Organizational culture and challenges in heathcare organizations
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Organizational culture and challenges in heathcare organizations
- 1. Organizational culture & unique challenges in healthcare Padma Puppala
- 2. Luis L. Martins Associate Professor University of Texas at Austin Dr Jonathan Pinto Assistant Professor Imperial College London
- 3. Culture is the sum of total of the learned behaviour of a group of people that are generally considered to be the tradition of that people and are transmitted from generation to generation
- 6. Attitude is a settled way of thinking or feeling about something that governs people’s behaviour Japanese culture
- 8. What is the culture in your university?
- 9. Culture is the sum of total of the learned behaviour of a group of people that are generally considered to be the tradition of that people and are transmitted from generation to generation
- 10. “The specific collection of values and norms that are shared by people and groups in an organization and that control the way they interact with each other and with stakeholders outside the organization.” (Hill & Jones, 2001) “A pattern of shared basic assumptions that the group learned as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid, and therefore, to be taught to new members as the correct way you perceive, think, and feel in relation to those problems.” (Schein, 1985)
- 14. Levels of Organizational Culture • Symbols, stories, texts • Ceremonies, rituals, facilities, awards Artifacts (observable products) • Norms about what is right/wrong, un/important • Slogans, mission statements Values (Rules of behavior ) • Taken-for-granted shared beliefs • Hidden, must be inferredAssumptions
- 15. Values • Espoused Values (“talk”): – concepts or beliefs – pertain to desirable end-states or behaviours – transcend situations – guide selection or evaluation of behaviour – are ordered by relative importance. • Enacted Values (“walk”): – what is actually exhibited by employees • Core Values: – The primary values (which may or may not be included in the “espoused values”) that are accepted throughout the organization, which trump all other decision-making criteria.
- 16. Norms Legitimate, socially shared standards against which the appropriateness of behaviour can be evaluated. Categories of norms: • Performance norms • Appearance norms • Social arrangement norms • Allocation of resources norms
- 17. Culture • Dominant culture: Expresses the core values that are shared by a majority of the organization’s members. • Subcultures: Mini-cultures within an organization, typically defined by departmental and geographical boundaries. • Strong Culture: A culture in which core values are intensely held and widely shared. Strong cultures facilitate performance by – Energizing people, by appealing to a higher ideals, values, and goals – Shaping and coordinating behaviours by communicating organizational priorities Google culture
- 18. The culture of a health care organization can powerfully influence its ability to manage human resources and serve patients, and ultimately has a strong impact on its economic performance (Kotter & Heskett, 1992).
- 20. Creating & maintaining culture Define culture in mission statement Recruit individuals whose values are consistent with the organization's culture Reinforce such values through training and socialization Rewards are a powerful tool in constructive cultures Staff empowerment to use their own means to achieve patient satisfaction The Taj way
- 23. Universal Healthcare Decommercialized Healthcare] Human Values in Healthcare Spiritualisation of Healthcare
- 25. Work Demanding work environment Stress High emotional turmoil 24/7 service Difficult to strike a work life balance Support system No social support systems in India
- 27. Government Private Power distance Hierarchial Hierarchial Individualism Collective Individualistic Uncertainity avoidance Scores low Expected to be high Masculinity Feminine Masculine Performance driven Competitive & Assertive Long term Long term Changing strategy Reward systems Time bound Pay-for-performance reward structures
- 29. No hospital or healthcare delivery system can be successful unless there is a seamless interface between departments, teams and individuals.
- 30. Thank you
Editor's Notes
- Culture is the sum of total of the learned behavior of a group of people that are generally considered to be the tradition of that people and are transmitted from generation to generation.
- Values are set of principles that govern our judgement and behaviour
- A traditional practice or usual way of doing something followed by a social group or people
- The role of culture is important in assessing an organization’s performance. Culture generates a commitment to something larger than the individual self-interest. Employee performance attributes like productivity, job satisfaction and motivation have been found to be positively correlated to organizational cultureV. Organizational culture has impact on various aspects of the Organization including strategy, management practices, employee behavior, organizational structure, policies, processes and procedures.Organizational culture has been classified as two types: strong and weak culture. Although, a strong culture shows tremendous unity at the workplace, and commitment to the principles of the organization, strong cultures have been shown to be associated with high inertia to change. Strong culture may lead to failure of the organization if the employees stick to their existing beliefs and methodologies at the face of change. But organizations with strong culture also see high levels of commitment from employees and low employee turnover.
- Let us now focus on organizational culture in healthcare industry. The health care industry has lagged in its understanding of how to develop effective organizational cultures. This knowledge lag is unfortunate since an effective organizational culture is crucial in health care organizations that face issues such as complex managed health care structures, competitive labor markets, and declining levels of patient satisfaction.
- For example, when Baptist Hospital in Pensacola, Florida crafted a vision to become "the best healthcare system in America," the chief executive officer began by revamping the hospital's organizational culture. The cognitive map or driving force for this culture transformation was based on empowerment, as communicated through Baptist Hospital's mission, values, and patient service philosophy (Reeder, 2002). Constructive relationships between patients and employees became the top priority. Because of these cultural changes, the hospital was acknowledged for its patient service quality by the prestigious Baldrige group and received high patient satisfaction ratings on the Press, Garney & Associates' survey, all while generating substantial cost savings. Similarly, when Griffin Hospital in Derby, Connecticut transformed itself from a bureaucratic culture to a caring culture, patient satisfaction soared 96%, nursing turnover decreased, and the hospital was in a better strategic position to compete against neighboring hospitals (Freedman, 1999). This transformation of Griffin's culture entailed creating a work environment where nurses were empowered to develop ways to cater to their patients' needs.
- Recruit individuals whose values are consistent with the organization's culture Reinforce such values through training and socialization Rewards are a powerful tool in constructive cultures
- Apollo hospitals are one of the largest healthcare organizations operating in India and Asia, with their businesses ranging from hospitals to pharmacies and consultancies. This vision and mission statement shows that the organizational culture of this organization is more leaned towards innovation and competition. The inclusion of education and research in its mission statement shows that Apollo hospital is promoting an innovative and knowledge-oriented work culture. The vision to touch billion lives basically indicates the management is emphasizing on being competitive. On analyzing the artifacts and business processes of Apollo Hospitals, it is found that most of the processes are computerized, again leading towards technology innovation- and competition-oriented organizational culture.The doctors and nurses are provided with customized training programs. This provides a sense of involvement to the doctors and nurses and encourages them to develop themselves, helping the organization build a culture focusing on education and innovation.
- Healthcare Organizations in general have a demanding work environment. The nurses and physicians, in particular, have a hectic job-life, with a weak social-support system in the hospitals. Many a times, high emotional turmoil is faced by nurses and physicians involved with patients nearing their ends. Physicians and nurses working in surgical departments and ICUs also deal with stress. Nurses, especially, face with stress of balancing work-home life. This stressful work environment requires for a social support system, which however is not well-developed in Indian Healthcare Organizations. Physicians and nurses have been found to favor a culture of internal focus, stability and control VIII. Physicians and nurses also indicated that they had a low level of personal involvement in their organizations, with both of these groups perceiving the organizational structure to be hierarchical VIII. However, they have high preference for clan culture and least performance for hierarchical culture VIII. Moreover, nurses perceive the existence of high power-distance in the organization and believe they have less possibility to propose changes in management activities VIII. Lack of flexibility at the job place is another challenge for the healthcare organizations. Maintaining a work-life balance is tough for the hospital staff with shift duties assigned to them.Female hospital staffs, including nurses and receptionists, have to manage night-time shifts, along with taking care of their family. This gives rise to the need for support at workplace and from the family. Many a times, the family of the female staffs are not supportive of their working night shifts. Turmoil at home with lack of a social support system at workplace does not provide a healthy work climate for the female employees of the hospital. Jobs related to intensive-patient care have high attrition rates, especially in the private sector health care organizations. This problem is not limited to India only. Continence care in nursing homes is one such area which sees high attrition rates across the worldIX.
- Government Healthcare Organizations The healthcare services provided by the Government extend from national level to village level. At the central level there is the Union Ministry of Health and Family Welfare, followed by various state level, regional level, and district level and community level healthcare centersVII. The Government Healthcare Organizations are run with a no-profit motive. These organizations are characterized by a hierarchical structure. The employees have job security, along with benefits like accommodation facilities. Moreover, the Government healthcare organizations generally have pay-for-experience compensation systems. The performance measurement systems use traditional methods, mostly assessment by the immediate supervisor. Using Hofstede’s cultural dimensions IV the culture of Government Healthcare Organizations can be easily described. Government healthcare employees perceive the existence of the large power gaps between the superiors and subordinates. Thus, the culture is more segmented than unified in terms of power. Government healthcare employees are more set in their ways, with low levels of change-acceptance and change-management. Thus, this culture scores low on the uncertainty avoidance dimension. Government healthcare organizations have more feminine characteristics with low-importance on competitiveness and high-importance on personal attributes. The absence of pay-for-performance reward structures promotes a collectivist work culture in these organizations. Private Healthcare Organizations Private Healthcare Organizations run with a profit-motive. These organizations are characterized by higher efficiency systems and processes, use of modern technology and systems for operations, and competitiveness. The Organizational Structure commonly found in the private healthcare organizations is hierarchical. Employees are performance driven. Most of these organizations have high treatment costs as compared to Government healthcare organizations. Accordingly, they aim to provide better services through state-of-the art infrastructure, better food facilities, more personal care through higher value of nurse-patient ratio etc. The organizational culture varies with different private organizations. However, some common characteristics do exist, which can be explained through Hofstede’s cultural dimensions IV.There is existence of power-gaps in the organization, with the management and leadership essentially in control of decision taking and change management processes. Physicians are more empowered than the nurses to suggest any changes in the management processes. These healthcare organizations are highly competitive as they are run with profit-motives. Hence, higher emphasis is given on masculine cultural dimensions like competitiveness and assertiveness. Pay-for-performance reward structures encourage individualistic culture rather than collectivist culture. The management’s focus is on sustaining in the competitive healthcare industry, and hence, they frequently change strategies. The employees, thus, are more open to changes and are adaptable. Thus, there exists a culture of lower uncertainty avoidance.