​Authors want to better understand associations between organizational culture, organizational management structure, and quality management in hospitals.

As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany, and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study included professional quality managers and hospital trustees. 

Findings Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. 

Some structural characteristics were associated with the development of quality management systems. The type of organizational culture was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An organizational management structure that uses fewer protocols is associated with a less developed quality management system, whereas an organizational management structure which supports innovation in care is associated with a more developed quality management system.