Abstract
BackgroundAn in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. This research examined HWs’ working experiences and perceptions of organisational culture within private-not-for-profit, largely mission-based hospitals, and how this influenced retention.MethodsThirty-two HWs, including managers, in 19 health facilities in Uganda were interviewed using a semi-structured topic guide. Interview transcripts were analysed using thematic content analysis.ResultsInterviews showed that the organizational culture was predominantly hierarchical, with non-participative management styles which emphasized control and efficiency. HWs and managers held different perceptions of the organizational culture. While the managers valued results and performance, HWs valued team work, recognition and participative management.ConclusionsThe findings of this study indicate that organizational culture influences retention of HWs in health facilities and provide a useful context to inform health care managers in the PNFP sub-sector in Uganda and similar contexts. To improve retention of HWs, a gradual shift in organizational culture will be necessary, focussing on the values, beliefs and perceptions which have the greatest influence on observable behaviour.
Highlights
An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies
Uganda is among the 57 countries that was identified in 2006 as having a critical shortage of Health workers (HWs) with health worker numbers and skill mix deemed inadequate for service provision [1]
A total of 32 semi-structured face-to-face interviews were held with 23 HWs and five managers who were employed in the health facilities at the time of the study, and four HWs who were previously employed in the health facilities who volunteered to participate in the study
Summary
An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. Staffing establishments in PNFP hospitals are required to follow the minimumstaffing norms set by the Government, they can be adjusted to cater for variations in local conditions [4]. In the country, both the public sector and privatenot-for-profit (PNFP) health facilities are unable to retain HWs [5] and while retention of HWs is a major problem for the country at large, the magnitude is greater in the PNFP sector compared to the public sector [6].
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