Conclusion
Our findings provide insights into the perceptions of health care professionals regarding organizational culture and QI implementation in the level III NICU and the effect of these factors on neonatal outcomes, both of which have important implications for QI initiatives. Our demonstration that group culture is highest among NICU management and older staff members suggests that occupation and employee demographics should be taken into account when considering QI implementation, particularly in the NICU. We also found that hierarchical culture is associated with better patient outcomes in this sample of Canadian level III NICUs. Whether our findings can be applied to other ICU populations, and whether it is necessary for ICU culture to differ from that of other care units to achieve the same efficient and positive outcomes, will be important questions to explore.