This work presents a redesign of the organizational climate questionnaire for high-complexity hospitals, by evaluating the hospital dimensions and reaction processes in the Primary Health Care (PHC) units. Two sample groups were used: 389 cases in Chile and 583 in Ecuador. The reaction processes were made sensitive according to an analysis of factor loads and commonalities and were then validated with a modelling based on structural equations. Four dimensions summarize the 27 reaction processes validated herein. Direct and inverse relations between the factors match the assumptions provided in the theory. The variance and covariance of the matrices conrmed that it is a homoscedastic model. The measures of goodness of t validated the model. It is then conrmed that both the internal tension and the professional development inuence signicantly and inversely the internal management factors as well as the organization and performance. The adjustments done to the model and the goodness of t measures conrmed that the model represents appropriately the reality.