Organizational and managerial factors associated with clinical practice guideline adherence: a simulation-based study in 36 French hospital wards. 
To identify managerial and organizational characteristics of multi-specialty medicine wards and individual characteristics of health professionals that are most strongly associated with clinical practice guidelines (CPG) adherence.  Cross-sectional stratified cluster sample design.  Data were gathered from 36 randomly selected multi-specialty medicine wards.  The study population included all health professionals involved in patient care working in the participating wards.  The degree of CPG adherence was measured using clinical vignettes on three topics: pain management, managing heart failure and managing diabetes.  Responses from each professional to each clinical case were quantified using a 10-point scale.  Managerial and organizational characteristics of medical department and individual characteristics of health professionals were obtained using three questionnaires.  The study sample consisted of 859 professionals (362 orderlies, 361 nurses and 136 physicians).  Factors independently and positively associated with CPG adherence were (i) individual factors: low age of professionals, expertise in diabetology and activity in cardiology; (ii) organizational and managerial factors: good understanding between physicians and other personnel; and (iii) structural factors: computer-based test results and prescriptions, presence of medical specialists, inter-department mobility of orderlies, medium-length stay (between 7 and 10 days) and large bed capacity.  Good CPG adherence in general medicine needs institutional dynamism, availability of clinical competence and team culture based on cooperation.