Organizational climate and health care outcomes.

Background: Relationships between organizational climate-which reflects the employees' perception of the organizational culture and is easily measured through employee questionnaires-and patient and employee outcomes were examined in a literature review.

Methods: A systematic search was conducted, with the review limited to primary research published between January 1995 and June 2007. An integrative model of organizational climate was used to guide the search and organize evidence.

Findings: Twenty studies, all cross-sectional in design, were identified. Samples ranged from 632 clinicians in 3 hospitals to almost 250,000 providers in 168 hospitals. Most researchers studied nurses in hospitals, but other providers were also surveyed. Perceptions of processes such as scheduling practices, collaboration, and autonomy were associated with nurse outcomes (for example, job satisfaction, turnover, occupational safety). There was some evidence that aspects of organizational climate were associated with patient outcomes, but the results were inconsistent. Measurement of the organizational climate factors and outcomes varied across studies.

Conclusions: The evidence that organizational climate influences nurse outcomes is more robust than is the evidence that it influences patient outcomes. The findings underscore the importance of promoting a positive organizational climate.