Organizational culture is defined as the underlying beliefs, assumptions, values and ways of interacting that contribute to the unique social and psychological environment of an organization. In the healthcare industry, providers deal with people of diverse cultures. A growing body of evidence links cultures which may be driving forces for change or may undermine quality improvement initiatives. The culture of healthcare, which so critically affects all other aspects of the service which patients receive, must develop and change to ensure more patient engagement and accuracy in the offering of treatment. Three levels of organizational culture in healthcare:
Visible manifestations
It includes the long-established divides between secondary and primary care and between health and social care, the physical layouts of facilities (receptionists behind desks and doctors in consulting rooms), the established pathways through care, demarcation between staff groups in activities performed, staffing practices and reporting arrangements, dress codes (such as different coloured scrubs for different staff groups in emergency departments), reward systems (pay and pensions, but also the less tangible rewards of autonomy and respect), and the local rituals and ceremonies that support approved practices. Visible manifestations of culture also include the established ways (both formal and informal) of tackling quality improvement and patient safety, the management of risk, and the accepted ways of responding to staff concerns and patient feedback or complaints.
Shared ways of thinking
It talks about the values and beliefs used to justify and sustain the visible manifestations above and their associated behaviors, as well as the rationales put forward for doing things differently. This might include prevailing views on patient needs, autonomy, and dignity; ideas about evidence for action; and expectations about safety, quality, clinical performance, and service improvement.
Healthcare organizations are notoriously varied, fractured by specialty, occupational groupings, professional hierarchies, and service lines. Some cultural attributes might be widespread and stable, whereas others may be shared only in subgroups or held only tentatively. Hospitals, on the other hand, are dynamic in their culture system. Two of the major professional groupings concerned with quality improvement—doctors and managers—may differ in several important ways, for example, Doctors may focus on patients as individuals rather than groups and view them through a science lens. Managers may be more concerned with patients as groups and value a social science-based experiential perspective. Making sense of this subcultural diversity should be an essential part of any cultural “diagnosis” in seeking quality improvement.
Finally, the cultural framing of healthcare organizations draws attention to specific aspects of organizational life: the shared patterns of feeling, thinking, talking, and accomplishing that underpin local practice. In doing so, other equally important aspects of organizational life may be marginalized or neglected, such as individual skill, attitude, and responsibility; governance and performance management arrangements; the macro structural arrangements within which local service lines are embedded; the incentives spread across the system; and the availability of material resources, human capital, and knowledge.
