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Original research
Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study
  1. Limakatso Lebina1,2,
  2. Mary Kawonga3,
  3. Olufunke Alaba4,
  4. Natasha Khamisa3,
  5. Kennedy Otwombe1,5,
  6. Tolu Oni2,6
  1. 1Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
  2. 2Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
  3. 3School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
  4. 4Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
  5. 5Statistics and Data Management Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
  6. 6MRC Epidemiology Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
  1. Correspondence to Dr Limakatso Lebina; lebinal{at}phru.co.za

Abstract

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.

  • health services administration & management
  • health policy
  • human resource management
  • quality in health care
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Footnotes

  • Contributors LL was involved in the conception, study design, data collection, data cleaning and analysis and writing of the manuscript. NK was involved in critical review and editing of the manuscript. KO contributed in the data analysis, interpretation of results and review of the manuscript. MK, OA and TO have contributed to the conception, study design and critical review of the manuscript.

  • Funding This work was supported by the South African Medical Research Council (SA MRC) under a Self-Initiated Research Grant (grant number: 494184).

  • Disclaimer The views and opinions expressed are those of the authors and do not necessarily represent the official views of the SA MRC.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for this study was obtained from the University of Cape Town (Ref: 127/2018) and the University of the Witwatersrand (Ref: R14/49) Human Research Ethics Committees. The Gauteng and North West Provincial departments of health also provided administrative approvals. Each of the healthcare workers interviewed provided written informed consent to participate in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The data on Organizational Culture and the Integrated Chronic Diseases Management Model Implementation Fidelity in South Africa is available on Figshare via the following URL: https://doi.org/10.6084/m9.figshare.11365721.v2