Diagnosing Organisational Culture During Community Healthcare Reform. A Mixed Methods Study Applying the Competing Values Framework

Abstract

Background: Across the globe healthcare systems are in a constant state of reform. However, the results of these reform activities are described as weak at best and situational dependent. While the research on organisational culture in healthcare is limited, studies suggest that unless organisational culture is included in pre-reform planning and change initiatives, global healthcare reform will not deliver the necessary changes to address their common challenges.

Aims and Objectives; The research aims to measure and identify the prevailing organisational culture in a community healthcare region during a period of planned reform. The preferred future culture will also be identifying, in order to establish the gap between the current and preferred culture necessary to deliver the transformation. The influences and barriers to the reform will also be investigated as will the alignment between the current policy and the current practices.

Methods: The study adopts a two phased Explanatory Sequential Mixed Methods design. The Competing Values Theory underpins the methodology, which is supported by a survey derived from the theory?s framework. The framework domains are also applied in the qualitative thematic analysis prior to the integration of the findings through joint display.

Main Findings: The prevailing organisational culture was identified as overwhelmingly Hierarchial. The participants (n=445) identified a significant change was necessary to deliver the reform, with the preference for a culture (collaborative and participatory) culture. The qualitative findings collaborated these findings and highlighted the barrier to the desired cultural change. The investigation also confirmed that the current policy is not alighted to current practices, indicating a substantial challenge to the planned reform.

Conclusion & Implications; The current Hierarchal culture does not support the innovative, collaborative, and mentoring culture desired by participants, which is also ideal to deliver whole system reform. The current reform policy lacks specific organisational cultural actions which will facilitate cultural change and deliver reform.