الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 176 |  |  |
| | | from | 176 | | |
Abstract
Various approaches for improving the quality of health care services have
been adopted by different countries. Clinical governance is one of these
approaches. This concept was first proposed by the United Kingdom state health
system as a strategy to improve the quality of clinical care in 1998 following
exposure to number of failures within the NHS. It provides a unique and
comprehensive strategy for bringing all local activities into a single coherent
program for continuous quality improvement as a systematic model. The
success of this approach depends on the existence of a strong and suitable
organizational culture. Health service organizations need to have a culture that
has a strong strategic and cultural leadership of clinical services, focusing on
effective planning to enable development and improvement opportunities to be
captured. Also, organizational culture gives the whole organization a sense of
how to behave, what to do, and where to set the priorities in getting the job
done. It affects the way the managerial functions of planning, organizing,
staffing, leading and controlling are carried out. In addition, it influences how
managers approach problems, reacts to competition, and implements new
strategies and also has practical benefits for nurses who are looking for a new
position.
Aim of the study:
Determine the relationship between clinical governance and organizational
culture at Kafr El Dawar Central Hospital.
Study design:
A descriptive correlational research design was used in this study.
Setting of the study:
The study was conducted at Kafr El Dawar Central Hospital with 38 beds,
and which is affiliated to the Ministry of Health and Population. It included
Summary
77
inpatient units namely; obstetric, medical, surgical, orthopedic, paediatric,
dialysis unit, and clinics.
Subjects of the study:
This study subjects included all nurses in the hospital who are responsible
for providing direct patient care (n= 126) and who are working in the previous
units and willing to participate.
Tools of the study
The study utilized two tools for data collection:
Tool 1: Clinical Governance Climate Questionnaire (CGCQ).
This tool was developed by Freeman (2003) to assess clinical governance.
It consists of 60 items divided into six dimensions: Planned and integrated
quality improvement (21 items), Proactive risk management (11 items), climate
of blame and punishment (9items), Working with colleagues (6 items), Training
and development (8 items), and finally, Organizational learning (5items). The
response will be measured on a 5 point Likert scale ranging from 1 strongly
disagree to 5 strongly agree. A reverse score was done for negative items which
are 32 negative items. The overall score ranges from (60-300), the higher score
reflects positive climate for clinical governance, and includes:
60- 140 score means negative climate for clinical governance
141-220 score means moderate climate for clinical governance
221-300 score means positive climate for clinical governance
Tool II: The Denison Organizational Culture Survey (DOCS).
This tool was developed by Denison et al. (2012) which was used to
assess the organizational culture traits. The DOCS is comprised of 60 questions.
It measures four organizational culture dimensins; Involvement, Consistency,
Adaptability and Mission. The cultural traits are measured by three culture
indices and each cultural index is represented by five questions in the survey.
The response was measured on a 5 point Likert scale ranging from 1 strongly
Summary
77
disagree to 5 strongly agree. Eight items are phrased negatively and answers
was reversed in the analysis. The overall score ranges from (60-300).
60- 140 score means negative organizational culture
141-220 score means moderate organizational culture
221-300 score means positive organizational culture
In addition to, demographic characteristics of the staff nurses such as:
age, gender, working unit, level of education, years of experience and marital
status was added to the questionnaire.
Methods
1. An official permission was obtained from the Dean of Faculty of Nursing,
Damanhour University and the administrators of the identified setting for
data collection.
2. The two tools were translated into Arabic and tested for their content validity
and translation by a panel of five experts in the field of the study at the
faculties of nursing (Appendex III ). Accordingly the necessary
modifications were done based on their opinions.
3. A pilot study for the questionnaires was carried out on (10%) of the total
sample size (n=13), who were not included in the study sample; in order to
check and to ensure the clarity and feasibility of the tool and to identify
obstacles and problems that encountered during data collection. the
necessary modifications were done.
4. The two tools were tested for its reliability by using Cronbach’alpha
.correlation co-efficient test to measure internal consistency of items. The
two tools were proved to be reliable where r = 0.870 and 0.940 for tool one
and tool two respectively.
5. Data collection:
Summary
78
- Data were collected from the identified nurses, by the researcher after
meeting with each nurse and necessary clarification about the aim of the
study was done through hand-delivered questionnaire at their working
settings. Instructions were given after obtaining informed consent from
the studied nurses before the distribution of the 00questionnaire.
- The questionnaires were completed in the presence of the researcher to
ensure the objectivity of nurses’ response, non- contamination of their
opinions, and to check that all items were answered.
- Answering the questionnaires took approximately 20-30 minutes, Data
collection took a period of slightly more than two months from the
beginning of August 2021to the beginning of November 2021.
The main results of the present study were as follows:
1. There is statistical significant relationship between total clinical
governance and total organizational culture.
2. The studied nurses perceived moderate mean percent score of total clinical
governance . The highest mean percent score was related to working with
colleagues and the lowest mean percent score was related to planned and
integrated quality improvement.
3. The studied nurses perceived moderate mean percent score of total
organizational culture. The highest mean percent score was related to
involvement followed by adaptability and the lowest mean percent score
was related to mission and consistency.
4. There is statistical significant relationship between all studied nurses’
demographic characteristics and clinical governance except gender.
5. There is statistical significant relationship between studied nurses’
demographic characteristics in terms of working unit and years of
experience and organizational culture. While, there was no statistical
significant
relationship
between
studied
nurses’
demographic
Summary
78
characteristics in the term of age, gender, level of education and marital
status and organizational culture.
In the light of the results of the current study, the following
recommendations can be suggested:
Hospital managers and nurse managers should:
1.Establish planned and integrated program for quality improvements, where
the full commitment and support for the implementation of the goals for
achieving nursing care of high quality.
2. Improve senior management supports as agents to make relevant changes for
quality patient care.
3. Provide opportunities for nurses to participate in all stages of quality
improvement programs.
4. Create a blame-free atmosphere for making a “learning from mistakes”
culture.
5. Identify educational needs of staff on planned and integrated program for
quality improvements and motivating culture.
6. Provide a clear job description to orient the nurses with their duties and
responsibilities.
7. Managers should take the perceived barriers of implementing CG into
account at both hospital and policy making levels to increase The CG .
8. Application of new information and communication technologies and
network technologies. It can be achieved through internal tutorials via the
intranet for the education on the relevant knowledge for hospitals’ personnel.
This allows the nurses to be aware of the information to share healthcare
knowledge and enrich nurses’ knowledge online.
9. Review the organization policies to add policies that facilitate and foster the
implementation of CG.
Summary
78
10. Frequent performance appraisals of nurses and provide incentives for the
best nurse as bonuses, flexible work hours, extra days off, and a friendly
supportive atmosphere and not punish the worst one.
Nurses should :
1.Change step by step their culture and start taking risks. That means they
should not be afraid to participate in decision making processes related to health
policy.
2. Get involved in research activities more actively and apply the results of
scientific research that enhance their creativity through mutual cooperation
between the Faculty of Nursing and the hospital’s staff nurse
3. Follow organizational policies, rules and regulations regarding CG culture
and special training programs.
4. Communicate openly with their managers in order to discuss obstacles
that face them when applying their work and ways for improvement of their
performance.
5. Participate in different committees to increase their skills and their
engagement in their organization such as policy making, strategic plan, patient
care …etc.
6. Attend regular training programs to improve their knowledge regarding
communication skills, team building , team work and increase their awareness
about CG and organizational culture that motivate high quality patient care.
Future/ further studies should be conducted:
1. Develop strategies to enhance CG strategy.
2. Determine the relationship between CG and job satisfaction.
3. Determine the relationship between OC and organizational performance.
4. Determine the relationship between OC and readiness for change.
5. Challenges facing CG implementation as perceived by healthcare team.