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Influence of Organizational Culture on Provider Adherence to the Diabetic Clinical Practice Guideline: Using the Competing Values Framework in Palestinian Primary Healthcare Centers Publisher



Radwan M1 ; Sari AA1 ; Rashidian A1 ; Takian A1 ; Aboudagga S2 ; Elsous A1
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Authors Affiliations
  1. 1. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
  2. 2. Department of Research Affairs and Graduates Studies, Islamic University of Gaza, Gaza Strip, Palestine

Source: International Journal of General Medicine Published:2017


Abstract

Background: Diabetes mellitus (DM) is a serious chronic disease and an important public health issue. This study aimed to identify the predominant culture within the Palestinian Primary Healthcare Centers of the Ministry of Health (PHC-MoH) and the Primary Healthcare Centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA) by using the competing values framework (CVF) and examining its influence on the adherence to the Clinical Practice Guideline (CPG) for DM. Methods: A cross-sectional design was employed with a census sample of all the Palestinian family doctors and nurses (n=323) who work within 71 PHC clinic. A cross-cultural adaptation framework was followed to develop the Arabic version of the CVF questionnaire. Results: The overall adherence level to the diabetic guideline was disappointingly suboptimal (51.5%, p<0.001; 47.3% in the PHC-MoH and 55.5% in the PHC-UNRWA). In the PHC-MoH, the clan/group culture was the most predominant (mean =41.13; standard deviation [SD] =8.92), followed by hierarchical (mean =33.14; SD=5.96), while in the PHC-UNRWA, hierarchical was the prevailing culture (mean =48.43; SD =12.51), followed by clan/group (mean =29.73; SD =8.37). Although a positively significant association between the adherence to CPG and the rational culture and a negatively significant association with the developmental archetype were detected in the PHC-MoH, no significant associations were found in the PHC-UNRWA. Conclusion: Our study demonstrates that the organizational culture has a marginal influence on the adherence to the diabetic guideline. Future research should preferably mix quantitative and qualitative approaches and explore the use of more sensitive instruments to measure such a complex construct and its effects on guideline adherence in small-sized clinics. © 2017 Radwan et al.
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