Effective workplace culture | Establishing a Positive Workplace Culture

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Effective workplace culture


Original Pratice Development And Research

Effective workplace culture: The attributes, enabling factors and consequences of a new concept


Workplace culture in healthcare settings impacts on patients’ and users’ experience (Kennedy, 2001; Francis, 2010); the motivation, commitment and effectiveness of staff (Manley, 2001; 2004; Lok et al., 2005); evidence implementation and use in practice (Kitson et al., 1998; 2008; 2010; Rycroft- Malone et al., 2004); patient safety (NPSA, 2004); innovation uptake (Apekey et al., 2011) and productivity (Naydeck et al., 2008; Goetzel and Ozminkowski, 2008). The consequences of ineffective and toxic cultures have resulted in serious implications for patient outcomes (Kennedy, 2001; Francis, 2010); staff well-being, and also wastes valuable economic resources. The relationship between workplace culture and its potential consequences therefore highlights the need to recognise, understand and develop effective cultures in healthcare, specifically at the level of care delivery where patients, service users and staff interface. 

With recent reports of poor care and failures in healthcare focussed at the level of the patients’ experience (Francis, 2010; Patient Association, 2009, 2010; New South Wales Department of Health, 2009), the importance of understanding workplace culture and the strategies necessary to improve it are urgent priorities for policy makers, clinical leaders as well as healthcare provider organisations, regulators and policy analysts. If healthcare services are to meet the needs of patients (Department of Health, 2002; 2009; 2010; Rycroft-Malone et al., 2002a,b; Bevington et al., 2004a, b; Scalzi et al., 2006; Manley et al., 2011) and those people who support them; as well as recruit and retain valuable staff expertise (Manley, 1997; 2001; 2004; Buchan, 1999) the need for cultural change is of significant importance.

To understand workplace culture, to know what is an effective culture at the frontline, and also, how to develop one is therefore an essential skill-set for all clinical leaders and facilitators of change in healthcare settings. Culture is not about individuals but about the social contexts that influence the way people behave and the social norms that are accepted and expected. To transform how things are done at the practice level, requires fundamental changes in mindsets and patterns of behaviour as it is these that manifest culture reflecting the values, beliefs and assumptions held or accepted by staff in the workplace.

The notion of culture: corporate, organisational and workplace

In its simplest form culture can be understood as `how things are done around here’ (Drennan, 1992, p3). Schein (1985) proposes that culture is best thought of as a set of psychological predispositions called basic assumptions held by members of an organisation and which tend to influence the ways in which they behave. However, the concept ‘culture’ is complex reflected in the lack of consensus about how it is defined with most general and health related literature focusing extensively on corporate and organisational culture (Davies et al., 2000; Scott et al., 2003; Mannion et al., 2005) rather than culture at the local level – ‘the workplace’ which is the focus of this paper.

Corporate culture refers to values and practices shared across all groups in an organisation, at least within senior management (Kotter and Heskett, 1992). Anthony (1994) argues that corporate culture reflects what is espoused, that is, the culture that organisations want to portray for the purpose of influencing public relations or employee motivation, rather than, the organisational culture which is the actual culture experienced by staff and service users. Organisational culture in the past has been assumed to be singular and pervasive, monolithic and integrative, but all organisations have multiple cultures usually associated with different functional groupings or geographical locations (Kotter and Heskett, 1992; Bolan and Bolan, 1994), shared common interests, assumptions and associated values (Schein et al., 1985). Now, organisational culture is considered to include every aspect of an organisation and cannot be understood as separate from it, that is, culture is not an objective tangible or measurable aspect of an organization; organisations are cultures (Pacanowsky and O’Donnell-Trujillo, 1982; Bate, 1994).

In the context of healthcare the interplay between corporate, organisational and workplace cultures has major implications for merging different organisations, achieving consistent standards, and establishing social norms based on shared values of all employees. Over the last decade in healthcare, there has been a focus on organisational culture linking it in particular to performance (Mannion et al., 2005). The rationalist/instrumental approach to organisations has led to increasing standardisation and uniformity, with the false assumption that if all units operate the same, they will perform the same. Healthcare regulators and change facilitators with a more holistic approach to patient, service user and staff satisfaction, will have to delve under this mantle of organisations’ overall performance culture, and tackle the workplace culture i.e. the culture that has a direct impact on user and staff experiences. If each organisational unit is acknowledged as having its own workplace culture, each will have its own point of departure in terms of change and development (McCormack et al., 2011). However, with the predominant focus on corporate and organisational culture in the literature, little attention has been given to local workplace cultures (Patterson et al., 2011), although there is a growing recognition of the importance of a local safety culture (NPSA, 2004).

Developing our theoretical and practical understanding of effective workplace culture 

Bevan (2004) argues that the theoretical base underpinning healthcare quality improvement requires development. Concept analysis provides one approach towards this end, as concepts are the building blocks of theory (Chin and Jacobs, 1983). Concepts are socially constructed, evolve over time through use and can be associated with a set of attributes developed through socialisation and debate associated with this use (Rodgers, 1989; 1993; Morse, 1995; Walker and Avant, 2005). This approach is consistent with the idea that culture is a social phenomenon (Bate, 1994); is a concept that is still evolving; and our focus is on concept use so as to inform practice development interventions in the workplace.



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