Organizational Culture and the Integrated Chronic Diseases Management Model Implementation Fidelity in South Africa

Abstract

Organizational culture could facilitate or impede the implementation of new interventions or policies. The Integrated Chronic Disease Management (ICDM) model was introduced in clinics across South Africa to strengthen delivery of care and improve clinical outcomes for patients with chronic conditions, but the determinants of its implementation have not been assessed. This study assessed whether organizational culture influences the fidelity of implementation of the ICDM model at primary health care (PHC) clinics in South Africa. The abbreviated Denison organizational culture survey tool was administered to 90 staff members to assess three cultural traits: involvement, consistency and adaptability of six PHC clinics in two health districts in South Africa. 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. Participants’ mean age was 38.8 (SD = 10.35) years, and 54.4% (49/90) were nurses. The overall mean score for the Denison organizational culture 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 was a weak, non-statistically significant negative correlation between fidelity level and organizational culture scores ( r = -0.117; p= 0.272). There were no statistically significant differences in cultural indices and cultural traits scores between the six PHC clinics. However, culture scores were significantly different by health districts. Leadership intervention is required to purposefully align the organizational culture of clinics with their mission.