Healthcare Organizational Culture Research Articles

Cocreation Culture in Health Care Organizations

Both health care practice and academe recognize that organizations should modify their business practices to adopt cocreative behaviors and a service-dominant orientation. However, research has provided little understanding of the organizational culture that supports and facilitates cocreation. Contemporary organizational culture models are constrained from explaining cocreation, as they differentiate between an internal and external focus and do not acknowledge the interconnectedness of all actors across traditional organizational boundaries. This research conceptualizes organizational culture from a service-dominant perspective and provides a framework for a cocreation culture type. It utilizes two case studies in the health care industry, inclusive of 10 in-depth interviews and six focus groups, to conduct a systematic inductive approach to concept development. The findings reveal that a cocreation culture comprises five core cocreation behaviors: coproduction, codevelopment, coadvocacy, colearning, and cogovernance. Additionally, a series of supportive cocreation behaviors stimulate the interactive nature of cocreation: dialogue, shared market intelligence, mutual capability development, and shared decision-making. These behaviors are underpinned by organizational values of mutual respect, empowerment, and mutual trust. Health care practitioners are encouraged to create opportunities for customers to participate in cocreation activities related to their own treatment plans, ongoing strategic planning, and promotion and governance of the organization.

Solving work-related ethical problems.

Nurse managers are responsible for solving work-related ethical problems to promote a positive ethical culture in healthcare organizations. The aim of this study was to describe the activities that nurse managers use to solve work-related ethical problems. The ultimate aim was to enhance the ethical awareness of all nurse managers. The data for this descriptive cross-sectional survey were analyzed through inductive content analysis and quantification. Participants and research context: The data were collected in 2011 using a questionnaire that included an open-ended question and background factors. Participants were nurse managers working in Finnish healthcare organizations (n = 122). Ethical considerations: Permission for the study was given by the Finnish Association of Academic Managers and Experts of Health Sciences. Nurse managers identified a variety of activities they use to solve work-related ethical problems: discussion (30%), cooperation (25%), work organization (17%), intervention (10%), personal values (9%), operational models (4%), statistics and feedback (4%), and personal examples (1%). However, these activities did not follow any common or systematic model. In the future, nurse managers need a more systematic approach to solve ethical problems. It is important to establish new kinds of ethics structures in organizations, such as a common, systematic ethical decision-making model and an ethics club for nurse manager problems, to support nurse managers in solving work-related ethical problems.

A Social Exchange Perspective for Achieving Safety Culture in Healthcare Organizations

This paper used Social Exchange Theory (SET) and Cooper’s (2000) model to operationalize a comprehensive model of safety culture, and tests whether SET factors (supervisor-employee relationships an...

THE FORMATION AND DEVELOPMENT OF CORPORATE CULTURE OF THE MEDICAL ORGANIZATIONS

The article is devoted to the problem of formation and development of corporate culture as the main factor of the successful functioning of medical organization in terms of optimization of activity of the health system. Discusses the importance and main directions of development of corporate culture for personal and organizational development. The authors identified features of the corporate culture of healthcare organizations, the approaches, showing the sequence and contents of the main practical activities on the formation, maintenance and development of corporate culture. Emphasized the need for further research and introduction of corporate culture and cultural values in health care organizations. Purpose/ objectives: to Study and evaluate the corporate culture of healthcare organizations to improve institutional management and increase of efficiency activity of medical organizations. Materials and methods: For data collection methods were used: direct observation, interviews, questionnaires. In conducting this study used data from official sources, a literature review, a systematic approach, comparative analysis, historical, sociological, statistical research methods. The results of the study indicate the need for concept development, tools implementation and development of corporate culture in the practice of the medical organizations. Conclusions/Significance: Corporate culture – the system of collectively shared values, symbols, beliefs, standards of behaviour employees of the organization that contributes to the originality and uniqueness of the activities of medical organizations that promote the identification of employees with the organization; Corporate culture is formed with the influence of factors external and internal environment of the organization, solving problems, external adaptation and internal integration in the environment; Generated and promoted by the corporate culture is an important management tool, creates strong competitive advantage, increases the social responsibility of medical institutions to the society and patients, improves the quality of medical activities; The presence of the corporate culture of the organization, a coherent system of values and behavior models allows us to improve policy development processes, internal communication, unity and team cohesion, to create a single vector of development of human resources to reduce employee turnover in your organization; Medical organizations need the formation of the concept, mechanisms of implementation and development of corporate culture in practice activities; The system of continuous professional education of managerial staff of health must ensure the implementation of educational programs in the field of formation and development of the corporate culture of healthcare organizations.

Safety culture and teamwork to improve patient safety in mental healthcare in Austria

Background The purpose of this study is to investigate the need for a safety culture in health care organizations, to enhance patient safety through effective teamwork in mental healthcare. Although there is much information about adverse events and teamwork in surgical units, there is a lack of awareness about safety issues in non-surgical units, especially in neurological and psychiatric settings. Methods The survey was …

Organizational culture enhancement: A quality initiative

Broadly speaking, organizational culture is what results from an amalgamation of shared values and behavioral norms in an organization. Organizational values provide a moral compass for employees and direction regarding what is important. Behavioral norms complement values by indicating how things should be done. Organizational cultures can be strong,weak, or even virtually nonexistent.

To Move Health Care to Health Caring: A Conversation With Julie Kennedy Oehlert, DNP, RN.

The complex nature of health care requires a culture of interprofessionality that supports high-functioning interprofessional teams. Wolf and Prince (2014) wrote, "Culture is the foundation on which any healthcare encounter is delivered" (p. 3). It is therefore important for nursing to elevate thought leaders who can address the culture of health care organizations and how culture can be transformed. Julie Kennedy Oehlert is one of these leaders.

Patients-people-place: developing a framework for researching organizational culture during health service redesign and change.

BackgroundOrganizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory.MethodsAs part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model.ResultsIn workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas (‘domains’) and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization’s culture in each domain.ConclusionsThis paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization’s culture are addressed in future health service research.

Promover uma cultura de segurança em cuidados de saúde primários

The quality of Portuguese health system response from the perspective of the citizen, is still far from achieving a reasonable level of satisfaction, contributing for that a poor safety culture in the Portuguese health services and particularly in primary care where this issue has not been, to date, included in the priorities of those who organizes and provides this type of care. This article presents a review of the literature on the subject of safety culture in healthcare organizations, basing the relevance of its implementation in primary care.

Patient Safety Culture in a Turkish Public Hospital: A Study of Nurses’ Perceptions About Patient Safety

The objective of this study was to investigate nurses’ perceptions about the culture of patient safety in a Turkish public hospital. The study adopted a cross-sectional research design and utilized the hospital survey of patient safety culture. The population studied consisted of approximately 300 nurses from which 200 nurses were surveyed. The response rate was 66.6 % of the population. Nurses responded most positively to two dimensions, hospital management support for patient safety (80 %) and supervisor/manager expectations and actions promoting patient safety (79 %). Four dimensions with a positive response rate of <50 % (‘Frequency of events reported’, ‘Nonpunitive response to error’, ‘Communication openness’ and ‘Hospital handoffs and transitions’) were considered as potential targets for improvement in our study. This study revealed six significant predictors of Overall Perceptions of Safety: Organizational Learning-Continuous Improvement; Communication Openness; Teamwork within Units; Staffing; Frequency of Event Reporting; and the Patient Safety Grade (of the Hospital Unit). Additionally, four significant predictors of the Patient Safety Grade (of the Hospital Unit) emerged: Feedback and Communication about Error; Organizational Learning-Continuous Improvement; Hospital Management Support for Patient Safety; and Supervisor/Manager Expectations and Actions Promoting Safety. Interventions designed to improve the safety culture in Turkish hospitals should be focused on the concerns of staff nurses and the improvement of communication between these nurses and their managers. The determination and evaluation of the patient safety culture level in hospitals should be viewed as a continuous process in Turkey where a need for continuous improvements in the hospital patient safety culture exists. To improve the patient safety level, nurses’ perceptions about patient safety appear to be essential. Nurses are important for the improvement of the patient safety culture in health care organizations. Moreover, some hospitals have recognized that providing patients with safe, high-quality care is fundamental to protecting the financial assets of the institution and therefore, falls within risk management’s role. In this new landscape, risk management and patient safety professionals are engaged in a close working relationship.

Cultural change in healthcare organisations through lean practices

This paper's main purpose is to understand the change of organisational culture as a result of adopting new workplace practices from implementation of lean in healthcare organisations. Therefore, a multi-case study approach with qualitative data from four hospitals running lean projects was adopted, exploring, through cross-case analysis, what were the enablers and failure motives. A path for a lean culture construction, from practice repetition changing behaviour to change thinking, is presented. The propositions formulated provide a research agenda for future studies. Also, a lean maturity model for healthcare organisations is presented as a starting point for developing a healthcare lean assessment (HLA) instrument. This paper contributes to the recent research stream on cultural aspects of lean, in a culturally rich service setting, healthcare. It brings some new insights to organisational culture change theory in context of lean deployment and provides a framework for understanding lean maturity stages. This paper explores both the hard and the soft side in healthcare settings, absent from many of lean literature. Addressing the healthcare organisational culture change under national culture awareness, it brings a new approach to lean deployment assessment in healthcare settings.

Obstáculos percibidos por las enfermeras para la práctica basada en evidencias: Un estudio cualitativo

To examine the obstacles perceived by nurses to implement an evidence-based clinical practice. A qualitative study through semi-structured interviews conducted in 2010-2011 including 11 nurses purposively selected from public hospitals and community centres in Jaén and Córdoba (Spain). A content analysis was performed, using Miles and Huberman as a reference and comprising the following steps: data reduction, data presentation, and data conclusion/verification. Data saturation was reached in these categories (obstacles). The obstacles perceived by nurses to introduce an evidence-based clinical practice (EBCP) were grouped into 3 major categories: obstacles related with professionals (routine-based practice, unwilling and stagnant attitudes, and lack of training in EBCP), obstacles related to the social context (reluctance from other professionals and from patients or families), and obstacles related to the organization (obsolete cultures that do not promote innovation in nursing care). This study highlights the persistence of various factors that hinder the use of research findings in clinical practice. The results underline the need to change the culture of healthcare organizations, to motivate professionals, and to break some of the resistance attitudes that hinder the implementation of evidence-based practice.

Assessment of patient safety culture among personnel in the hospitals associated with Islamic Azad University in Tehran in 2013.

Background:Patient safety is an essential element in the quality of healthcare, and a clear knowledge of its culture in healthcare organizations will lead to both improved healthcare and patient safety. The aim of this study was to assess the patient safety culture at Islamic Azad University hospitals in Tehran, Iran, in 2013.Methods:This cross-sectional study was conducted on clinical and diagnostic staff in all Islamic Azad University hospitals in Tehran in June 2013. The international “Hospital Survey on Patient Safety Culture” questionnaire was used as the measurement tool.Results:In these hospitals, the overall positive score of patient safety culture was 35%. “Teamwork within units” (48% positive) was evaluated as reflecting the most knowledge of the aspects of patient safety culture, and “non-punitive response to error” (12% positive) was evaluated as reflecting the least knowledge of the aspects of patient safety culture.Conclusion:The patient safety culture in the hospitals that were studied should be improved. This goal could be achieved by reinforcing the basics of patient safety culture by teaching the staff members about the aspects of a positive patient safety culture and encouraging them to incorporate these aspects in their day-to-day activities.

The Affordable Care Act

Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.

Intrinsic motivation: how can it play a pivotal role in changing clinician behaviour?

In the light of an increasing healthcare burden, this paper seeks to offer insight about how intrinsic motivation could play a pivotal role in improving the pre-existing healthcare service delivery systems by altering clinician behaviour. The paper argues the case for four salient dimensions worth exploring through the lens of intrinsic motivation--non-financial incentives, positive affective states, organizational culture and prescribing quality. This article reviews literature from both social sciences and health management practices to provide rationale on how intrinsic motivational approaches could optimize healthcare service delivery systems. The scrutiny of the body of evidence leads to the assertion that there is neglect in the initiatives to reinforce intrinsic motivation as a method to address the ailing morale of doctors. This seems to have exacerbated negative outcomes that include job dissatisfaction, compromise in the quality of care and poor patient-doctor relationships. Diminution in positive affective states amongst doctors, largely controlled by intrinsic motivation, led to strained doctor-patient communication and poor quality of care. Barriers in a healthcare organizational culture that restricts autonomy and empowerment seem to directly undermine job satisfaction. The article argues that it is crucial to shift away from the conventional tendencies promoting tangible rewards. A more holistic approach should be adopted by conducting formal research into intrinsic motivation and how it could aid the formulation of policies tailored to meet the current demands of the healthcare system.

Organizational culture and performance in health care for older people: a systematic review

AbstractIn recent years, there has been a growing understanding that organizational culture is an important characteristic that may influence the effectiveness of health care provision, not least for the growing numbers of older people needing care. The purpose of this paper is to review the literature to uncover any reliable evidence supporting the assertion that organizational culture in health care organizations is related, in terms of activity and outcome, to their performance. Searches identified 20 relevant papers published between 1993 and 2010. A number of studies reviewed claims to have uncovered evidence of a relationship in terms of activity, while others failed to find a clear relationship. None of the studies found much evidence against. In terms of outcomes, none of the studies reviewed found evidence of a relationship between culture and performance. It is clear that any relationship between culture and performance is highly unlikely to be simple: such relationships are more likely to be multiple, complex, contingent and dynamic.

Work Life and Patient Safety Culture in Canadian Healthcare: Connecting the Quality Dots Using National Accreditation Results

Fostering quality work life is paramount to building a strong patient safety culture in healthcare organizations. Data from two patient safety culture and work-life questionnaires used for Accreditation Canada's national program were analyzed. Strong team leadership was reported in that units were doing a good job of identifying, assessing and managing risks to patients. Seventy-one percent of respondents gave their unit a positive overall grade on patient safety, and 79% of respondents felt that they could often do their best-quality work in their job. However, healthcare workers felt that they did not have enough time to do their jobs adequately and indicated that co-workers were cutting corners in patient care in order to save time. This article discusses engaging both senior leadership and the entire organization in the change process, ensuring supervisory support, and using performance measures to focus organizational efforts on key priorities all as improvement strategies relevant to these findings. These strategies can be used by organizations across sectors and jurisdictions and by healthcare leaders to positively affect work life and patient safety.

Generational Diversity: Implications For Healthcare Leaders

&lt;p class="MsoNormal" style="text-justify: inter-ideograph; text-align: justify; margin: 0in 0.5in 0pt; mso-layout-grid-align: none;"&gt;&lt;span style="color: black; font-size: 10pt;"&gt;&lt;span style="font-family: Times New Roman;"&gt;Amid the multifaceted complexities of the current health care environment and today&amp;rsquo;s workforce, intergenerational issues created uncharted territory for health care leaders. As a result, healthcare institutions reveal organizational cultures of conflict due to the generational differences in core values and work related issues. In addition, driving forces also consist of the economic, political and social influences of the generational period. It is essential that healthcare leaders understand and take proactive strategies to develop synergism to span the generational gaps as integral components of healthcare organizational culture.&lt;span style="mso-spacerun: yes;"&gt;&amp;nbsp; &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

Hand hygiene in rural Indonesian healthcare workers: barriers beyond sinks, hand rubs and in-service training

Few attempts to increase healthcare workers' hand hygiene compliance have included an in-depth analysis of the social and behavioural context in which hand hygiene is not undertaken. We used a mixed method approach to explore hand hygiene barriers in rural Indonesian healthcare facilities to develop a resource-appropriate adoption of international guidelines. Two hospitals and eight clinics (private and public) in a rural Indonesian district were studied for three months each. Hand hygiene compliance was covertly observed for two shifts each in three adult wards at two hospitals. Qualitative data were collected from direct observation, focus group discussions and semistructured in-depth and informal interviews within healthcare facilities and the community. Major barriers to compliance included longstanding water scarcity, tolerance of dirtiness by the community and the healthcare organisational culture. Hand hygiene compliance was poor (20%; 57/281; 95% CI: 16-25%) and was more likely to be undertaken after patient contact (34% after-patient contact vs 5% before-patient contact, P<0.001) and 'inherent' opportunities associated with contacts perceived to be dirty (49% 'inherent' vs 11% 'elective' opportunities associated with clean contacts, P<0.001). Clinicians frequently touched patients without hand hygiene, and some clinicians avoided touching patients altogether. The provision of clean soap and water and in-service training will not overcome strong social and behavioural barriers unless interventions focus on long term community education and managerial commitment to the provision of supportive working conditions.

Your hospital was a ‘clan’, now it’s ‘rational’

Look around you and you might be surprised to learn that the culture of your hospital is changing. For years, policy wonks complained that the major barrier to improving clinical care and productivity was the intransigent culture of healthcare organizations. If you want to achieve change, the argument goes, change the culture.