The relationship between organizational culture of nursing staff and quality of care for residents with dementia: questionnaire surveys and systematic observations in nursing homes

Int J Nurs Stud. 2010 Oct;47(10):1274-82. doi: 10.1016/j.ijnurstu.2010.02.010. Epub 2010 Apr 3.


Background: Since the 1990s, several studies have shown that organizational culture is an important characteristic in long-term care. However, at the moment little is known about organizational culture and its relationship with quality of care.

Objectives: In this study, the relationship between organizational culture and quality of care in long-term care was investigated using the competing values framework. Thereto, two independent measurements of quality of care were applied: the perceived quality of care by nursing staff of dementia units and the observed quality of care on the units by researchers.

Design: The study used a cross-sectional design.

Settings: Data were collected on 11 dementia units in 11 Dutch nursing homes.

Participants: All nursing staff on the units were asked to complete a questionnaire, of whom 248 staff members responded. The average response rate on the 11 units was 63%.

Methods: Data were collected during two days of field-work on each unit. Systematic observations were performed, and questionnaires were distributed among nursing staff. Data were analyzed using multilevel analyses.

Results: Organizational culture was related to both perceived and observed quality of care on the units. Units that are characterized by a clan culture provide better quality of care, both in the eyes of the nursing staff as in the eyes of outsiders. Market culture, compared to clan culture, is negatively related to quality of care in this sample.

Conclusions: The results indicate that organizational culture in long-term dementia care is important for organizational performance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Dementia / nursing*
  • Humans
  • Nursing Homes / organization & administration*
  • Nursing Homes / standards
  • Nursing Staff*
  • Organizational Culture*
  • Quality of Health Care*
  • Surveys and Questionnaires