Perspectives on Organizational Culture in Healthcare

Over the past 30 years, the term organizational culture has gained prominence and have stimulated plenty of interest. Theories have been developed, definitions abound and debates have spurred. Today we still talk about how (and if) one can change organizational culture.  

And “whether managers think that the culture is too soft or too complicated to bother about or whether there is no unique corporate culture does not reduce the significance of culture” (Alvesson, 2002).

“Culture isn’t everything” says a title that caught my eye. The article mentions that even though it's difficult, culture is something that can be enforced. One of two perspectives on organizational culture developed by Smircich (1983) - "culture as a variable"- implies that culture is something the organization "HAS". In essence, it implies that organizational culture needs to be viewed as a tool for enhancing organizational effectiveness. Hence, the existence of "strong culture organizations" that are highly effective (Google, Southwest Airlines, Nordstrom, Westjet).

The second perspective – "culture as root metaphor" – treats culture as “the process of sense-making created and sustained through communication and interaction” (Borkowski, 2002). It implies that "organization IS culture", and culture is a communicative construction. And because the organizational members connect it to deeply seated emotional needs, it becomes a very powerful force. This perspective considers culture as naturally consisting of subcultures and countercultures.

It is interesting how some transformational leaders have turned failing hospitals into success stories by tapping into the power of culture (Mount Auburn Hospital, BDMC). It seems they actually started there. Did they enforce it? Hardly. They surveyed through any means possible what fundamental values are important to the employees, and built everything around these values. They made every decision in context of these core values. So while culture isn't everything, values are, and value without culture is like dust in the wind.

Although some seemed to have an almost fatalistic view that one couldn’t change the manners people have for communicating and working together, they nevertheless succeeded. They used levers to influence social control systems and shaped culture through participation, commitment and symbolic actions. It is more like "House of Cards" and less like "Dracula".

There are many perspectives on organizational culture, and it is difficult to find agreement in defining this concept. However, one important consideration remains: in healthcare organizations, communication is the one that influences organizational culture, and culture is influenced by communication. Our culture is based on human interaction so it’s bound to be changeable and complex. Shaping culture is more likely to succeed.

References:

Borkowski, N. (2002). Organizational Behaviour in Healthcare. 3rd Ed.

Chatman & Cha (2003). Leading by Leveraging Culture.

Modaff et al. (2012). Organizational Communication. 

Tushman et al. (2007). Shaping Organizational Culture.