Organizational Culture in Pediatric Cardiology: Results of a Multinational Exploratory Physician Survey with Implications for Team Performance and Patient Safety

Organizational culture is increasingly recognized as a determinant of team performance, patient safety, and clinician well-being, yet remains poorly characterized in pediatric cardiology. Existing approaches typically assess individual domains rather than culture as a multidimensional construct. We conducted a multinational exploratory study to examine physician perceptions of organizational culture and to develop an integrated conceptual framework. We performed a cross-sectional, anonymized survey of pediatric cardiology physicians across tertiary congenital heart programs internationally. The survey, informed by established constructs including the Safety Attitudes Questionnaire, assessed domains such as psychological safety, leadership, team structure, workload, and medicolegal climate. Analyses were descriptive and hypothesis-generating. A total of 133 physicians from 27 centers participated. Overall, 54.9% agreed that organizational culture influenced professional performance (85.0% agreed or were neutral), with limited disagreement across regions. Additionally, 36.2% reported negative spillover into personal or family life. Workload intensity and administrative burden were consistently identified as dominant stressors (≥ 60% across regions). Structural and team-related challenges were also prominent: 42.9% reported silo mentality in large teams, and 41.4% identified insufficient staffing as detrimental to culture. Response patterns were broadly consistent across geographic regions. Respondents demonstrated receptivity to improvement strategies, including open forums and structured feedback mechanisms. Organizational culture is widely perceived to influence performance and well-being in pediatric cardiology. Across healthcare systems, physicians identified consistent structural and relational drivers, including workload, administrative burden, and team integration. The proposed conceptual framework provides a basis for reflection and future research.