Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study
Objective To assess whether organisational culture influences the fidelity of implementation of the Integrated Chronic Disease Management (ICDM) model at primary healthcare (PHC) clinics.Design A cross-sectional study.Setting The ICDM model was introduced in South African clinics to strengthen deliv...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-07-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/7/e036683.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850179519886917632 |
|---|---|
| author | Limakatso Lebina Olufunke Alaba Mary Kawonga Tolu Oni Kennedy Otwombe Natasha Khamisa |
| author_facet | Limakatso Lebina Olufunke Alaba Mary Kawonga Tolu Oni Kennedy Otwombe Natasha Khamisa |
| author_sort | Limakatso Lebina |
| collection | DOAJ |
| description | Objective To assess whether organisational culture influences the fidelity of implementation of the Integrated Chronic Disease Management (ICDM) model at primary healthcare (PHC) clinics.Design A cross-sectional study.Setting The ICDM model was introduced in South African clinics to strengthen delivery of care and improve clinical outcomes for patients with chronic conditions, but the determinants of its implementation have not been assessed.Participants The abbreviated Denison organisational culture (DOC) survey tool was administered to 90 staff members to assess three cultural traits: involvement, consistency and adaptability of six PHC clinics in Dr. Kenneth Kaunda and West Rand (WR) health districts.Primary and secondary outcome measures Each cultural trait has three indices with five items, giving a total of 45 items. The items were scored on a Likert scale ranging from one (strongly disagree) to five (strongly agree), and mean scores were calculated for each item, cultural traits and indices. Descriptive statistics were used to describe participants and clinics, and Pearson correlation coefficient to asses association between fidelity and culture.Results Participants’ mean age was 38.8 (SD=10.35) years, and 54.4% (49/90) were nurses. The overall mean score for the DOC was 3.63 (SD=0.58). The involvement (team orientation, empowerment and capability development) cultural trait had the highest (3.71; SD=0.72) mean score, followed by adaptability (external focus) (3.62; SD=0.56) and consistency (3.56; SD=0.63). There were no statistically significant differences in cultural scores between PHC clinics. However, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p=0.011; adaptability 3.40 vs 3.73, p=0.007; consistency 3.34 vs 3.68, p=0.034).Conclusion Leadership intervention is required to purposefully enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model’s principles of coordinated, integrated, patient-centred care. |
| format | Article |
| id | doaj-art-06999135965b4b7e8528c3fd16adc8ff |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-06999135965b4b7e8528c3fd16adc8ff2025-08-20T02:18:28ZengBMJ Publishing GroupBMJ Open2044-60552020-07-0110710.1136/bmjopen-2019-036683Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional studyLimakatso Lebina0Olufunke Alaba1Mary Kawonga2Tolu Oni3Kennedy Otwombe4Natasha Khamisa5Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South AfricaHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South AfricaSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South AfricaMRC Epidemiology Unit, University of Cambridge, Cambridge, Cambridgeshire, UKSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa1 School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaObjective To assess whether organisational culture influences the fidelity of implementation of the Integrated Chronic Disease Management (ICDM) model at primary healthcare (PHC) clinics.Design A cross-sectional study.Setting The ICDM model was introduced in South African clinics to strengthen delivery of care and improve clinical outcomes for patients with chronic conditions, but the determinants of its implementation have not been assessed.Participants The abbreviated Denison organisational culture (DOC) survey tool was administered to 90 staff members to assess three cultural traits: involvement, consistency and adaptability of six PHC clinics in Dr. Kenneth Kaunda and West Rand (WR) health districts.Primary and secondary outcome measures Each cultural trait has three indices with five items, giving a total of 45 items. The items were scored on a Likert scale ranging from one (strongly disagree) to five (strongly agree), and mean scores were calculated for each item, cultural traits and indices. Descriptive statistics were used to describe participants and clinics, and Pearson correlation coefficient to asses association between fidelity and culture.Results Participants’ mean age was 38.8 (SD=10.35) years, and 54.4% (49/90) were nurses. The overall mean score for the DOC was 3.63 (SD=0.58). The involvement (team orientation, empowerment and capability development) cultural trait had the highest (3.71; SD=0.72) mean score, followed by adaptability (external focus) (3.62; SD=0.56) and consistency (3.56; SD=0.63). There were no statistically significant differences in cultural scores between PHC clinics. However, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p=0.011; adaptability 3.40 vs 3.73, p=0.007; consistency 3.34 vs 3.68, p=0.034).Conclusion Leadership intervention is required to purposefully enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model’s principles of coordinated, integrated, patient-centred care.https://bmjopen.bmj.com/content/10/7/e036683.full |
| spellingShingle | Limakatso Lebina Olufunke Alaba Mary Kawonga Tolu Oni Kennedy Otwombe Natasha Khamisa Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study BMJ Open |
| title | Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study |
| title_full | Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study |
| title_fullStr | Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study |
| title_full_unstemmed | Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study |
| title_short | Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study |
| title_sort | organisational culture and the integrated chronic diseases management model implementation fidelity in south africa a cross sectional study |
| url | https://bmjopen.bmj.com/content/10/7/e036683.full |
| work_keys_str_mv | AT limakatsolebina organisationalcultureandtheintegratedchronicdiseasesmanagementmodelimplementationfidelityinsouthafricaacrosssectionalstudy AT olufunkealaba organisationalcultureandtheintegratedchronicdiseasesmanagementmodelimplementationfidelityinsouthafricaacrosssectionalstudy AT marykawonga organisationalcultureandtheintegratedchronicdiseasesmanagementmodelimplementationfidelityinsouthafricaacrosssectionalstudy AT toluoni organisationalcultureandtheintegratedchronicdiseasesmanagementmodelimplementationfidelityinsouthafricaacrosssectionalstudy AT kennedyotwombe organisationalcultureandtheintegratedchronicdiseasesmanagementmodelimplementationfidelityinsouthafricaacrosssectionalstudy AT natashakhamisa organisationalcultureandtheintegratedchronicdiseasesmanagementmodelimplementationfidelityinsouthafricaacrosssectionalstudy |