The integrative model is presented in Figure 1. The model’s core climate
domains include leadership and organizational structural characteristics.
Sub constructs of leadership include organizational values, as well as style and
strategies used by top management. The subconstructs associated with
organizational structural characteristics include formal communication processes,
governance structures, and information technology infrastructure. The direct
impact of these variables on patient and health care worker outcomes is mediated
by four process domains: (1) supervision, (2) group behavior, (3) quality
emphasis, and (4) work design. This model distinguishes between leadership and
supervision. Supervision refers to the direct managers’ style or the recognition an
employee receives on a daily basis. Work design includes five subconstructs: (1)
manageable workload, (2) resources and training, (3) rewards (defined as
monetary compensation such as salary and bonuses), (4) autonomy, and (5)
employee safety. Group behavior includes two subconstructs—collaboration and
consensus (the latter including items such as “there is general agreement on
treatment methods”). Subconstructs associated with quality emphasis include
patient centeredness, patient safety, innovation, outcome measurement, and