Perceptions of organisational subculture and their significance for organisational commitment

This paper investigates the relationship between perceptions of organisational culture, organisational subculture, leadership style, and commitment. The impact of culture and leadership style on commitment has been previously noted, but there is a lack of detail regarding how different types of culture and leadership styles relate to commitment. The paper particularly addresses the notion of organisational subcultures and how the perception of those cultures relates to commitment, subculture being a neglected variable in the commitment literature. These issues were addressed in a survey of 258 nurses drawn from a range of hospital settings and wards within the Sydney metropolitan region. Results indicate that perceived organisational subculture has a strong relationship with commitment. Furthermore, the results identify the relative strength of specific types of leadership style and specific types of subculture with commitment. Both innovative and supportive subcultures have a clear positive relationship, while bureaucratic subcultures have a negative relationship. In terms of leadership style, a consideration style had a stronger relationship with commitment than a structuring style. Regression analysis was used to investigate the possible role of subculture as a mediator for the influence of leadership on commitment. Both direct and indirect effects of leadership on commitment were found. Implications for practice and for further research are discussed.

Empiric management of community-acquired pneumonia in Australian emergency departments

Objective: To describe empiric community-acquired pneumonia (CAP) management in Australian hospital emergency departments (EDs) and evaluate this against national guidelines, including use of the pneumonia severity index and antibiotic selection. Design: A multicentre, cross-sectional, retrospective audit, April 2003 to February 2005. Setting: 37 Australian hospitals: 22 principal referral hospitals, six large major city hospitals, four large regional hospitals, four medium hospitals and one private hospital. Participants: Adult patients with a diagnosis of CAP made in the ED. Data on 20 consecutive CAP ED presentations were collected in participating hospitals. Outcome measures: Documented use of the pneumonia severity index, initial antibiotic therapy prescribed in the ED, average length of stay, inpatient mortality, and concordance with national guidelines. Results: 691 CAP presentations were included. Pneumonia severity index use was documented in 5% of cases. Antibiotic therapy covering common bacterial causes of CAP was prescribed in 67% of presentations, although overall concordance with national guidelines was 18%. Antibiotic prescribing was discordant due to inadequate empiric antimicrobial cover, allergy status (including contraindication to penicillin), inappropriate route of administration and/or inappropriate antibiotic choice according to recommendations. There was no significant difference between concordant and discordant antibiotic prescribing episodes in average length of stay (5.0 v 5.7 days; P=0.22) or inpatient mortality (1.6% v 4.1%; chi(2) = 1.82; P=0.18). Conclusions: Antibiotic therapy for CAP prescribed in Australian EDs varied. Concordance with national CAP guidelines was generally low. Targeted interventions are required to improve concordance.