Organizational culture & unique challenges in healthcare

Padma Puppala

Luis L. MartinsAssociate ProfessorUniversity of Texas at Austin

Dr Jonathan PintoAssistant ProfessorImperial CollegeLondon

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

Culture

Values

Beliefs

Attitudes

Customs

Attitude is a settled way of thinking or feeling about something that

governs people’s behaviour

Japanese culture

What is the culture in your university?

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

“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)

Organizational culture

Strategy

Org. Structure

Management practices

Policies

Processes

Employee behaviour

Edgar Schein’s classification

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

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.

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

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 prioritiesGoogle culture

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).

Patient satisfaction

Employee satisfaction

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

Universal HealthcareDecommercialized Healthcare]

Human Values in HealthcareSpiritualisation of Healthcare

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

Government Private

Power distance Hierarchial Hierarchial

Individualism Collective Individualistic

Uncertainity avoidance Scores low Expected to be high

Masculinity Feminine MasculinePerformance drivenCompetitive & Assertive

Long term Long term Changing strategy

Reward systems Time bound Pay-for-performance reward structures

No hospital or healthcare delivery system can be successful unless there is a seamless interface between

departments, teams and individuals.

Thank you