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The relationship between organizational culture and family satisfaction in critical care*

Dodek, Peter M. MD, MHSc; Wong, Hubert PhD; Heyland, Daren K. MD, MSc; Cook, Deborah J. MD, MSc; Rocker, Graeme M. MA, MHSc, DM; Kutsogiannis, Demetrios J. MD; Dale, Craig RN, PhD(c); Fowler, Robert MD, MSc; Robinson, Sandra PhD; Ayas, Najib T. MD, MPH

doi: 10.1097/CCM.0b013e318241e368
Clinical Investigations
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Objectives: Family satisfaction with critical care is influenced by a variety of factors. We investigated the relationship between measures of organizational and safety culture, and family satisfaction in critical care. We further explored differences in this relationship depending on intensive care unit survival status and length of intensive care unit stay of the patient.

Design: Cross-sectional surveys.

Setting: Twenty-three tertiary and community intensive care units within three provinces in Canada.

Subjects: One thousand two-hundred eighty-five respondents from 2374 intensive care unit clinical staff, and 880 respondents from 1381 family members of intensive care unit patients.

Interventions: None.

Measurements and Main Results: Intensive care unit staff completed the Organization and Management of Intensive Care Units survey and the Hospital Survey on Patient Safety Culture. Family members completed the Family Satisfaction in the Intensive Care Unit 24, a validated survey of family satisfaction. A priori, we analyzed adjusted relationships between each domain score from the culture surveys and either satisfaction with care or satisfaction with decision-making for each of four subgroups of family members according to patient descriptors: intensive care unit survivors who had length of intensive care unit stay <14 days or >14 days, and intensive care unit nonsurvivors who had length of stay <14 days or ≥14 days. We found strong positive relationships between most domains of organizational and safety culture, and satisfaction with care or decision-making for family members of intensive care unit nonsurvivors who spent at least 14 days in the intensive care unit. For the other three groups, there were only a few weak relationships between domains of organizational and safety culture and family satisfaction.

Conclusions: Our findings suggest that the effect of organizational culture on care delivery is most easily detectable by family members of the most seriously ill patients who interact frequently with intensive care unit staff, who are intensive care unit nonsurvivors, and who spend a longer time in the intensive care unit. Positive relationships between measures of organizational and safety culture and family satisfaction suggest that by improving organizational culture, we may also improve family satisfaction.

From the Center for Health Evaluation and OutcomeSciences and Division of Critical Care Medicine (PMD, NTA), Providence Health Care and University of British Columbia, Vancouver, BC; Center for Health Evaluation and Outcome Sciences and School of Population and Public Health (HW), University of British Columbia, Vancouver, BC; Department of Medicine (DKH), Queen’s University, Kingston, ON; Departments of Medicine (DJC), Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON; QEII Health Sciences Centre (GMR), Dalhousie University, Halifax, NS; Division of Critical Care Medicine (DJK), University of Alberta, Edmonton, AB; Trauma, Emergency & Critical Care Program (CD), Sunnybrook Health Sciences Centre, Toronto, ON; Departments of Medicine and Critical Care Medicine (RF), Sunnybrook Health Sciences Centre, University of Toronto, ON; Sauder School of Business (SR), University of British Columbia, Vancouver, BC, Canada.

*See also p. 1667.

Supported, in part, by Canadian Institutes of Health Research, Michael Smith Foundation for Health Research. This study was supported by the Canadian Researchers at the End of Life Network (CARENET). CARENET is supported by a grant from the Canadian Institutes of Health Research and Heart and Stroke Foundation of Canada.

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Dr. Deborah Cook holds a Canada Research Chair with the Canadian Institutes of Health Research. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: peter.dodek@ubc.ca.

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins