Mediation of professional commitment in the relationship between organizational culture and quality of care among community health centres: A multilevel study in China

Organizational culture is increasingly recognized as crucial to improving the quality of care. However, there is limited evidence in primary care, especially the underlying mechanism between organizational culture and care quality. This study aims to investigate the relationship of organizational culture with quality of care and the mediated effect of professional commitment. We conducted a cross-sectional survey of 224 primary care physicians (PCPs) from 38 community health centres (CHCs) in four large cities in China. The director of CHC completed the organization survey including organizational culture and other organizational characteristics. PCPs completed a PCP survey, including information such as personal characteristics, professional commitment and self-reported quality of care. The data was analysed using a multilevel mediation testing method based on a hierarchical linear model. Over half of the CHCs have group culture as their dominant culture. CHCs with higher scores on developmental culture are more likely to perform better in care quality, while CHCs with higher scores on hierarchical culture are less likely to perform well in care quality, with professional commitment playing a partially mediated role. Building a developmental culture and enhancing professional commitment should be considered as modifiable strategies to improve PCPs’ quality of care.