Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling Anastasia A. Mallidou *, Greta G. Cummings, Carole A. Estabrooks, Phyllis B. Giovannetti Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada What is already known about the topic?  Organizations consist of multiple subcultures, which influence employee quality of work life and organiza- tional outcomes.  Healthcare organizations are characterized by distinct disciplines (e.g., medical, nursing, etc.), but they lag behind in exploring their own cultures and sub- cultures.  A few studies found an association between hospital subcultures and selected nurse and patient outcomes. What this paper adds  Nurse specialty subcultures do exist within acute hospitals in Alberta. International Journal of Nursing Studies xxx (2010) xxx–xxx ARTICLE INFO Article history: Received 16 January 2010 Received in revised form 8 May 2010 Accepted 1 June 2010 Keywords: Hospital organizational culture Nurse specialty subcultures Adverse patient outcomes Patient safety Structural equation modeling ABSTRACT Background: Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs. Objectives: To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events). Method: Martin’s differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse–physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada. Results: Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses’ control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties. Conclusions: Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals. ß 2010 Elsevier Ltd. All rights reserved. * Corresponding author at: 5-112 Clinical Sciences Building, Faculty of Nursing, University of Alberta, Edmonton, Canada AB T6G 2G3. Tel.: +1 780 492 8475; fax: +1 780 492 6186. E-mail addresses: amallidou@yahoo.com, anastasia.mallidou@ualberta.ca (A.A. Mallidou). G Model NS-1693; No. of Pages 13 Please cite this article in press as: Mallidou, A.A., et al., Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling. Int. J. Nurs. Stud. (2010), doi:10.1016/j.ijnurstu.2010.06.002 Contents lists available at ScienceDirect International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns 0020-7489/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2010.06.002