related to quality. Variabilele dependente n The dependent variables in
Aceste studii includ absenteism angajat, punerea n aplicare a bazate pe dovezi these studies
include employee absenteeism, implementation of evidence-based
practici de management de ngrijire, satisfacia pacientului, i de performan. care
management practices, patient satisfaction, and performance.
28-31 2831
Cu toate acestea, However,
dovezi solide care arat efectele directe ale culturii organizaionale sau climatice asupra solid
evidence showing direct impacts of organizational culture or climate on
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Modelarea climatului organizational Modeling Organizational Climate
469 469
i a sistemului de rezultatele clinice este rare. clinical and system outcomes is sparse.

33 33
excepii importante includ rezultatele Important exceptions include findings of
o asociere pozitiv ntre o cultur orientat spre lucrul n echip i pacient a positive
association between a teamwork-oriented culture and patient
satisfacie n Veteranilor de sntate spitale Administraie. satisfaction in Veterans Health
Administration hospitals.
30 30
n plus, Clark et al, Moreover, Clark et al,
raporteaz c asistentele medicale din unitile cu un nivel sczut de organizare i personal
sraci spital report that hospital nurses from units with low staffing and poor organizational
climate (n termeni de resurse i de conducere) au fost de dou ori mai probabil ca asistente
medicale pe climates (in terms of resources and leadership) were twice as likely as nurses on
bine-personal i-a organizat uniti mai bine s raporteze factorii de risc, rnile cauzate de
ace, well-staffed and better-organized units to report risk factors, needlestick injuries,
i lng rateaz. and near misses.
33 33
n cazurile n care cultura i schimbrile climatice nu independent In instances where culture
and climate do not independently
prezice i organizatorice rezultatele clinice, ele pot aciona n continuare la fel de importante
predict clinical and organizational outcomes, they may still act as important
contextuale sau factori de mediere. mediating or contextual factors.
29, 34, 35 29, 34, 35
De exemplu, n canadian ngrijire pe termen lung For example, in Canadian long-term care
faciliti, o cultur care accept nvarea organizaional i angajat facilities, a culture that
supports organizational learning and employee
de dezvoltare sa dovedit a fi o condiie necesar pentru mbuntirea calitii development
was found to be a necessary condition for quality improvement
programe pentru a atinge obiectivele lor de organizare. programs to achieve their
organizational objectives.
27 27
studii cantitative ale culturii organizaionale, cum ar fi cele raportate mai sus, Quantitative
studies of organizational culture, such as those reported above,
de multe ori au ntocmit fie pe modele de dimensiuni sau tipologic. often have drawn on
either typological or dimensional models.
19 19
Tipologic Typological
modele ncearc s clasifice culturi organizaionale ntreg n termeni de o valoare dominant
models seek to classify entire organizational cultures in terms of a dominant value
sau normativ orientare. or normative orientation. De exemplu, concurente cadrul valorile
clasific For example, the competing values framework classifies
organizaii ca fiind predominant orientate spre coeziunea intern i umane organizations as
predominantly oriented toward internal cohesiveness and human
relaii de dezvoltare, creativitate i inovare, ordine i previzibilitate, sau relations
development, creativity and innovation, order and predictability, or
competitivitii i atingerea scopului. competitiveness and goal attainment.
36 36
Shortell i colegii si au adoptat acest Shortell and his colleagues adopted this
model pentru culturile de organizaiile medicale prin caracterizarea respective model to the
cultures of medical organizations by characterizing the respective

tipuri culturale, ierarhic, de dezvoltare de grup, sau lor raional n cultural types as group,
hierarchical, developmental, or rational in their
orientri. orientations.
29, 32 29, 32
modele tipologic presupune c ntreaga culturi pot fi Typological models assume that entire
cultures can be
caracterizat n termeni de o tem de fond global. characterized in terms of an overarching
substantive theme. n schimb, In contrast,
modele dimensionale, inclusiv unele derivate din valorile concurente dimensional models,
including some derived from the competing values
cadru, pentru a permite posibilitatea de variaiile interne de-a lungul separate, framework,
allow for the possibility of internal variations along separate,
definite conceptual orientri. conceptually defined orientations.
37 37
De exemplu, Kralewski, Wingert and For example, Kralewski, Wingert and
Barbouche a dezvoltat un instrument pentru evaluarea accentul de ctre membrii Barbouche
developed an instrument for assessing emphasis by members of
grup practicilor medicale pe fiecare din cele nou dimensiuni-inovare, grup medical group
practices on each of nine dimensionsinnovativeness, group
solidaritate, cost-eficacitate orientare, formalitate de organizare, metoda de cost solidarity,
cost-effectiveness orientation, organizational formality, method of cost
controlului, centralizarea deciziilor, entrepreneurism, medic control, centralization of
decisionmaking, entrepreneurism, physician
individualitate, i vizibilitatea a costurilor. individuality, and visibility of costs.
38 38
Din pcate, lipsa de consens cu privire la dimensiunile cheie i subconstructs pentru
Unfortunately, lack of consensus on the key dimensions and subconstructs for
cultura evaluarea i climatice a ncetinit acumularea de dovezi cu privire la modul n care
assessing culture and climate has slowed the accumulation of evidence about how
norme, valori, i percepii afecta sigurana pacienilor i alte aspecte ale calitii norms,
values, and perceptions affect patient safety and other aspects of quality of
de ngrijire. care. Anchetatorii i n afar de ngrijire a sntii au folosit o varietate foarte
larg de Investigators in and out of health care have used a very wide variety of
definiii, concepte, msuri i metode pentru a studia cultura i definitions, concepts,
measures, and methods to study culture and
climatice. climate.
17, 24, 31, 39-41 17, 24, 31, 3941
Dei acest amestec larg de msuri i definiii reflect Although this broad mix of measures
and definitions reflects
complexitatea fenomenelor sub studiu, lipsa de definiii and the complexity of the phenomena
under study, lack of definitional and
coerenei metodologice face greu de a generaliza n toate studiile i methodological
consistency makes it hard to generalize across studies and
dezvoltarea pe baz de dovezi implicaii pentru practic. develop evidence-based implications
for practice.
Aceast lucrare rapoartele de un efort de a ajuta aduce ordine si consistenta la aceast linie de
This paper reports an effort to help bring order and consistency to this line of
de cercetare. research. n ea ne dezvolta si testa un model de climat organizaionale n
domeniul sntii In it we develop and test a model of organizational climate in health care

peste livrare setri diverse. across diverse delivery settings. Ne concentrm asupra climatului
organizational pentru un numr We focus on organizational climate for a number
de motive. of reasons. n primul rnd, climatul organizaional caracteristici pot fi mai
susceptibile de a schimba First, organizational climate features may be more amenable to
change
dect cu rdcini culturale ipoteze profund i valori. than deep-rooted cultural assumptions
and values. n al doilea rnd, accentul pe Second, the focus on
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climatului organizational, mai degrab dect cultura, pot prevedea o logic potrivi mai bine
organizational climate, rather than culture, may provide for a better logical fit
ntre concepte i msuri chestionar dect uneori apare n between concepts and questionnaire
measures than sometimes occurs in
cultura stocurilor cantitative; se pare destul de logic c membrii unei quantitative culture
inventories; it seems quite logical that members of an
organizaie va fi contieni de perceptiile lor de condiii organizatorice organization will be
aware of their perceptions of organizational conditions
(Climatice) i va fi n msur s raporteze aceste percepii cu exactitate n tip nchis (climate)
and will be able to report these perceptions accurately in closed-ended
ntrebri. questions. n schimb, membrii sunt mai puin probabil s fie pe deplin contieni de
comun In contrast, members are less likely to be fully cognizant of shared
norme, valori, i ipotezele de baz, i poate confrunta cu dificulti n caracterizarea norms,
values, and basic assumptions, and may face difficulties in characterizing
astfel de fenomene complexe, n rspunsurile lor la ntrebri cu variante de fix. such complex
phenomena in their responses to fixed-choice questions.
42-44 4244
n sfrit, Lastly,
ne concentrm asupra faete ale climatului organizational, care sunt deosebit de relevante
pentru ngrijirea we focus on facets of organizational climate that are particularly relevant to
care
furnizori, manageri de sntate, precum i factorii de decizie. providers, health managers, and
decisionmakers.
Acest proiect a rezultat dintr-o iniiativ de ctre Agenia pentru Sanatate si Cercetare This
project resulted from an initiative by the Agency for Healthcare Research
i Calitate (AHRQ) care vizeaz fora de munc de ngrijire a sntii i a siguranei
pacienilor (RFA and Quality (AHRQ) targeting the health care workforce and patient safety
(RFA
HS01-005). HS01-005). AHRQ sponsorizat o serie de grupuri de lucru, dintre care unul axat
AHRQ sponsored a number of working groups, one of which focused
privind condiiile de munc i climatul organizaional. on working conditions and
organizational climate. Acest grup de lucru a organizat o This working group held a
numrul de apeluri de conferine pe o perioad de 3 ani, pentru a discuta aspecte n curs de
dezvoltare la number of conference calls over a 3-year period to discuss issues developing at
AHRQ, ofer un schimb deschis de idei n ceea ce privete msurarea AHRQ, provide an
open exchange of ideas regarding the measurement of
climatice organizaionale de pe teritoriul setrile de ngrijire a sntii i relaia sa cu
pacientul organizational climate across health care settings and its relationship to patient

siguran, i s dezvolte sinergia dintre bursierii. safety, and develop synergy among grantees.
Anchetatorii au implicat n acest forum Investigators involved in this forum
au fost invitai s participe la acest proiect, dac acestea au fost parte dintr-o echip studiu
care a avut were invited to participate in this project if they were part of a study team that had
intervievai lucrtor grij de sntatea percepiilor climatului organizational. surveyed health
care worker perceptions of organizational climate. Bazat pe o Based on a
literatura de specialitate nainte de intrare i de anchetatori diferite, grupul prior literature
review and input from the various investigators, the group
discutat domenii conceptuale i subconstructs a climatului organizational legate de discussed
conceptual domains and subconstructs of organizational climate related
la condiiile de munc percepute i relaia sa cu lucrtor de siguran de ngrijire a sntii to
perceived working conditions and its relationship to health care worker safety
i pacientul siguran. and patient safety.
18 18
Un model conceptual de integrare a climatului organizational An integrative conceptual
model of organizational climate
a fost dezvoltat prin cutarea consens n rndul participanilor despre empiric i was
developed by seeking consensus among participants about empirically and
teoretic important construiete. theoretically important constructs.
Integrative model The integrative model
Modelul de integrare este prezentat n figura 1. The integrative model is presented in Figure
1. Modelul de baz climatice The model's core climate
domenii includ conducere i caracteristici structurale de organizare. domains include
leadership and organizational structural characteristics.
Subconstructs de conducere includ valori organizaionale, precum i ca stil i Subconstructs
of leadership include organizational values, as well as style and
strategiile folosite de top management. strategies used by top management. Subconstructs
asociate cu The subconstructs associated with
caracteristici structurale de organizare include procesele de comunicare formale,
organizational structural characteristics include formal communication processes,
structuri de guvernare, i informaii infrastructurii tehnologice. governance structures, and
information technology infrastructure. Directe The direct
impactul acestor variabile asupra pacientului i asistena rezultatele lucrtor de sntate este
mediat impact of these variables on patient and health care worker outcomes is mediated
de patru domenii proces: (1) supravegherea, (2) comportamentul de grup, (3) de calitate by
four process domains: (1) supervision, (2) group behavior, (3) quality
accent, i) de munc design, de 4 (. emphasis, and (4) work design. Acest model face
distincia ntre conducere i This model distinguishes between leadership and
de supraveghere. supervision. Supravegherea direct se refer la "managerilor stil sau o
recunoatere Supervision refers to the direct managers' style or the recognition an
angajat primete pe o baz de zi cu zi. employee receives on a daily basis. design de lucru
include cinci subconstructs: (1) Work design includes five subconstructs: (1)
volumul de gestionat, (2), resurse i formare profesional, (3) recompense (definite ca
manageable workload, (2) resources and training, (3) rewards (defined as
compensaii monetare, cum ar fi salarii i bonusuri), (4), autonomia, i (5) monetary
compensation such as salary and bonuses), (4) autonomy, and (5)
angajat de siguran. employee safety. Comportamentul Group include doua subconstructscolaborare i Group behavior includes two subconstructscollaboration and
consens (denumit inclusiv articole din urm, cum ar fi "exist un acord general privind
consensus (the latter including items such as there is general agreement on

metodele de tratament "). treatment methods). Subconstructs asociate cu accent de calitate


includ Subconstructs associated with quality emphasis include
centrata pacient, sigurana pacienilor, inovatie, msurarea rezultatelor, i patient
centeredness, patient safety, innovation, outcome measurement, and
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Modelarea climatului organizational Modeling Organizational Climate
471 471
bazate pe dovezi practica. evidence-based practice. Cele patru domenii procesul de influen
lucrtor rezultatele The four process domains influence worker outcomes
i rezultatele pacient. and patient outcomes. n cele din urm, rezultatele lucrtor se ateapt
la un impact asupra Finally, worker outcomes are expected to impact upon
rezultatele pacient. patient outcomes.
Metode de validare a modelului Methods of validating the model
Dei fiecare echipa de cercetare a conceptualizat iniial relaiile cheie ntre Although each
research team initially conceptualized key relationships among
elemente de organizare i de performan diferit, toate participante organizational elements
and performance differently, all participating
Echipele de anchetatori a cutat s neleag elementele eseniale ale climei. investigative
teams sought to understand essential elements of climate. Prin urmare, Therefore,
fiecare anchetator cu condiia ca elementele de ngrijire lucrtor din anchetele de sntate n
prezent fiind each investigator provided the health care worker survey items currently being
lor utilizate n curs de desfurare proiecte de cercetare separat. used in their separate
ongoing research projects. Un element-de-analiza element de toate An item-by-item analysis
of all
sondaje a fost realizat de doi dintre autori (PS i MH). surveys was conducted by two of the
authors (PS and MH). n acest proces, In this process, the
climatice scale originale au fost descompuse, i fiecare element a fost teoretic original climate
scales were decomposed, and each item was theoretically
clasificate utiliznd integratoare modelul dezvoltat in-montaj domeniu cele mai bune
classified using the developed integrative model into the best-fitting domain
i / sau n subconstruct model integrativ. and/or subconstruct in the integrative model. De
exemplu, articole clasificate ca For example, items classified as
msurare stil de supraveghere includ "Simt c am supravegheat mai atent dect measuring
supervision style include I feel that I am supervised more closely than
este necesar, "i" un personal de supraveghere, care este de susinere de asistente medicale.
"O copie a tuturor is necessary, and a supervisory staff that is supportive of nurses. A copy
of all
scale final este disponibil de la autor corespunztoare. final scales is available from the
corresponding author.
Fiabilitatea statisticilor (de alfa Cronbach) de scale au fost examinate i articole Reliability
statistics (Cronbach's alpha) of scales were examined and items
s-au diminuat dup cum este necesar pentru a dezvolta stabil msurile cele mai posibile ale
were dropped as necessary to develop the most stable measures possible of the
concepte teoretice. theoretical concepts. Cntare care au fost instabile s-au diminuat de la
modelul n continuare Scales that were unstable were dropped from further model
Figura 1. Figure 1. Un model integrativ de ngrijire a sntii condiiilor de munc pe
organizationala An integrative model of health care working conditions on
organizational
climatice i de siguran climate and safety

Cutii prezentate cu linii punctate reprezinta domenii ale climatului organizational. Boxes
outlined with dotted lines represent domains of organizational climate. Cutii prezentate cu
Boxes outlined with
Liniile solide reprezinta rezultatele. solid lines represent outcomes. domenii Core sunt n
aldine. Core domains are in bold. Subconstructs sunt marcatori Subconstructs are bulleted
dedesubt. underneath. Sgeile punctate conectarea structurale domenii de baz reprezint
efecte directe asupra The dotted arrows connecting core structural domains represent direct
effects on
rezultatele, care sunt mediate de domenii proces. outcomes, which are mediated by the
process domains.
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472 472
de testare. testing. Toate proiectele au fost testate pentru multicollinearity printre cntare
folosind pereche All projects were tested for multicollinearity among scales using pairwise
corelaie Pearson ntre solzi. Pearson correlation between scales. Patru dintre studii nu a gasit
nici corelatii c Four of the studies found no correlations that
depit o limit cutoff de r 0,60. exceeded a cutoff limit of r 0.60. Dou echipe de
cercetare a descoperit o corelaie peste Two research teams found a correlation over
0.60, si fiecare dintre cei doi a eliminat pe aceast baz. 0.60, and each eliminated one of the
pair on this basis. n plus, un studiu Additionally, one study
examinat diagnostic colinearitii incluse n pachetul statistic pentru examined the collinearity
diagnostics included in Statistical Package for the
tiine Sociale (SPSS) 11.5 i sa constatat c nivelurile de colinearitii suficient de mare
pentru a afecta Social Sciences (SPSS) 11.5 and found levels of collinearity high enough to
affect
modele. the models. Unul scar, cu cel mai mare factor inflaie variaie (VIF), a fost One
scale, with the highest variance inflation factor (VIF), was
eliminate nainte paii de modelare final. eliminated before the final modeling steps. Final de
modele pentru toate studiile au fost astfel Final models for all studies were thus
circulaie a nivelurilor colinearitii care ar putea afecta stabilitatea modelului. free of
collinearity levels that would affect model stability.
Deoarece anchetatorii participante au fost furnizarea de date de la curs, Because the
participating investigators were supplying data from ongoing,
AHRQ-finanate de sigurana pacienilor proiecte, multe dintre anchetatorii erau nc n
AHRQ-funded patient safety projects, many of the investigators were still in the
procesul de colectare a datelor. process of data collection. Prin urmare, datele privind
rezultatul principal al pacientului Therefore, data on the primary outcome of patient
de siguran au fost de multe ori nu sunt disponibile. safety were often not available. n
schimb, membrii grupului au decis s valideze Instead, the group members decided to
validate
model utiliznd cele mai frecvente lucrtor medical de ngrijire rezultatelor constatate n
diferite the model using the most common health care worker outcomes found across
studii, care au fost satisfacia angajailor i intenia de a prsi. studies, which were employee
satisfaction and intention to leave.
Pentru a testa diferite aspecte ale modelului, fiecare echip de anchet a efectuat o To test
different aspects of the model, each investigative team conducted a
serie de analize similare. series of similar analyses. n primul rnd, regresii liniare au fost
realizate pentru a investiga First, linear regressions were conducted to investigate

relaia dintre climat de baz subconstructs de conducere i the relationship among the core
climate subconstructs of leadership and
organizaionale caracteristicile structurale. organizational structural characteristics. n al
doilea rnd, pentru a nelege relaia Second, to understand the relationship
printre climatice domeniile de baz i cele patru domenii procesul-supraveghere, among the
core climate domains and the four process domainssupervision,
comportamentul de grup, accentul de calitate, si design-liniar regresii de lucru au fost group
behavior, quality emphasis, and work designlinear regressions were
efectuate folosind domenii de baz ca variabile predictor i procesul de conducted using the
core domains as the predictor variables and the process
domenii ca variabile dependente. domains as the dependent variables. n al treilea rnd,
regresii liniare s-au efectuat Third, linear regressions were conducted
domenii de baz folosind ca variabilele independente i de ngrijire a sntii rezultatul
lucrtor using core domains as the independent variables and health care worker outcome
msuri ca variabile dependente. measures as the dependent variables. n cele din urm,
anchetatorii au testat independent Finally, investigators tested the independent
efecte ale fiecrui proces privind asistena subconstruct rezultatelor lucrtor de sntate, de
control effects of each process subconstruct on health care worker outcomes, controlling
pentru domeniile de baz folosind trepte regresii multivariate. for the core domains using
multivariate stepwise regressions. n aceste modele, In these models, the
climat de baz subconstructs asociate cu conducerea i organizatorice core climate
subconstructs associated with leadership and organizational
Caracteristicile structurale au fost nscrise ca primul bloc de variabile independente. structural
characteristics were entered as the first block of independent variables.
Apoi, subconstructs asociate cu domeniile procesul de patru (supraveghere, Then, the
subconstructs associated with the four process domains (supervision,
comportamentul de grup, accentul de calitate, si design de munc) au fost introduse ca un al
doilea group behavior, quality emphasis, and work design) were entered as a second
bloc de variabile independente. block of independent variables. Cand anchetatorii au
descoperit ca angajat When investigators found that employee
demografice a prezis aceste rezultate, variabilele demografice au fost demographics predicted
these outcomes, the demographic variables were
statistic controlate pentru. statistically controlled for. Sa emis ipoteza c variabilele
independente It was hypothesized that the independent variables
ar fi pozitiv legate de satisfacie i negativ legate de intenia de a would be positively related
to satisfaction and negatively related to intention to
concediu. leave.
Nu a fost necesar uoar variaie n mijloacele utilizate de investigaie There was slight
necessary variation in the means used by the investigative
echipe pentru a efectua regresii lor, din cauza naturii de analiza datelor secundare. teams to
conduct their regressions, due to the nature of secondary data analysis.
Cele mai multe echipe de anchet folosit subconstructs descris ca independent Most
investigative teams used the subconstructs described as the independent
variabile. variables. Cu toate acestea, o echip de investigaie a combinat subconstructs n
However, one investigative team combined the subconstructs into
climatice globale domenii de organizare. overall organizational climate domains. ntr-un alt
studiu, intenia de a pleca a fost In another study, intention to leave was
msurat ca o variabil dihotomice, i, prin urmare, o regresie logistic a fost measured as a
dichotomous variable, and therefore, a logistic regression was

efectuat ntr-o manier similar cu cea a regresii liniare. conducted in a fashion similar to that
of the linear regressions.
Page 7 Page 7
Modelarea climatului organizational Modeling Organizational Climate
473 473
Rezultate Results
Demografia participante studii Demographics of participating studies
Cele ase echipe participante de investigaie reprezint studii individuale The six participating
investigative teams represent individual studies
efectuate n ntreaga naiune n sntate setri de ngrijire urmtoarele: ngrijire acut (n =
conducted across the nation in the following health care settings: acute care (n =
1), de ngrijire la domiciliu de sntate (n = 1), ingrijirea pe termen lung lung (n = 1), setrile
de ngrijire primar (n = 2), 1), home health care (n = 1), long-term care (n = 1), primary care
settings (n = 2),
i setri multiple (n = 1). and multiple settings (n = 1). Mai mult de 80.000 de muncitori de
ngrijire a sntii au fost More than 80,000 health care workers were
intervievai n aceste proiecte, i demografia angajat chestionate de ctre fiecare surveyed in
these projects, and employee demographics surveyed by each
Echipa de investigaie sunt descrise n tabelul 1. investigative team are described in Table 1.
Diverse categorii de locuri de munc de la Diverse job categories ranging from
asisten medical asisteni certificate la administratori de spitale i asisteni medicali la
certified nursing assistants to hospital administrators and medical assistants to
Furnizorii de asisten primar sunt reprezentate, cu cea mai mare proba asociate cu o
primary care providers are represented, with the largest sample associated with a
multisite studiu efectuat prin intermediul a Sntii Veteranilor Administraie. multisite study
conducted through the Veterans Health Administration. The
Sondajele folosite de ctre fiecare echip de investigaie variaz. surveys used by each
investigative team vary.
Tabelul 1. Table 1. Descrierea probelor i studii de la fiecare proiect independent
Description of samples and surveys from each independent project
Studiu Study
Caracteristic Characteristic
11
22
33
44
55
66
Descriere Description
ngrijire la domiciliu Home care
General General
medicin medicine
i familia and family
medicin medicine
practici practices
De ngrijire primar Primary care
echipe teams
Mai multe Multiple
setri settings

peste VHA across VHA


faciliti facilities
32 Colorado 32 Colorado
ngrijire nursing
case homes
109 109
intensiv intensive
uniti de ngrijire care units
Descrierea Description of
eantion sample
Nonclinicians Nonclinicians
(M) i (M) and
clinicieni clinicians
(RN, T) (RN, T)
Clinicieni Clinicians
(MD) (MD)
Nonclinicians Nonclinicians
(R, S) i (R, S) and
clinicieni clinicians
(LPN, MD, (LPN, MD,
MA, NP, PA, MA, NP, PA,
RN) RN)
Nonclinicians Nonclinicians
(U) i (U) and
clinicieni (U) clinicians (U)
Nonclinicians Nonclinicians
(U) i (U) and
clinicieni clinicians
(CNA, RN, (CNA, RN,
LPN) LPN)
Clinicieni Clinicians
(RN) (RN)
Final eantion Final sample
dimensiunea size
952 952
420 420
600 600
74,595 74,595
1,763 1,763
2,324 2,324
Numrul de Number of
articole n sondaj items in survey
99 99
31 31
18 18
29 29
52 52
59 59
VHA = Veteranilor Health Administration VHA = Veterans Health Administration

Nonclinicians include manageri (M), recepioneri (R), personal (S), i nespecificate (U).
Nonclinicians include managers (M), receptionists (R), staff (S), and unspecified (U).
Clinicienii includ certificate asistent care alpteaz (CNA), liceniat asistent practice (LPN),
medicale Clinicians include certified nursing assistant (CNA), licensed practical nurse (LPN),
medical
asistent (MA), medic (MD), medic asistent (NP), asistent medic (AP), nregistrate assistant
(MA), medical doctor (MD), nurse practitioner (NP), physician assistant (PA), registered
asistent medical (RN), terapeut (T), i nespecificate (U). nurse (RN), therapist (T), and
unspecified (U).
Rezultatele testelor empirice ale modelului Results of empirical testing of the model
Numrul de elemente aplicabile pentru fiecare domeniu i fiabilitatea nou The number of
applicable items per domain and the reliability of the newly
scale dezvoltate din fiecare studiu sunt raportate n Tabelul 2. developed scales from each
study are reported in Table 2. Toate echipele de investigaie, All investigative teams,
cu excepia faptului c implicat cu Studiul 2, au reuit s dezvolte scale relativ stabile la
except that involved with Study 2, were able to develop relatively stable scales at
the subconstruct nivel. the subconstruct level. Toate studiile, cu excepia faptului c implicat
cu Studiul 3, a avut unele All studies, except that involved with Study 3, had some
tip de msur referitoare la domeniile de organizare climatice de baz. type of measure
related to the core organizational climate domains. The
"Tehnologia informaiei" subconstruct nu a fost reprezentat de un independent information
technology subconstruct was not represented by an independent
msur n orice anchet, cu toate acestea, elementele aferente au fost gsite n Studiul 2 a
measure in any investigation; however, related items were found in Study 2's
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Tabelul 2. Table 2. Fiabilitatea de msuri Reliability of measures
Studiu Study
11
22
33
44
55
66
Core climatice domenii de organizare Core organizational climate domains
Conducere Leadership
-2 (.69) 2 (.69)
----Valori Values
---11
--

2 (.66) 2 (.66)
Strategie / stil Strategy/style
---11
6 (.78) 6 (.78)
-Organizaionale structurale Organizational structural
caracteristici characteristics
-7 (.76) 7 (.76)
----Proceselor de comunicare Communication processes
9 (.90) 9 (.90)
---3 (.70) 3 (.70)
2 (0.47) 2 (.47)
Guvernare Governance
---2 (.74) 2 (.74)
2 (0.49) 4 (0.71) 2 (.49) 4 (.71)
Tehnologia informaiei Information technology
------Procesul de organizare climatice domenii Organizational climate process domains
Supravegherea Supervision
------Stil Style
7 (.88) 7 (.88)
--4 (.78) 4 (.78)
11

4 (.86) 4 (.86)
Angajat de recunoatere Employee recognition
---2 (.70) 2 (.70)
-2 (.71) 2 (.71)
Lucrrile de proiectare Work design
-11
----Gestionat volumul de munc Manageable workload
5 (.75) 5 (.75)
----7 (.72) 7 (.72)
Resurse / formare Resources/training
7 (.89) 7 (.89)
-6 (0.74) 2 (0.58) un 6 (.74) 2 (.58) 1
5 (.73) 5 (.73)
Recompense Rewards
4 (.77) 4 (.77)
-----Autonomie Autonomy
9 (.82) 9 (.82)
-7 (0.82) - 7 (.82) 3 (0.24) - 3 (.24) Angajat de siguran Employee safety
------Grup de comportament Group behavior
-9 (.79) 9 (.79)
--

---Colaborare Collaboration
12 (.89) 12 (.89)
-3 (.83) 1 3 (.83) 1
6 (.86) * 3 (.87) 6 (.86) * 3 (.87)
Consensul / armonie Consensus/harmony
---4 (.74) 4 (.74)
4 (.78) 4 (.78)
-Calitate accent Quality emphasis
-10 (.81) 10 (.81)
----Pacient centrata Patient centeredness
11
-2 (.73) 3 (.82) 2 (.73) 3 (.82)
--Siguranei pacienilor Patient safety
15 (.87) 15 (.87)
-----Inovare Innovation
---2 (.79) 2 (.79)
--Rezultatele de msurare Outcome measurement
---2 (.68) 2 (.68)
--Dovezi bazate pe practica Evidence-based practice

----11
-Sntate lucrtor rezultatele de ngrijire Health care worker outcomes
Satisfacie Satisfaction
12 (.90) 12 (.90)
5 (.86) 5 (.86)
6 (.87) 4 (.77) 6 (.87) 4 (.77)
-11
Intenia de a prsi Intention to leave
11
11
00
11
11
11
Not: Fiecare cifr reprezint numrul de articole n msura. Note: Each numeral represents
of the number of items in the measure. n paranteze este menionat In parentheses is the
Cronbach lui alfa de scara. Cronbach's alpha ( ) of the scale. Cratim (-) reprezint
domeniu sau subconstruct nu se msoar. Dash (-) represents domain or subconstruct not
measured.
* Aceast echip de investigaie a avut 4 scri individuale cu privire la colaborarea, numrul
de elemente i pentru *This investigative team had 4 individual scales on collaboration; the
number of items and for
scara 1 este raportat n tabel. scale 1 is reported in the table. Scar 2 coninea 6 obiecte
(0.80); scar 3 care figureaz 5 articole (0.80); Scale 2 contained 6 items (.80); scale 3
contained 5 items (.80);
scar de 4 coninute 4 obiecte (0.69). scale 4 contained 4 items (.69).

Indic o cifr cu scorul de alfa Cronbach o sub nivelul acceptabil (r 0.60). Indicates a figure
with a Cronbach's alpha score below the acceptable level ( r 0.60).
organizaionale structurale caracteristice scar. organizational structural characteristic scale.
Procesele legate direct Processes related to direct
de supraveghere au fost msurate n patru studii, cu toate acestea, studiul 5 au doar un singur
supervision were measured in four of the studies; however, Study 5 had only one
element n aceast categorie. item in this category. Toate studiile au avut o oarecare msur
de design de lucru, cu All studies had some measure of work design, with
resurse i / sau de formare fiind cel mai frecvent msurate subconstruct. resources and/or
training being the most commonly measured subconstruct. Toate All
studii au avut o oarecare msur de comportamentul de grup, i cel mai msurat colaborare
studies had some measure of group behavior, and most measured collaboration
(Cinci din ase studii). (five out of six studies). Studiu 5, care a fost realizat ntr-un termen de
ngrijire setare-lung, Study 5, which was conducted in a long-term care setting,

a avut patru stabil scale separate de colaborare. had four separate stable scales of
collaboration. Cele mai multe studii (patru din cele ase) au avut Most studies (four of six)
had
msuri stabil de accent de calitate, n timp ce Studiul 5-a avut un element singur msur.
stable measures of quality emphasis, while Study 5 had a single-item measure.
Satisfacia angajailor i intenia de a pleca au fost frecvent msurat pe Employee
satisfaction and intention to leave were commonly measured across
studii. studies. Studiul 6 au avut un singur element legate de satisfacie, n timp ce celelalte
cinci Study 6 had a single item related to satisfaction, while the other five
studii au avut-element scale multi disponibile pentru a msura satisfacia angajailor. studies
had multi-item scales available to measure employee satisfaction. De asemenea, n Also in
Studiul 6, msura de intenia de a pleca a fost dihotomice, n comparaie cu Study 6, the
measure of intention to leave was dichotomous, compared to the
alte patru studii, care a avut un element-, la nivel de variabile continue. other four studies,
which had one-item, continuous-level variables.
Page 9 Page 9
Modelarea climatului organizational Modeling Organizational Climate
475 475
Cum a prezis, analizele de regresie n studii separate a aratat ca exista As predicted, the
regression analyses within the separate studies showed there
a fost o relaie puternic ntre climatul de baz subconstructs de conducere i was a strong
relationship among the core climate subconstructs of leadership and
organizaionale caracteristicile structurale. organizational structural characteristics. Aceast
analiz nu era aplicabil la studiu This analysis was not applicable to Study
3, din cauza lipsei de msurare de domenii de baz. 3, due to the lack of measurement of core
domains. n celelalte cinci studii, In the other five studies, the
domeniu conducere sau unul dintre subconstructs semnificativ (P 0,05) a prezis leadership
domain or one of its subconstructs significantly ( P 0.05) predicted
msuri de caracteristici structurale organizatorice; variana explicat measures of
organizational structural characteristics; the variance explained
variat de 24-54 la sut. ranged from 24 to 54 percent. Cele dou domenii de baz, de
asemenea, semnificativ prezis The two core domains also significantly predicted
pentru construcii, n cadrul domeniilor procesul de patru. to constructs within the four
process domains. Dei numrul de procesul de Although the number of process
variabile variat ntre studii, n aproape fiecare caz, domeniile lor de baz sau variables varied
among the studies, in nearly every case the core domains or their
subconstructs statistic semnificativ a avut predictii ale variabilelor procesului. subconstructs
had statistically significant predictions of the process variables. The
domenii de baz a avut, de asemenea, direct efecte puternice asupra variabilelor rezultatul.
core domains also had strong direct effects on the outcome variables. Douzeci Twenty to
34 la sut din variaia satisfacia angajailor i 8 la 10 la sut din 34 percent of the variance in
employee satisfaction and 8 to 10 percent of the
variaia n intenia de a pleca a fost explicat de ctre domenii de baz. variance in intention
to leave was explained by the core domains.
Cinci dintre echipele de investigaie au fost capabili s efectueze treptat multivariat Five of
the investigative teams were able to conduct the multivariate stepwise
regresii predicia satisfacie (tabelul 3). regressions predicting satisfaction (Table 3). Multe
din miez de organizare Many of the core organizational

domenii climatice sau subconstructs (cinci din cele opt) a continuat s aib statistic climate
domains or subconstructs (five of eight) continued to have statistically
semnificativ (P <0,05) efecte independente asupra satisfactiei. significant ( P < 0.05)
independent effects on satisfaction. n plus, cele mai multe In addition, most of the
Procesul de domenii sau subconstructs (25 din 30) au avut efecte semnificative independent
process domains or subconstructs (25 of 30) had significant independent effects
pe satisfacie. on satisfaction. n general, modelul complet explicat 24-65 la sut din variaia
Overall, the full model explained 24 to 65 percent of the variance
a satisfaciei angajailor. in employee satisfaction.
Rezultatele de la trepte regresii multivariate intenia de a prezice Results from the
multivariate stepwise regressions predicting intention to
concediu sunt afiate n tabelul 4. leave are displayed in Table 4. n timp ce direcia de relaii
au fost While the direction of the relationships were as
i negative percepiile prezis de climatului organizational prezis intenia de a predicted and
negative perceptions of organizational climate predicted intention to
concediu, doar trei dintre elementele conducerii ase a avut un punct de vedere statistic
semnificativ leave, only three of the six leadership items had a statistically significant
efect independent cu privire la intenia de a prsi, i nici unul dintre organizaionale
structurale independent effect on intention to leave, and none of the organizational structural
caracteristici (n = 5) a fost un important predictor independent. characteristics (n = 5) was an
independent significant predictor. A procesului de Of the process
domenii si subconstructs, de supraveghere a avut cea mai consistent independent domains
and subconstructs, supervision had the most consistent independent
efect semnificativ asupra inteniei de a prsi. significant effect on intention to leave. n
general, modelul a explicat 8-23 Overall, the model explained 8 to 23
la sut din variaia n intenia de a pleca. percent of the variance in intention to leave.
Discuie Discussion
Aceast lucrare prezint un model de climat organizaional, care cuprinde This paper presents
a model of organizational climate, which encompasses
variabilele i conceptele gsite n ase studii independente. variables and concepts found in
six independent studies. Aceste studii au fost These studies were
efectuat ntr-o gam larg de setri i supravegheat o gam larg de sntate conducted across
a broad range of settings and surveyed a wide range of health
personal de ngrijire. care workers. Va prezentam un empirice de validare preliminar a
modelului de We present a preliminary empirical validation of the model by
de raportare plauzibil asociaii conceptual ntre modelul lui domenii i reporting conceptually
plausible associations among the model's domains and
artnd c variabilele din aceste domenii prezice satisfacia angajailor i showing that
variables from these domains predict employee satisfaction and
intenia de cifra de afaceri n moduri care sunt n concordan cu cercetri anterioare.
turnover intention in ways that are consistent with previous research. Peste Across
studii, modele similare de relaii au fost gsite. studies, similar patterns of relationships were
found. n plus, modelul complet Moreover, the full model
a fost un predictor mai bun al variabilelor rezultatul dect au fost elemente din cadrul was a
better predictor of the outcome variables than were the elements within the
model. model.
Cum ar fi putut fi anticipate din literatura de specialitate, msuri privind clima As might have
been anticipated from the literature, the climate measures
a prezis satisfacie mai puternic i mai coerent dect au prezis predicted satisfaction more
strongly and more consistently than they predicted

cifra de afaceri intenie. turnover intention. inteniile Cifra de afaceri sunt supuse multor
influente exogene Turnover intentions are subject to many influences exogenous
Pagina 10 Page 10
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Tabelul 3. Table 3. Rezultatele regresii multivariate prezice satisfacia angajailor
Results of multivariate regressions predicting employee satisfaction
Studiu Study
1 * 1*
22
33
4 * 4*
66
Core climatice domenii de organizare Core organizational climate domains
Conducere Leadership
-0.14 0.14

---Valori Values
---ns ns
0.05 0.05

Strategie / stil Strategy/style


---0.05 0.05

-Organizaionale caracteristicile structurale Organizational structural characteristics


-0.15 0.15

---Proceselor de comunicare Communication processes


ns ns
--ns ns
Guvernare Governance
--

---0.41 0.41

Tehnologia informaiei Information technology


-----Procesul de organizare climatice domenii Organizational climate process domains
Supravegherea Supervision
-----Stil Style
0.09 0.09

--0.06 0.06

0.67 0.67

Angajat de recunoatere Employee recognition


---0.04 0.04

ns ns
Lucrrile de proiectare Work design
-ns ns
---Gestionat volumul de munc Manageable workload
0.30 0.30

--0.04 0.04

0.04 0.04

Resurse / formare Resources/training

0.22 0.22

-0.38 0.38

0.09 0.09

0.06 0.06

Recompense Rewards
0.13 0.13

--0.05 0.05

-Angajat de siguran Employee safety


---0.07 0.07

-Autonomie Autonomy
0.07 0.07

--0.14 0.14

-Grup de comportament Group behavior


-0.27 0.27

--Colaborare Collaboration
0.12 0.12

-0.29 0.29

0.09 0.09

ns ns
Consensul / armonie Consensus/harmony
---

-0.05 0.05

-Calitate accent Quality emphasis


-ns ns
---Pacient centrata Patient centeredness
--0.13 0.13

0.31 0.31

-Siguranei pacienilor Patient safety


0.16 0.16

----Inovare Innovation
---ns ns
-Rezultatele de msurare Outcome measurement
---0.06 0.06

-Dovezi bazate pe practica Evidence-based practice


-----RR
22
0.57 0.57
0.24 0.24
0.40 0.40
0.58 0.58

0.65 0.65
Not: Dash (-) reprezint subconstruct nu se msoar i / sau la scar nu suficient de stabil
pentru a fi Note: Dash (-) represents subconstruct not measured and/or scale not stable
enough to be
incluse n model; ns nu este egal cu rezultate semnificative; alte rezultate raportate sunt beta
standardizate included in model; ns equals not significant results; other results reported are
standardized beta
coeficieni. coefficients.
* Modele ajustat pentru vrst, ras, i / sau gen. *Models adjusted for age, race, and/or
gender.

P 0,01, P 0.01,

P 0.001 P 0.001
la domeniul de clim, cum ar fi condiiile de pe piaa forei de munc, evaluri ale to the
realm of climate, such as labor market conditions, assessments of
de inserie profesional, situaia familial, i etapa de cariera. employability, family status,
and career stage.
45 45
Contribuia cea mai important a acestui studiu este clima domeniile sale i The most
important contribution of this study is its climate domains and
subconstructs, care poate oferi baza pentru studiile viitoare n sntate subconstructs, which
can provide the basis for future studies in health care
setrile. settings. Utilizarea acestui model n cercetrile viitoare vor promova consecvena
ntre The use of this model in future research will promote consistency across
setrile i studii, facilitnd astfel o acumulare a rezultatelor cercetrilor i settings and
studies, thereby facilitating an accumulation of research findings and
Bazate pe recomandrile dovezi. evidence-based recommendations. Dezvoltarea n
continuare a definiii operaionale Further development of operational definitions
generalizabile i msuri aplicabile la modelul este justificat i a invitat. and generalizable
measures applicable to the model is warranted and invited.
O contribuie suplimentar a modelului const n elaborarea de subconstructs An additional
contribution of the model lies in its elaboration of subconstructs
n domeniul structurii organizatorice; acestea sunt deosebit de importante pentru within the
domain of organizational structure; these are particularly important for
de cercetare privind sigurana pacienilor i de ngrijire de sntate de calitate. research on
patient safety and health care quality. Tehnologia informaiei, pentru Information technology,
for
de exemplu, este o caracteristic ce n ce mai proeminent al structurii organizatorice, care
example, is an increasingly prominent feature of organizational structure, which
deine promisiunea substaniale pentru sntate de calitate. holds substantial promise for
health quality.
46 46
Percepii a utilizrilor de Perceptions of the uses of
tehnologiei informaiei n organizaiile de ngrijire a sntii pot afecta modul in care
information technology in health care organizations may affect the ways that
clinicienii rspunde la inovaii tehnologia informaiei. clinicians respond to information
technology innovations.
47 47
Prin urmare, tehnologia Hence, technology

Pagina 11 Page 11
Modelarea climatului organizational Modeling Organizational Climate
477 477
Tabelul 4. Table 4. Rezultatele regresii multivariate cu intenia de a prsi ca
dependente Results of multivariate regressions with intention to leave as dependent
variabil variable
Studiu Study
1 * 1*
22
4 * 4*
5 * 5*
66

Core climatice domenii de organizare Core organizational climate domains


Conducere Leadership
--0.13 -0.13
---Valori Values
---0.03 -0.03
-0.12 -0.12
ns ns
Strategie / stil Strategy/style
--ns ns
ns ns
-Organizaionale caracteristicile structurale Organizational structural characteristics
-ns ns
---Proceselor de comunicare Communication processes
ns ns
--ns ns
ns ns
Guvernare Governance
-----

ns ns
Tehnologia informaiei Information technology
-----Procesul de climat organizaional domenii Process organizational climate domains
Supravegherea Supervision
----Stil Style
-0.09 -0.09
--0.08 -0.08
ns ns
1.1 1.1
Angajat de recunoatere Employee recognition
---0.02 -0.02
-ns ns
Lucrrile de proiectare Work design
-ns ns
---Gestionat volumul de munc Manageable workload
-0.13 -0.13
--0.06 -0.06
-ns ns
Resurse / formare Resources/training
ns ns
-ns ns
ns ns
ns ns
Recompense Rewards
ns ns
--0.01 -0.01
--Autonomie Autonomy

---0.06 -0.06
--Angajat de siguran Employee safety
-0.83 -0.83
----Grup de comportament Group behavior
--0.15 -0.15
---Colaborare Collaboration
-0.10 -0.10
--0.04 -0.04
-0.53 -0.53
ns ns
Consensul / armonie Consensus/harmony
--ns ns
ns ns
-Calitate accent Quality emphasis
-ns ns
---Pacient centrata Patient centeredness
---0.12 -0.12
--Siguran Safety
ns ns
----Inovare Innovation
---

ns ns
--Rezultatele de msurare Outcome measurement
---0.02 -0.02
--Dovezi bazate pe practica Evidence-based practice
---ns ns
-RR
22
0.18 0.18
0.08 0.08
0.15 0.15
0.23 0.23
-Not: ns nu este egal cu beta semnificativ coeficienii standardizate sau odds ratio. Note: ns
equals not significant standardized beta coefficients or odds ratios. Cratim (-) reprezint
Dash (-) represents
subconstruct nu se msoar i / sau la scar nu suficient de stabil pentru a fi incluse n model.
subconstruct not measured and/or scale not stable enough to be included in model. Toate All
coeficienii i odds ratio raportate n tabel sunt semnificative statistic (P 0,05). coefficients
and odds ratio reported in table are statistically significant ( P 0.05).
* Modele ajustat pentru vrst, sex, i / sau rasa. *Models adjusted for age, gender, and/or
race.

Intenia de a pleca a fost o variabil dihotomice n acest studiu. Intention to leave was a
dichotomous variable in this study. Prin urmare, rezultatele din acest Therefore, the results
from this
Echipa de anchet se bazeaz pe o regresie logistic, i raporturi de cote sunt prezentate.
investigative team are based on a logistic regression, and odds ratios are presented.

echip de investigaie a avut 4 scri individuale cu privire la colaborarea; beta coeficienii


standardizate pentru Investigative team had 4 individual scales on collaboration; standardized
beta coefficients for
scara 1 este raportat n tabel. scale 1 is reported in table. Coeficientul beta standardizat
pentru scara 2 a fost -0.14, pentru scara 3, acesta The standardized beta coefficient for scale 2
was -0.14, for scale 3 it
nu a fost semnificativ, precum i pentru scara 4, a fost -0.19. was not significant, and for
scale 4 it was -0.19.
percepiile sunt susceptibile s medieze ntre introducerea de informaii perceptions are likely
to mediate between the introduction of information
tehnologii i rezultatele lor. technologies and their outcomes. Datorit importanei sale, am
inclus Because of its importance, we included the

climatice tehnologie n modelul nostru, chiar dac nu a fost bine reprezentate n nostru
technology climate in our model, even though it was not well represented in our
studii de cercetare original. original research studies.
Modelul nostru solicit, de asemenea atenia asupra importanei a climatului de calitate, Our
model also calls attention to the importance of the climate for quality,
pe care am etichetat "accent de calitate." Modelul nostru specific climatice pentru calitate
which we labeled quality emphasis. Our model specifies the climate for quality
ca inclusiv gradul n care livrarea de organizare climatice este pacient- as including the
degree to which the delivery organization's climate is patientcentrat, ncurajeaz contientizarea siguran i a practicilor, stimuleaz inovarea i centered,
encourages safety awareness and practices, fosters innovation, and
susine utilizarea de medicamente pe baz de dovezi. sustains the use of evidence-based
medicine. Aa cum ali cercettori au sugerat, As other researchers have suggested,
pot exista climate mai multe n cadrul unei organizaii n domenii precum sigurana, there
may be multiple climates within an organization in areas such as safety,
serviciu, sau inovaie. service, or innovation.
35-48 3548
Aceste climate substaniale sunt susceptibile de a afecta ndeaproape These substantive
climates are likely to affect closely
atitudini i comportamente legate de chiar mai puternic dect climatice abstract related
attitudes and behaviors even more powerfully than abstract climate
Pagina 12 Page 12
Progresele n domeniul siguranei pacienilor: Vol. Advances in Patient Safety: Vol. 2 2
478 478
caracteristici cum ar fi coeziunea sau putere climatice. features such as cohesion or climate
strength.
29 29
Doar 2 din cele 13 instrumente pentru Only 2 of the 13 instruments for
cultur i evaluarea climatului citate ntr-un studiu recent conine msuri legate de assessing
culture and climate cited in a recent review contain measures related to
climatice de calitate, i nici unul se refer explicit la o tehnologie a informaiei quality
climate, and none refers explicitly to an information technology
climatice. climate.
19, 49 19, 49
Ca urmare a msurilor climatice divergente n cele ase studii au raportat aici, valabilitatea
Due to divergent climate measures in the six studies reported here, the validity
i generalizarea constatrile noastre poate fi limitat. and generalizability of our findings may
be limited. n plus, dei acest lucru Additionally, although this
Proiectul este un exemplu de colaborare i care rezult sinergie, separate project is an
exemplar of collaboration and resulting synergy, the separate
Echipele de anchetatori nu erau nc gata s pun n comun datele ntr-o singur baz de date
care investigative teams were not yet ready to pool the data into a single database that
ar fi supuse analizei prin modelare a ecuaiilor structurale. would be amenable to analysis
through structural equation modeling. Dei Although
ne-am explorat relaiile liniare dintre schimbrile climatice i alte variabile, cercettorii we
have explored linear relations between climate and other variables, researchers
ar fi bine sftuii s se uite atent la i noncausal relaii neliniare. would be well advised to
look closely at nonlinear and noncausal relations. Pentru For

exemplu, climatele foarte negativ ar putea afecta performana, n timp ce alte climate
example, very negative climates might affect performance, while other climates
nu. do not. n plus, schimbrile climatice ar putea aciona ca un mediator sau variabil de
context, mai degrab In addition, climate may act as a contextual or mediating variable,
rather
dect o cauz direct de rezultate importante. than a direct cause of important outcomes. n
cele din urm, dou scale construite n aceste Finally, two scales constructed in these
Analizele secundar inferior a avut mult de versiunile alfa Cronbach lui adesea considerate de
dorit. secondary analyses had lower Cronbach's alphas than often considered desirable.
Avnd n vedere natura multidimensional i multileveled a climatului organizational, Given
the multileveled and multidimensional nature of organizational climate,
de cutare pentru un singur instrument, sau chiar o metodologie unic, nu este ntotdeauna the
search for a single instrumentor even a single methodologyis not always
nelept. wise.
19, 44 19, 44
Dac o organizaie are n vedere punerea n aplicare a unui nou If an organization is
considering the implementation of a new
sistemul computerizat de ordine de intrare, de exemplu, anchetatorii ar putea avea nevoie s
computerized order entry system, for example, investigators may need to
nelege numai angajailor "percepia pe care a tehnologiei informaiei i understand only the
employees' perception of information technology and
inovare, nu valorile de conducere i stiluri de supraveghere. innovation, not leadership values
and styles of supervision. Cu toate acestea, unele dintre Nonetheless, some of
Msurile de baz n cadrul nostru set de concepte de climatului organizational n sntate the
measures within our core set of concepts of organizational climate in health
Setrile de ngrijire sunt susceptibile de a fi aplicabil la o gam de setri de livrare de
sntate. care settings are likely to be applicable to a range of health delivery settings.
Mai mult, ei pot fi afiate s posede predictive valabilitate suficiente pentru a justifica
Moreover, they may be shown to possess sufficient predictive validity to justify
includerea lor de rutin n investigaiile din cauzele rezultatelor ca pacient their routine
inclusion in investigations of the causes of outcomes like patient
siguran. safety.
Implicaii pentru politica i practica Implications for policy and practice
Dezvoltarea i validarea unui set de concepte i msuri pentru Development and validation of
a core set of concepts and measures for
climatice, care studiaz n domeniul sntii vor permite comparaii ntre setrile de livrare
studying climate in health care will permit comparisons across delivery settings
i de a facilita dezvoltarea de recomandri bazate pe dovezi despre uman and facilitate
development of evidence-based recommendations about human
gestionare a resurselor i design organizaional n cadrul serviciilor de sntate setrile.
resource management and organizational design within health services settings.
Bazele de date coninnd msuri climatice sunt deja n uz n unele sisteme, cum ar fi
Databases containing climate measures are already in use in some systems, like
Kaiser Permanente. Kaiser Permanente.
50 50
Mai mult dect att, multe spitale de ngrijire acut contribuie date Moreover, many acute
care hospitals are contributing data
bazei de date naionale de Nursing indicatorilor de calitate (NDNQI), care a to the National
Database of Nursing Quality Indicators (NDNQI), which has

msuri adaptate percepiilor asistentei medicale privind mediul de lucru i de locuri de munc
adapted measures of nurse perceptions regarding work environment and job
satisfacie. satisfaction.
51 51
n afara de ngrijire a sntii, multe agenii guvernamentale utilizarea standard Outside of
health care, many government agencies use standardized
evaluri climatice pentru benchmarking scopuri. climate assessments for benchmarking
purposes.
52 52
Adoptarea standardizate Adoption of standardized
instrumente climatice i de crearea de baze de date care analizeaz sprijin la diferite climate
tools and the creation of databases that support analyses at various
nivelurile de organizare va ajuta managerii de ngrijire a sntii pentru a urmri mai bine lor
organizational levels will help health care managers to better track their
la progresele nregistrate de organizaie n timp, s evalueze impactul de organizare i
organization's progress through time, assess impacts of organizational and
schimbrile tehnologice, i comparai climatice n unitatea lor sau organizaie cu
technological changes, and compare the climate in their unit or organization with
cele din setrile de organizare comparabile. those in comparable organizational settings.
Este sperana noastr c modelul prezentat aici va ncuraja cercettorii s It is our hope that
the model presented here will encourage researchers to
rafineze n continuare acest set de concepte i s dezvolte msurile standard pentru studierea
further refine this core set of concepts and develop standard measures for studying
Pagina 13 Page 13
Modelarea climatului organizational Modeling Organizational Climate
479 479
climatice n ngrijire a sntii care se refer la siguran. climate in health care as it relates
to safety. Standardizarea de msuri privind clima Standardization of climate measures
va ajuta n dezvoltarea de recomandri bazate pe dovezi pentru sntate will aid in the
development of evidence-based recommendations for health
Servicii de organizare i de gestionare a resurselor umane n cadrul livrare de sntate
services organization and human resource management within health delivery
setrile i s faciliteze, probabil, scopul final de a transforma rezultatele n probe settings and
perhaps facilitate the ultimate goal of turning results into evidencepractici de management bazate pe. based management practices. Modelul are nevoie de mai
mult de testare folosind sigurana pacienilor The model needs further testing using patient
safety
ca rezultat principal pentru a ajuta la acest proces. as the primary outcome to aid in this
process.
Mulumiri Acknowledgments
Autorii doresc s mulumeasc Pam Owens i Ronda Hughes, att din AHRQ, The authors
wish to thank Pam Owens and Ronda Hughes, both from AHRQ,
care iniial au participat la discuiile de grup de lucru. who originally participated in the
working group's discussions.
Autor afilieri Author affiliations
Columbia University School of Nursing (PWS). Columbia University School of Nursing
(PWS). Vizitarea Service Nurse din New York (PF, TP). Visiting Nurse Service of New York
(PF, TP).

Agenia pentru Sntate i Cercetare a Calitii (MH). Agency for Healthcare Research and
Quality (MH). Universitatea din Wisconsin (ML). University of Wisconsin (ML). Kaiser
Permanente Kaiser Permanente
Georgia (DR). Georgia (DR). coala Sinclair de Nursing, Universitatea din MissouriColumbia (SA). Sinclair School of Nursing, University of MissouriColumbia (JSC).
Universitatea din University of
Connecticut Centrul de Sanatate (NW). Connecticut Health Center (NW). Colegiul
Culverhouse de Comer i Administrarea Afacerilor, Culverhouse College of Commerce and
Business Administration,
Universitatea din Alabama (EW). University of Alabama (EW).
Adresa pentru coresponden: Patricia W. Stone, Ph.D., Columbia University School of
Nursing, 617 Address correspondence to: Patricia W. Stone, Ph.D., Columbia University
School of Nursing, 617
W. 168th Street, New York, NY 10032. W. 168th Street, New York, NY 10032. Telefon: 212305-1738; fax: 212-305-6937, e-mail: Phone: 212-305-1738; fax: 212-305-6937; e-mail:
Ps2024@columbia.edu. Ps2024@columbia.edu.
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