Mediation of professional commitment in the relationship between organizational culture and quality of care among community health centres: A multilevel study in China

ABSTRACT

Organizational culture is increasingly recognized as crucial to improving the quality of care. However, there is limited evidence in primary care, especially the underlying mechanism between organizational culture and care quality. This study aims to investigate the relationship of organizational culture with quality of care and the mediated effect of professional commitment. We conducted a cross-sectional survey of 224 primary care physicians (PCPs) from 38 community health centres (CHCs) in four large cities in China. The director of CHC completed the organization survey including organizational culture and other organizational characteristics. PCPs completed a PCP survey, including information such as personal characteristics, professional commitment and self-reported quality of care. The data was analysed using a multilevel mediation testing method based on a hierarchical linear model. Over half of the CHCs have group culture as their dominant culture. CHCs with higher scores on developmental culture are more likely to perform better in care quality, while CHCs with higher scores on hierarchical culture are less likely to perform well in care quality, with professional commitment playing a partially mediated role. Building a developmental culture and enhancing professional commitment should be considered as modifiable strategies to improve PCPs’ quality of care.

KEYWORDS:

• Organizational culture
• professional commitment
• physicians
• quality of care
• primary care

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [72004179].

Notes on contributors

Wenhua Wang

Wenhua Wang is an associate professor at Xi’an Jiao Tong University. His research focuses on health systems and policies. He had been the Steinberg Global Health Postdoctoral Fellow at McGill University from 2016 to 2019 and he was also awarded the Health System Impact Fellowship by CIHR in 2019.

Jinnan Zhang

Jinnan Zhang is a PhD candidate at Xi’an Jiao Tong University. His research interests lie in primary care quality and integrated care. He is currently under the guidance of Prof. Wenhua Wang to enhance his professional knowledge in organizational behaviour.

Rebecca J. Mitchell

Rebecca J. Mitchell is a professor at Macquarie University. Her research interests lie in the area of organizational behaviour, including health and well-being at work, team dynamics, leadership and social identity in organizations, particularly (but not exclusively) healthcare organizations.

Huiyun Yang

Huiyun Yang is a student at Seneca College in Canada. Her research interests include early child development, child health and community engagement. She has a strong interest in improving early child development through innovative education and health interventions in community settings.

Mengyao Li

Mengyao Li is a PhD candidate at Xi’an Jiao Tong University. Her research interests include health service delivery and human resources in primary care. She is passionate about improving the quality of diabetes care in primary care from implementation science.

Xiaolin Wei

Xiaolin Wei is a professor, medical doctor, public health specialist and the Dalla Lana Chair in Global Health Policy at the University of Toronto. His academic contribution has been focused on disease control and primary care in four areas: primary care policy; antimicrobial resistance; tuberculosis and hypertension and diabetes.