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Organizational Culture in Health and Medicine
Abstract
An organizational culture is a mindset, expressed through and influenced by tangible and intangible means, which characterizes an institution and its operation. More simply, it could be described as a philosophy of operation embraced by an organization and expressed through both visual and nonvisual means. Organizational cultures exist in all establishments, and they have a significant bearing on institutional performance. An organization’s culture, if well devised and properly managed, affords health and medical institutions with a strategic asset and key competitive advantage. Importantly, organizational culture educates and enlightens personnel regarding perspectives and practices deemed to be appropriate and acceptable, providing direction as duties and responsibilities are being completed. This is especially important in health and medical settings, as direct oversight often is not possible. Not unlike guidance systems used by rockets journeying into space, ensuring that they stay on course, a productive organizational culture helps healthcare establishments stay on course by creating an institutional mindset that guides employees and their associated decisions and actions. This chapter dedicates attention toward understanding organizational culture in healthcare institutions, complete with guidance on how to foster the development of cultures that are productive.
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Advice about enacting change in organizations often treats culture as malleable:
With the right processes, the right structures, and sufficient managerial resolve,
cultural change will happen. But OD practitioners often discover that there are
limits to how much culture can be changed. In this article, we argue that culture,
rather than shaping people, is often a reflection of relative personality homogeneity in firms. This homogeneity is the result of the attraction–selection–attrition
(ASA) cycle. Thus, efforts to change culture will often falter because it treats
culture as a force shaping employees, rather than it being a reflection of those
employees’ stable, enduring, and shared personality traits. We share evidence
from recent research documenting relative personality homogeneity in firms and
conclude with suggestions about what culture change might look like when we
accept the ASA idea that “the people make the place.”
Background
Modern marketing thought heavily emphasizes the need for healthcare providers to possess a customer orientation, placing patients at the focal point of attention within health and medical establishments. This has motivated significant investments in tools and techniques that foster outstanding service, attention, and support. Such investments in isolation, however, offer no guarantees that a true customer orientation will emerge. Proper implementation also is required—and that falls on the shoulders of health and medical personnel.
Discussion
The most innovative and expensive of customer-oriented tools and techniques mean very little unless they are placed in the hands of capable individuals possessing the ability and desire to serve patients well. But the rigors of industry life complicate matters, resulting occasionally in lost focus, compromising the patient experience. One of the simplest and most effective methods for encouraging patient attentiveness rests with a reflective exercise that encourages staff members to see themselves and their actions from the perspective of patients. Asking the operative question, “Am I seeing things through the eyes of patients?” serves as an effective reminder of priorities, building empathy and motivating personnel to continually deliver their very best.
Conclusions
Viewing one’s actions from the perspective of patients can be very revealing, opening eyes wide and permitting opportunities for any necessary improvements, making for a simple but powerful learning experience. The “Am I seeing things through the eyes of patients?” reflective exercise helps well-intentioned staff members avoid tendencies which can lull them into states of complacency, ensuring that they remain focused on those in their care.
Background
Branding—the assignment of names, logos, slogans, and related elements of identity to institutions and their product offerings for the purpose of conveying desired images to target audiences—is of paramount importance in the health services industry. Associated initiatives traditionally have centered on developing verbal and visual brand expressions, but opportunities abound to drive brand equity by supplementing traditional pursuits with new, different, and unexpected expressions that afford highly memorable experiences.
Discussion
Willis-Knighton Health System has possessed an expanded view of branding for decades. While the system has directed thorough attention toward traditional brand expressions, additional identity opportunities outside the bounds of traditional branding thought have been pursued vigorously. There perhaps is no better illustration of Willis-Knighton Health System’s expanded approach to branding than that of Willis the Bear, the institution’s iconic teddy bear mascot developed to promote labor and delivery services. This article presents the origins and development of this brand expression, particularly emphasizing the need to address nontraditional elements of identity for purposes of driving brand equity.
Conclusions
Given the importance of brand management and extraction of associated value, health services organizations must diligently direct attention toward branding initiatives. Traditional approaches, when executed well, deliver excellent results, but enhanced value can be derived by addressing nontraditional brand elements which afford unique opportunities to differentiate given establishments from their competitors, facilitating institutional viability and vitality.
In the global consumption culture, the human senses are often proposed as useful concepts for rethinking branding in practice and theory. The aim of this paper is to demonstrate the usefulness of a sensory branding framework grounded on sensory stimuli, sensory perceptions and sensory symbolism. Moreover, the role of societal culture in developing global branding sensory strategies is considered. Rsearch findings and conclusions on how brand managers can apply the framework are presented.
Background
Centers of excellence—specialized programs within healthcare institutions which supply exceptionally high concentrations of expertise and related resources centered on particular medical areas and delivered in a comprehensive, interdisciplinary fashion—afford many advantages for healthcare providers and the populations they serve. To achieve full value from centers of excellence, proper assembly is an absolute necessity, but guidance is somewhat limited. This effectively forces healthcare providers to pursue establishment largely via trial-and-error, diminishing opportunities for success.
Discussion
Successful development of a center of excellence first requires the acquisition of a detailed understanding of the delivery model and its benefits. Then, concerted actions must be taken on a particular series of administrative and clinical fronts, treating them in prescribed manners to afford synergies which yield an exceptionally high level of care. To reduce hardships associated with acquiring this rather elusive knowledge, remedy shortcomings in the literature, and potentially bolster community health broadly, this article presents information and insights gleaned from Willis-Knighton Health System’s extensive experience assembling and operating centers of excellence. This work is intended to educate and enlighten, but most importantly, supply guidance which will permit healthcare establishments to replicate noted processes to realize their own centers of excellence.
Conclusions
Centers of excellence have the ability to dramatically enhance the depth and breadth of healthcare services available in communities. Given the numerous mutual benefits afforded by this delivery model, it is hoped that the light shed by this article will help healthcare providers better understand centers of excellence and be more capable and confident in associated development initiatives, affording greater opportunities for themselves and their patient populations.
Climate has been viewed as a function of: (a) the organization's structure; (b) the organization's membership; and (c) more recently the memberships' efforts to understand the organization. The third view-interactionism-has been offered as a reconciliation of the objectivism of the first and the subjectivism of the second. The interactionist approach is extended here by a consideration of the roles of the workgroup, affect, corporate culture, symbolic management, and physical setting.
Up to now managers could find little evidence to support the idea that the organization's culture has an impact on its bottom-line performance. To remedy this, Denison draws on survey and performance data from 34 large corporations to show that those that have participative cultures experience better performance than those that do not. This difference in performance appears to have widened over the five years that these firms were studied. The results also hold up when the performance measures for each firm (return on investment and return on sales) are compared with those of their competitors. Denison suggests that this comparative approach to the study of organizational culture provides a way to capture the impact that culture has on organizational performance. This strategy, he argues, also provides a way of diagnosing organizations and measuring the ways in which human resources management, organizational culture, and management practices do, in fact, contribute to the success of business organizations.
The fields of organizational climate and organizational culture have co-existed for several decades with very little integration between the two. In Organizational Climate and Culture: An Introduction to Theory, Research, and Practice, Mark G. Ehrhart, Benjamin Schneider, and William H. Macey break down the barriers between these fields to encourage a broader understanding of how an organization's environment affects its functioning and performance. Building on in-depth reviews of the development of both the organizational climate and organizational culture literatures, the authors identify the key issues that researchers in each field could learn from the other and provide recommendations for the integration of the two. They also identify how practitioners can utilize the key concepts in the two literatures when conducting organizational cultural inquiries and leading change efforts. The end product is an in-depth discussion of organizational climate and culture unlike anything that has come before that provides unique insights for a broad audience of academics, practitioners, and students. © 2014 Mark G. Ehrhart, Benjamin Schneider, and William H. Macey.
In an excerpt from their new book, A Passion for Excellence, the authors show how managers at all levels can be more effective through MBWA (Managing By Walking Around). This process involves listening to your customers, keeping in touch with your people (staff), and paying attention to innovation. MBWA means spending time away from your desk or office and really listening—which is both the most obvious and hardest thing to do, but which is the mark of leadership and excellence. © 1985, The Regents of the University of California. All rights reserved.
The purpose of this article is to define the concept of organizational culture in terms of a dynamic model of how culture is learned, passed on, and changed. The definition highlights that culture: is always in the process of formation and change; tends to cover all aspects of human functioning; is learned around the major issues of external adaptation and internal integration; and is ultimately embodied as an interrelated, patterned set of basic assumptions that deal with ultimate issues, such as the nature of humanity, human relationships, time, space, and the nature of reality and truth itself. To decipher a given organization's culture, one must use a complex interview, observation, and joint-inquiry approach in which selected members of the group work with the outsider to uncover the unconscious assumptions that are hypothesized to be the essence of the culture.
This article has no abstract
This paper examines the significance of the concept of culture for organizational analysis. The intersection of culture theory and organization theory is evident in five current research themes: comparative management, corporate culture, organizational cognition, organizational symbolism, and unconscious processes and organization. Researchers pursue these themes for different purposes and their work is based on different assumptions about the nature of culture and organization. The task of evaluating the power and limitations of the concept of culture must be conducted within this assumptive context. This review demonstrates that the concept of culture takes organization analysis in several different and promising directions.
The meta-theme of this book is integration of diverse perspectives on culture and on organizations. In this book, we bring together various cultural perspectives, main-stream theories of organizations, and empirical work from various social science disciplines on cultural phenomena in organizations. The inclusiveness of our approach allows us to tell many stories about organizational cultures.
The "Greatest Business Book of All Time" (Bloomsbury UK), In Search of Excellence has long been a must-have for the boardroom, business school, and bedside table. Based on a study of forty-three of America's best-run companies from a diverse array of business sectors, In Search of Excellence describes eight basic principles of management -- action-stimulating, people-oriented, profit-maximizing practices -- that made these organizations successful. Joining the HarperBusiness Essentials series, this phenomenal bestseller features a new Authors' Note, and reintroduces these vital principles in an accessible and practical way for today's management reader.
Takes exception to a set of common assumptions that underlie recent work on organizational culture: that the culture serves the objectives of a firm's top management team, that the primary function of culture is to unify the diverse elements in an organization, and that culture is a monolithic phenomenon. Instead, the authors claim that the core values of a firm's dominant culture may be directly challenged by the core values of an internal counterculture—that a dominant and a counterculture exist in uneasy symbiosis, taking opposite positions on value issues critically important to each of them. In exploring their ideas, the authors examine the dominant culture of General Motors (GM) and the counterculture in J. DeLorean's division. DeLorean articulated countercultural values, both directly and indirectly, and used rituals and stories to ridicule the values of the dominant culture. DeLorean left GM under a cloud, making it clear that maintaining the uneasy symbiosis between the dominant and the counterculture is a complex process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents a case for the idea that the most powerful aspect of culture is shared and taken-for-granted assumptions. In illustrating how to look at organizational culture in terms of shared assumptions, the author points out the problems that must be overcome to do so. For the most part, assumptions must be inferred from the popular stories and the routine behavior of employees, the type of language they use, and other overt manifestations of culture. Those who would truly understand an organization's culture must sift through its myriad culture manifestations. This is a potentially time-consuming process for which most organizations have neither time nor resources. Two ways to cope with this problem are suggested: one must look at the particular types of assumptions that are most clearly related to organization performance and then discover where in organizational life to look to discern culture most easily and quickly. Also discussed is how executives might use what they have learned through such "culture audits" to nudge and redirect the culture if changes are desirable. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
http://deepblue.lib.umich.edu/bitstream/2027.42/35463/2/b1407934.0001.001.pdf http://deepblue.lib.umich.edu/bitstream/2027.42/35463/1/b1407934.0001.001.txt
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