Employee working conditions and healthcare system performance: the Veterans Health Administration experience.

Objective: The authors explored the association between health care employees’ perceptions of their organizations and objective measures of system performance. Methods: A national survey of employees conducted in 2001 by the Veterans Administration (VA) assessed employee perceptions of hospital organizational characteristics. The authors analyzed cross-sectional associations between these perceptions and objective measures of health care system performance—employee and patient care outcomes. Results: Employee perceptions of organizational climate (indicators of the organizational culture) were strongly related to overall satisfaction and measures of system performance. Overall, change in perceptions of organizational climate by 1 standard deviation (SD) was potentially associated with changes of 2% to 35% in selected outcomes. Conclusions: Organizational climate, policies, and resultant working conditions in health care institutions appear to be strong drivers of system performance. Interventions directed toward improving care quality and safety should address these factors. (J Occup Environ Med. 2007;49:417–429)