Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities

Bernardes, Andrea; Gabriel, Carmen Silvia; Cummings, Greta G.; Zanetti, Ariane Cristina Barboza; Leoneti, Alexandre Bevilacqua; Caldana, Graziela; Maziero, Vanessa Gomes

doi:10.1590/0034-7167-2019-0732

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. bras. enferm. 73 (Suppl 5) • 2020 • https://doi.org/10.1590/0034-7167-2019-0732 copy

Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities

Cultura organizacional, liderança autêntica e melhoria da qualidade em instituições de saúde canadenses

Cultura organizacional, liderazgo auténtico y mejorías en la calidade de instituciones de salud canadienses

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities.

Method:

Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05).

Results:

Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices.

Conclusion:

This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

Descriptors:
Healthcare Quality Assessment; Leadership; Accreditation; Organizational Culture; Nursing

Variables	n	%
Gender
Male	15	6.6
Female	207	91.6
Missing	4	1.8
Position at the institution
Patient care manager	86	38.1
Unit manager	68	30.1
Director	47	20.8
Coordinator	12	5.3
Other	11	4.8
Missing	2	0.9
Education degree
Undergraduate Nursing	148	65.4
MBA	11	4.9
Master	56	24.8
PhD	2	0.9
Other	2	0.9
Missing	7	3.1
Type of institution
Public	195	86.3
Private	29	12.8
Missing	2	0.9
Bed size
49 beds or less	37	16.4
50-149 beds	30	13.3
150-499 beds	79	35.0
49 beds or less and 50-149 beds	1	0.4
More than 500 beds	62	27.4
Missing	17	7.5
Type of facility
General Hospital	75	33.2
Specialized Hospital	17	7.5
Teaching Hospital	41	18.1
Long Term Care	44	19.5
Community health center/primary care/home care	26	11.5
Administrative healthcare institutions	5	2.2
More than one facility	14	6.2
Other types of facilities	3	1.4
Missing	1	0.4

Variables	n	%
Institutional accreditation
No	5	2.2
In process	11	4.9
Yes	207	91.6
Missing	3	1.3
Accreditation program
Accreditation Canada	203	89.8
Other	9	4.0
Missing	14	6.2
Participant Involvement in the accreditation program
Not involved	17	7.5
Rarely	18	8.0
Partially	114	50.4
Totally	70	31.0
Missing	7	3.1
Respondent's Membership in quality council
Yes	90	39.8
No	134	59.3
Missing	2	0.9
Adoption of a participatory management model
No	102	45.1
In process	22	9.7
Yes	90	39.8
Missing	12	5.3
Involvement in the participatory management model
Not involved	16	7.1
Rarely	12	5.3
Partially	50	22.1
Totally	32	14.2
Missing	116	51.3
Level of satisfaction with the current management model
Very dissatisfied	11	4.9
Dissatisfied	35	15.5
Satisfied	91	40.3
Very satisfied	27	11.9
Missing	62	27.4
Level of satisfaction with accreditation process
Very dissatisfied	2	0.9
Dissatisfied	23	10.2
Satisfied	105	46.5
Very satisfied	31	13.7
Missing	65	28.8
Organizational culture
Group (culture A)	103	45.5
Developmental (culture B)	9	4.0
Rational (culture C)	84	37.2
Hierarchical (culture D)	30	13.3

Variables	χ²
QIIS
Information and analysis	15.896^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
Strategic quality planning	31.175^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
Human resource utilization	51.142^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
Quality management	19.553^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
Quality results	35.251^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
Custumer satisfaction	33.549^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
Leadership for quality improvement	37.508^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
ALQ - As a leader I (Self-assessed)
As leader_Transparency	1.642
As leader_Moral/Ethical	0.538
As leader_Balanced processing	0.632
As leader_Self-awareness	6.691
ALQ - My leader (Observer-assessed)
My leader_Transparency	22.210^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
My leader_Moral/Ethical	25.062^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
My leader_Balanced processing	11.961^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.
My leader_Self-awareness	23.416^* * Independent at p<0.05. QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.

Variables	Participatory management model	Involvement in the participatory management model	Level of satisfaction with current management model	Level of satisfaction with accreditation process	Cronbach's alpha
QIIS	ρ	ρ	ρ	ρ
Information and analysis	0.15^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.17	0.40^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.34^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.851
Strategic quality planning	0.25^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.17	0.40^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.28^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.798
Human resource utilization	0.26^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.17	0.52^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.34^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.857
Quality management	0.17^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.18	0.52^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.37^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.854
Quality results	0.18^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.20^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.48^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.41^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.840
Customer satisfaction	0.19^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.14	0.46^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.26^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.890
Leadership for quality improvement	0.27^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.20^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.57^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.36^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.954
ALQ - As a leader I (Self-assessed)
Transparency	0.16^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.07	0.18^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.17^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.572
Moral / Ethical	0.12	0.07	0.11	0.18^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.711
Balanced processing	0.20^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.08	0.09	0.10	0.603
Self-awareness	0.22^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.05	0.14	0.11	0.726
ALQ - My leader (Observer-assessed)
Transparency	0.25^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.12	0.55^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.28^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.853
Moral / Ethical	0.19^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.17	0.57^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.25^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.881
Balanced processing	0.23^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.17	0.53^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.14	0.833
Self-awareness	0.21^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.21^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.56^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.25^* * Correlation is significant at p<0.05; QIIS - Quality Improvement Implementation Survey II; ALQ - Authentic Leadership Questionnaire.	0.915

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[1] Corresponding author: Andrea Bernardes. E-mail: andreab@eerp.usp.br