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Culture as a predictor of resistance to change: A study of competing values in a psychiatric nursing context
Abstract
It is well known that a conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method - a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments - an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) - was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions.
... Accepting change in the core of nursing and health care is considered a challenge, and some of these challenges are related to the movement of information and knowledge from research to the implementation of evidencebased best practices [24]. It is because employees and organizations simply do not like change [25], and the organizational culture (context and environment of the organization) that is conservative and may strengthen the resistance that can prevent the implementation of new changes [26]. This kind of resistance is the result of the cognitive and behavioral reactions of the recipients of the change towards the change [27], which is often in conflict with the organizational identity and causes an unpleasant image of individual, and threats the organizational identity [28]. ...
... All personnel in an organization does not react equally to ongoing changes in their organization [37]. A feeling of insecurity, doubt, and on the other hand, low motivation in implementing change [36], with a lack of trust and negative belief in change [26,27], and a lack of readiness to accept change [35] seeks resistance to change. Individuals with conservative personality traits and low flexibility to change can also make this process more difficult [26]. ...
... A feeling of insecurity, doubt, and on the other hand, low motivation in implementing change [36], with a lack of trust and negative belief in change [26,27], and a lack of readiness to accept change [35] seeks resistance to change. Individuals with conservative personality traits and low flexibility to change can also make this process more difficult [26]. Changes in the structure or design of organizations as a result of the introduction of new technologies are likely to lead to changes in work roles and increased feelings of uncertainty and insecurity among personnel. ...
Background
Change is a very complex and multifaceted phenomenon that is intertwined with the understanding of nursing practice, so, resistance to change in nursing can be considered as an important challenge. Knowing the reasons for this resistance can help in solving it in nursing. Therefore, the present study was conducted with the aim of investigating the reasons for resistance to change in nursing as an integrated review.
Methods
This integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, CINAHL, and Scopus were searched using the keywords; “Resistance”, “Change”, “Nursing”, “Resistance to Change” and their Persian equivalents in the time range of 2000 to January 2023. After applying inclusion criteria and assessing the articles using Bowling’s Quality Assessment Tool, finally, 15 papers were included from 2964.
Results
After reviewing and critically appraisal of the qualified articles, the findings were placed in three main categories including; (1) individual factors, (2) interpersonal factors, and (3) organizational factors and six subcategories.
Conclusion
Undoubtedly, change is an integral component in nursing care, and resistance to it is the result of a set of individual, interpersonal and organizational factors that change managers should pay special attention to in order to make changes due to the reasons of this resistance, and the development process of developing changes in the clinical field is easily possible.
... For instance, ref. [35] highlights that organizational culture is key to the successful implementation of change initiatives. The authors of [36] claim that disregarding the impact of organizational culture is a major hurdle that management faces when implementing change initiatives. Thus, they recommend that organizations first determine what type of culture they practice before executing any change plans. ...
... An organization's culture can impact the degree to which employees feel ready for a change implementation [52]. Organizations must understand what type of OC exists within their organization prior to implementing change to better customize and address their change initiatives before execution [36]. Hence, it is surprising that there is a deficiency of inquiry on the effect different OC types can have on readiness for change, given its importance [47]. ...
A comprehensive review of the literature indicates that there is a lack of research on the influence of all the organizational culture (OC) types on academics’ readiness and behavioral intention to implement eLearning changes in higher education institutions (HEIs). To address this gap, this study empirically investigates the impact of OC on academics’ readiness and behavioral intention to implement eLearning changes within HEIs in Kuwait during the COVID-19 pandemic. A 218 self-administered survey was distributed to public and private HEIs. The analysis of collected data reveal that the most prominent OCs are hierarchy and market types which support readiness for change. The contribution of this study lies in further understanding the impact of OC on academics’ readiness for eLearning changes and behavioral intention to support eLearning implementation. The findings further offer an original contribution by confirming the mediating role of academics’ readiness for eLearning changes in the relationship between OC and behavioral intention. This paper adds to the change management literature by collecting data during the COVID-19 pandemic within the interesting context of HEIs in the Gulf Cooperation Council (GCC), which is currently scarce. The implications of this study contribute to the sustainability of Kuwaiti HEIs.
... Because these relations are most of the time in equilibrium, social systems tend to be inert (Coiera, 2011), that is, with a finite degree of readiness for change (Weiner, 2020). When crises create perturbations that alter the system's equilibrium, resistance to change will be the default collective response (Oreg and Sverdlik, 2011;Johansson et al. 2014;Pardo del Val and Martínez Fuentes, 2003). To surmount this, governments may impose change through explicitly top-down social control to enforce (pandemic-related) behavioural rules. ...
Whilst policymaking will always remain a highly political process, especially amidst crises, evidence-based pandemic management can benefit from adopting a socioecological perspective that integrates multi- and trans-disciplinary insights: from biology, biomedicine, mathematics, statistics, social and behavioural sciences, as well as the perspectives and experiences of non-scientific stakeholders. We make a case for an “integrated inter- and transdisciplinarity” that overcomes the typical additive nature of current interdisciplinary work and better captures the inherent complexity of public health and other public policy problems. We propose systems science and systems thinking approaches as a useful meta-theoretical, self-reflecting approach for such integration to take place. Enabled by systems thinking, the praxis of “integrated inter- and transdisciplinarity” allows for an understanding of public health crises in a human-centred socio-ecological perspective. This grounds more holistic policy responses, which by mobilising the whole of government and whole of society, put individuals, groups, governments and society at large in critical dialogue to co-produce and co-design interventions that address crises in all their physical, social, psychological, economic and political dimensions.
... Implementing changes in healthcare settings, such as EMS departments, is not easy. Only a small percentage of healthcare professionals are typically change-inclined, meaning that they are willing to participate in or accept changes [18,19]. Changes are more likely to be met with resistance, skepticism, or even rejection by regular workers. ...
Background: Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing a number of challenges that require rigorous research and innovative solutions. Objectives: To highlight the key challenges facing EMS departments in their daily operations and discuss potential solutions. Methods: A narrative literature review was conducted. Relevant studies were identified by searching electronic databases, such as PubMed, MEDLINE, CINAHL, and Google Scholar. Results: The main challenges facing EMS departments include an increasing demand for services, limited resources, aging infrastructure, technological advancements, and regulatory compliance. Operational-level solutions that can be used to address these challenges include investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations. Conclusion: EMS departments today face a variety of challenges. However, there are a number of approaches that can be taken to address these challenges. By investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations, EMS departments can improve their operations and provide the best possible care to patients.
... Staff particularly emphasised the need for CCC to be embedded into the culture of the ward. Previous research has demonstrated the key role of ward culture in facilitating or obstructing the implementation of new approaches to care (Johansson et al. 2014) and how discussion of ward culture is often an important step in practice development (Wilson et al. 2005). This suggests it would be important to identify, understand, and work with staff in implementing CCC through a bottom-up approach, in fitting with the concept of creating a 'culture of therapy' (Clarke 2015;Clarke & Wilson 2008). ...
'Comprehend, Cope and Connect' (CCC) is an evidence-based psychological intervention for psychological crisis designed for use in inpatient settings. The aims of the current study were to gain the perspectives of multidisciplinary team (MDT) staff, patients and carers to inform the design of a potential CCC training programme for MDT staff to deliver CCC interventions. Staff, patient and carer perspectives on developing a CCC training programme were collected through video call-based group consultations and written feedback. Thematic analysis was employed to organise and explore latent themes within the data. Thirteen MDT inpatient staff and an expert patient and carer panel of four participated in the study. Feedback showed that the CCC model supported staff in understanding patients beyond labels in a patient-centred and led capacity, and that CCC was helpful in bringing clarity to crisis. Staff participants stated that learning and practicing psychological skills and encouraging confidence would be important when training staff in CCC. They identified needs to embed CCC into ward culture and integrate CCC with care planning for successful implementation of CCC in inpatient settings. The patient and carer panel focused on the needs of patients, concluding that CCC training should emphasise the need to understand patient experience, and promote compassion and empathy. These findings provide evidence for what staff, patients, and carers consider to be important when training MDT staff to deliver CCC interventions in an inpatient setting and form a foundation for implementation of CCC training.
... The second component is organizational leadership, which helps develop a successful organizational culture, while the third is employee management. Organizational glue refers to the fourth essential component of the model, effectively holding organizational culture and employees together (Johansson, Åström, Kauffeldt, Helldin, and Carlström, 2014). The fifth component is the strategic emphasis, which refers to the strategic role of management in creating value. ...
There is a need to fill the gap between adopting the change in organizational culture and employees' readiness to adopt the organizational cultural differences. The present research investigates the effect of organizational culture on the learning tendencies of the workforce. The study adopted a cross-sectional study design. Whereas a self-administered questionnaire was employed to collect data from 100 Sharjah transportation authority employees. The hierarchical model is based on four variables; organizational leadership, the management of employees, success criterion, as well as learning encouragement. Results indicated that organizational leadership and management of employees positively affect the employees’ readiness to change. Organizations with successful organizational cultures develop a high level of preparedness among employees. This domain remains a scarcely studied area for the transportation system, particularly in UAE, despite the vast literature on the subject.
... Positive organizational culture that emphasizes collaboration and teamwork contributes to improve healthcare services, patient satisfaction, and implementation of new innovations [3]. Some cultures facilitate improvement, support to generate new ideas and motivate employees to attempt for organizational success [4] while others defend to maintain the status quo [5] and negatively affect organizational reforms [6].Thus, it is of paramount importance to encourage cultures that can help organizations to be strong and competitive [7]. ...
Background
Cardiovascular disease is a major contributor to high mortality in Ethiopia. Hospital organizational culture affects patient outcomes including mortality rates for patients with cardiovascular disease. Therefore, the purpose of this study was to assess organizational culture and determine barriers to change in the Cardiac Unit of University of Gondar Comprehensive Specialized Hospital.
Methods
We used a mixed methods approach with a sequential explanatory design. We collected data through a survey adapted from a validated instrument measuring organizational culture (n = 78) and in-depth interviews (n = 10) with key informants from different specialty areas. We analyzed the quantitative data using descriptive statistics and the qualitative data through a constant comparative method of thematic analysis. We integrated the data during the interpretation phase to generate a comprehensive understanding of the culture within the Cardiac Unit.
Results
The quantitative results indicated poor psychological safety and learning and problem solving aspects of culture. On the other hand, there were high levels of organizational commitment and adequate time for improvement. The qualitative results also indicated resistance to change among employees working in the Cardiac Unit as well as other barriers to organizational culture change.
Conclusion
Most aspects of the Cardiac Unit culture were poor or weak, signaling opportunities to improve culture through identifying culture changing needs, implying the need to be aware of the subcultures within the hospitals that influence performance. Thus, it is important to consider hospital culture in planning health policy, strategies, and guidelines.
Recommendations
It is of paramount importance to strengthen organizational culture through fostering a safe space that enables workers to express divergent views and actively considering such views to improve the quality of care, supporting multidisciplinary teams to think creatively to address problems, and investing in data collection to monitor changes in practice and patient outcomes.
... Organizational culture boosts employees' readiness to change through motivation, alignment, flexibility and trust. They are organizational culture dimensions impacting change readiness [32]. Organizational culture can impact employees' readiness to change through intrinsic motivation. ...
The purpose of this study was to look into the impact of change leadership on employee readiness to change in a few public organizations in Ethiopia's Amhara national regional state. The study's population consists of 2546 employees from eight public organizations that had begun implementing various change initiatives. Quantitative survey method was applied to conduct this study. A total of 514 employees were chosen for the survey using a simple random sampling technique. The measurement instruments' reliability and validity were tested using exploratory and confirmatory factor analysis methods. The data were analyzed, and the hypotheses were tested using structural equation modeling method. Change leadership and organizational culture, as well as organizational culture and employee readiness to change, were found to have a significant relationship. However, change leadership has no direct effect on employees' readiness to change, and organizational culture does not affect the relationship between change leadership and employee readiness to change. The study will add knowledge and provide a base for future research.
Purpose
The purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination.
Design/methodology/approach
We used observations and qualitative interviews to develop “deep” knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of “boundary work” and “boundary objects” to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM).
Findings
The study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a “boundary object”, being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of “lifelong health promotion” helped to transgress existing organizational and professional boundaries.
Research limitations/implications
The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic.
Practical implications
For practice this can build bridges between organizational and professional boundaries.
Originality/value
The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.
The purpose of this survey is to identify cultural barriers the administrative system of Iran faces. Considering the existing theoretical basis and library studies, 21 cultural characteristics have been identified which the administrative system of Iran comes up with as obstacles. Delphi Method is applied to collect data. Fuzzy method is used to analyze data, and in order to cluster cultural characteristics, k-means clustering method is used. Fuzzy clustering is done for three modes in k-means algorithm, based on which fuzzy clustering with three branches is the optimal cluster. Fuzzy method shows that cultural characteristics like authority and hierarchy, low confidence in each other, favoritism, and nepotism, weakness in meritocracy and general irrational culture are the most average. Therefore, they are the characteristics the administrative system of Iran considers as the obstacles.
This meta-analysis examined how demand and resource correlates and behavioral and attitudinal correlates were related to each of the 3 dimensions of job burnout. Both the demand and resource correlates were more strongly related to emotional exhaustion than to either depersonalization or personal accomplishment. Consistent with the conservation of resources theory of stress, emotional exhaustion was more strongly related to the demand correlates than to the resource correlates, suggesting that workers might have been sensitive to the possibility of resource loss. The 3 burnout dimensions were differentially related to turnover intentions, organizational commitment, and control coping. Implications for research and the amelioration of burnout are discussed.
The dichotomies which have been proposed to distinguish between what can be labelled 'sociotechnical' and 'Japanese' teams oversimplify the 'team discussion'. They combine team characteristics and contextual factors which should be separated, contain biases, and have an infirm basis. As an alternative we propose an analytical framework to improve our theoretical understanding of how relevant contextual factors impact the design of jobs and organizations.
Objectives. To review some of the key debates relating to the nature of organizational culture and culture change in health care organizations and systems.
Methods. A literature review was conducted that covered both theoretical contributions and published studies of the processes and outcomes of culture change programmes across a range of health and non-health care settings.
Results. There is little consensus among scholars over the precise meaning of organizational culture. Competing claims exist concerning whether organizational cultures are capable of being shaped by external manipulation to beneficial effect. A range of culture change models has been developed. A number of underlying factors that commonly attenuate culture change programmes can be identified. Key factors that appear to impede culture change across a range of sectors include: inadequate or inappropriate leadership; constraints imposed by external stakeholders and professional allegiances; perceived lack of ownership; and subcultural diversity within health care organizations and systems.
Conclusions. Managing organizational culture is increasingly viewed as an essential part of health system reform. To transform the culture of a whole health system such as the UK National Health Service would be a complex, multi-level, and uncertain process, comprising a range of interlocking strategies and supporting tactics unfolding over a period of years.