Management of Health Care Organizations: Week 3

Chapter 9: Building a Culture of

Improvement

Objectives

• Understand the meaning of organizational culture and indicators of organizational culture.

• Be able to describe at least one way of classifying differences in national cultures.

• Describe common but essential values of organizations in general and health organizations in particular: diversity, safety, learning, collaboration, and service.

• Be able to discuss key strategies for culture change.

Outline

• Meaning of Organizational Culture

• Indicators of Organizational Culture

• Organizational Cultures in Health

• Strategies for Culture Change

Meaning of Organizational Culture

• Culture is “the way we do things around here.”

• Culture can be applied to groups, communities, and entire societies.

• Culture encompasses the assumptions, beliefs, values, and norms of an organization.

Components of Culture

• Values are the ideals, customs, and institutions of an organization that its members hold in high regard.

• Social norms are expectations about behavior.

• Assumptions and beliefs underlie an organization’s culture and often include the conviction that the organization is pursuing worthwhile ends—what is good for the organization is good for society

How to Recognize Culture

• Examine a range of activities, artifacts, and behaviors.

• This provides insights into details of its culture.

• Use multiple measures because culture is broad and sometime internally inconsistent within organizations.

Espoused Values

• Espoused values are stated in an organization’s vision, mission, and value statements.

• Often the organizational values reflect the opinions of decision-makers at the top of the formal hierarchy.

• Espoused values are often formalized in the ethical guidelines of professions.

• Many norms are enacted and transmitted informally through daily behavior.

• Norms about such issues as length of breaks, dress, and attendance at social functions have to be learned informally.

Symbols of Culture

• Indirect manifestations of norms, values, beliefs, and assumptions.

• Examples include:

– Specialized language

– Rituals

– Ceremonies

– Physical artifacts such as logos

Stories as a Symbol of Culture

• Stories reflect important values.

• Stories about an organization’s founder or past leaders are used to transmit important guidelines for attitudes and behavior.

• Stories about heroic behavior, such as service during emergencies or difficult times, may promote the value of service to potential clients or customers.

Four Types of Culture

• Four groups:

– Networked

– Mercenary

– Fragmented

– Communal

Four Types of Culture

• Classification is based on the degree to which workers share goals (solidarity) and the degree to which they are friends (sociability).

• Fragmented cultures are lowest on both criteria.

• Communal cultures are highest on both.

• Managers can help cultures of organizations change over time based on external conditions.

Organizational Cultures in Health

• Some organizational values are particularly important in health.

• Health organizations are beginning to develop expertise in cultural transformation.

• They create cultures that emphasize: – Cultural diversity

– Cross-understanding

– Safety

– Learning

Cultural Diversity

• Diversity in the cultures of client or customer populations, and in an organization’s workforce, is a reality for most public health organizations.

• Respect for cultural diversity is an imperative for effective organizational performance.

• Respect for cultural diversity is a moral imperative for many people.

• Five dimensions of cultures that distinguish residents of different countries from each other have been identified.

Power Distance

• Indicates the degree of equality among individuals.

• High power distance ratings reflect cultures in which inequalities between people are accepted and perpetuated.

• Employees are more likely to expect clear guidance from upper management, and the relationships between managers and workers are rarely close and personal.

Uncertainty Avoidance

• Encompasses the extent to which people are comfortable with ambiguity and uncertainty.

• More rule-oriented, with well-established laws, regulations, and controls.

• Organizational change may be more difficult to achieve, and proposals for change will be examined in detail.

• Individuals in countries that exhibit lower levels of uncertainty avoidance are more willing to take risks and accept change.

Individualism • Reflects the importance of individuals versus

collective populations.

• Residents tend to have relationships with many other people, but the relationships are relatively weak.

• More likely to express their own personalities at work, and individual rights such as freedom of speech are often brought into the workplace.

• In more collectivist societies, ties between individuals are very strong and the family is given more weight.

Masculinity

• The degree to which a culture emphasizes the traditional male work role model of ambition and achievement, versus caring and nurture.

• Males tend to dominate the power structure more than in less masculine societies.

• Workers are expected to sacrifice personal life for their jobs.

• Communication style is more direct, concise, and impersonal.

Long-Term Orientation

• Indicates respect for long-standing traditions and values.

• Showing respect for traditions, honoring social obligations, and avoiding loss of face are important in cultures with high levels of long- term orientation.

• In cultures with low levels of long-term orientation, creativity and self-actualization are valued more.

Cross-Understanding • Provides a way for organizations to develop an

appreciation for all types of employee differences, including cultural diversity.

• The extent to which group members have an accurate understanding of one another’s mental models.

• Group members are better able to anticipate the behavior of their colleagues and then adjust their own behavior.

• Can be developed through self-awareness, shifting of perspective, and adaptation of new behavior.

Culture of Safety

• Health organization work includes interaction with clients in situations that can result in injury or death if safety is not a value.

• Excellent guidelines for promoting cultures of safety are emerging in organizations that are committed to safe practices.

• These include applying labels such as “cultures of safety” and “fair and just culture.”

Fair and Just Culture • One that learns and improves by openly identifying

and examining its own weaknesses.

• Employees feel they are supported and safe when voicing concerns.

• Employees speak safely on issues regarding their own actions and the actions of others.

• Employees seek help when concerned that the quality of the services being delivered are threatened.

• Employees are comfortable monitoring others, detecting excessive workloads, and redistributing work.

Culture of Safety

• Continuously seeks to minimize harm to customers or clients that may result from the processes used to deliver goods, programs, or services.

• Not acting when conditions are unsafe or safety protocols have been breached is unacceptable.

• Teamwork and openness to innovation should be prominent values in the pursuit of organizational safety.

High-Reliability Organizations

• Strive to maximize reliability of organizational operations and services when the consequences of error can be disastrous.

• Establishing and maintaining an underlying high reliability structure constitutes an organizational commitment to values and behaviors that increase reliability, improve responses to surprises, and reduce the probability of errors.

High-Reliability Organizations (continued)

• Creating a culture of mindfulness requires organizational commitment and infrastructure in at least four areas. – Commitment to mindfulness in their beliefs,

values, and actions.

– Commitment must be perceived by workers as being consistent rather than hypocritical.

– Rewards flow toward those who act mindfully and away from those who do not.

– Emphasize the need to “walk the talk.”

Learning

• When learning is valued in an organization, workers improve processes and structures in the fields for which they have been trained.

• Learning organizations create and capture knowledge, disseminate it to all employees, and apply it in their products and services

• The value of learning through scientific research and evidence is central to the mission of many health organizations.

• Evidence-based management is a movement that attempts to promote the better use of scientific evidence in strategic and operational decision-making.

Collaboration and Service

• Teamwork and collaboration are synergistic when both occur simultaneously. – Teamwork is sharing duties and responsibilities. – Collaboration is sharing knowledge and

information. • Promoting service as a cultural value requires

managers that model, recognize, and reward workers who deliver high quality service.

• These organizational leaders must convey passion and inspiration through stories, presentations from consumers, and publicly recognizing consumer service heroes and heroines.

Strategies for Culture Change

• Implementing new cultures requires both a commitment to goals and hard work.

• Three strategies to change culture:

– Enthusiastic support of top management

– Use rewards, incentives, and public recognition

– Consideration of terminating or moving those who are uncomfortable with the new culture