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Association between organisational and workplace cultures, and patient outcomes: systematic review
  1. Jeffrey Braithwaite,
  2. Jessica Herkes,
  3. Kristiana Ludlow,
  4. Luke Testa,
  5. Gina Lamprell
  1. Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
  1. Correspondence to Professor Jeffrey Braithwaite; jeffrey.braithwaite{at}


Design and objectives Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes.

Setting A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts.

Participants The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review.

Primary and secondary outcome measures Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience.

Results The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction.

Conclusions Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.

  • Health & safety
  • health policy
  • public health
  • quality in healthcare
  • clinical governance
  • organisational development

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors JB led the study and provided a conceptualisation of the topic to the team, and acted as an arbitrator and adviser where necessary. JH, KL, GL and LT did the abstract and full-text reviews of the articles. All authors contributed to the writing of the drafts, and agree with the final version.

  • Funding This work is supported by NHMRC Programme Grant 1054146, NHMRC Partnership Centre in Health Systems Sustainability Grant 9100002 and other grants held by JB.

  • Competing interests None declared.

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

  • Data sharing statement No additional data available.

  • Author note Any minor adjustments to the protocol have been documented in this systematic review.