RESUMO
Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage.
RESUMO
Molting in decapod crustaceans is regulated by ecdysteroids produced by a pair of Y-organs (YOs) located in the cephalothorax. YO ecdysteroidogenesis is suppressed by molt-inhibiting hormone (MIH), a neuropeptide produced in the X-organ of the eyestalk (ES) ganglia. MIH signaling may involve nitric oxide synthase (NOS) and NO-sensitive guanylyl cyclase (GC-I). A full-length cDNA encoding Carcinus maenas NOS (Cm-NOS; 3836 base pairs) of 1164 amino acid residues (estimated mass 131,833 Da) was cloned with 88% identity to Gecarcinus lateralis NOS (Gl-NOS). End-point reverse transcription-polymerase chain reaction (RT-PCR) showed that Cm-NOS was expressed at varying levels in the YO, testis, ovary, hepatopancreas, midgut, hindgut, heart, thoracic ganglion, and skeletal muscle and was not detected in the gill. Immunofluorescence microscopy showed localization of NOS and cGMP in the steroidogenic cells and the surrounding connective tissue layer of the C. maenas YO. ES ablation (ESA) induced molting in G. lateralis; hemolymph ecdysteroid titers increased during premolt and reached a peak of about 400 pg/µL at 20 days and 24 days post-ESA. By contrast, ESA did not induce molting in C. maenas; hemolymph ecdysteroid titers increased about 2-fold (53 to 121 pg/µL) by 3 days post-ESA and remained at that level at 7 days post-ESA. Real time PCR was used to quantify the effects of ESA on the expression of NOS in C. maenas and G. lateralis YOs. ESA caused 32-fold and 5-fold increases in Gl-NOS and Cm-NOS transcripts by 24 days and 7 days post-ESA, respectively, which were correlated with hemolymph ecdysteroid levels. In addition, GC-I catalytic subunit (Gl-GC-Iß) mRNA level increased 7.4-fold by 24 days post-ESA, but there was no significant effect of ESA on membrane GC (Gl-GC-II) mRNA level. These data indicate that the YO up-regulates NO signaling components in response to withdrawal of ES neuropeptides.
